Women in racial and ethnic minority groups and of low socioeconomic status are at increased risk for weight-related preventable chronic disease. On average, women retain an estimated 3kg weight per pregnancy 10 years after giving birth, with racial and ethnic minorities at considerably greater risk. The Women, Infants and Children (WIC) program is an ideal setting to target weight loss among low SES women. The WIC program is a federally funded nationwide program that provides free nutrition counseling and healthy foods to more than 18 million low-income pregnant and postpartum women and their children. However, the few interventions developed to address weight loss in this setting have been unsuccessful. In partnership with the Massachusetts WIC program we developed Fresh Start, a post-partum weight loss intervention with potential for long-term sustainability. The intervention uses peers and nutritionists to integrate skill building strategies from the Diabetes Prevention Program. Pilot testing yielded an average weight loss of 2.1 kg at 4 months and 32% of participants lost 5% or more of their baseline body weight Drawing upon expertise with the Center for Health Equity Intervention Research (CHEIR), we will enhance Fresh Start to improve participant self-efficacy and intervention fidelity via a storytelling component through which WIC clients share their experiences. The intervention will be compared to a print materials only control condition in a randomized controlled trial. A sample of 120 clients in WIC clinics in Worcester, MA will be enrolled. In-person assessments will be conducted at baseline, 3 months, and 12 months.
Our Specific Aims are to: (1) Compare weight loss in the Fresh Start intervention to a print materials only comparison condition;(2) Compare metabolic syndrome components (waist circumference, blood pressure, LDL, HDL, triglycerides, insulin sensitivity), physical activity, dietary behaviors, and quality of life In the Fresh Start intervention to a materials only comparison condition;and (3) Determine the potential external validity and sustainability of the Fresh Start intervention on reach, adoption, implementation and maintenance (REAIM framework). Fresh Start has tremendous potential to benefit diverse, low SES postpartum women.

Public Health Relevance

On average, women retain an estimated 3kg weight gain per pregnancy 10 years after giving birth, with racial and ethnic minorities at considerably greater risk of postpartum weight retention. Pilot data suggests that Fresh Start is a promising program for post-partum weight loss. If effective, the Fresh Start intervention has tremendous potential to reduce overweight and obesity among diverse, low SES postpartum women.

National Institute of Health (NIH)
National Institute on Minority Health and Health Disparities (NIMHD)
Comprehensive Center (P60)
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Special Emphasis Panel (ZMD1-RN (02))
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University of Massachusetts Medical School Worcester
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