The effect of a diet and exercise intervention on body composition and cardiometabolic risk factors in postpartum women

Obesity among women is a public health problem in the United States. Pregnancy may be one of the causes of this, with 56% of women of childbearing age being overweight or obese. Excessive weight gain during pregnancy and postpartum weight retention may increase a woman’s risk of obesity and chronic disease later in life. Moderate calorie restriction and exercise interventions have been shown to reduce body weight and improve body composition during the postpartum period. While weight loss interventions have been successful, high attrition rates limit the widespread effectiveness of these interventions. Furthermore, there is a lack of research examining the effects of a weight loss program on cardiometabolic risk factors in this population. Therefore, the primary aim of the studies in this dissertation were: 1) To determine the effect of a diet and exercise intervention on weight, body composition, and cardiometabolic risk factors, 2) to improve lifestyle behaviors through improved diet quality and cardiovascular fitness, and 3) to describe the relationship between chronic inflammation and bone mineral density (BMD) in overweight and obese postpartum women. The first study concluded that a home-based diet and exercise program resulted in greater reductions in weight, waist circumference, sagittal diameter, and abdominal fat mass compared to a control group. Additionally, the intervention resulted in a significant improvement in cardiovascular fitness. The second study concluded that the intervention improved triglyceride concentrations, decreased insulin resistance, and improved metabolic syndrome risk factors. Finally, the third study concluded that the intervention resulted in less loss of BMD at the total body and hip and less loss of BMC at the hip, lumbar spine, and femoral neck after controlling for lactation status and weeks postpartum at baseline. Change in cardiovascular fitness was a predictor of change in total hip and femoral neck BMD, while change in inflammation was a predictor of change in total body BMD. These results suggest that a home-based, diet and exercise intervention is effective in improving body composition, cardiovascular fitness, and some cardiometabolic risk factors in overweight and obese postpartum women. Additionally, moderate aerobic activity may attenuate bone loss during a weight loss program

Prioritization of Features for Mobile Apps for Families in a Federal Nutrition Program for Low-Income Women, Infants, and Children: User-Centered Design Approach

Background: The Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) is a federal nutrition program that provides nutritious food, education, and health care referrals to low-income women, infants, and children up to the age of 5 years. Although WIC is associated with positive health outcomes for each participant category, modernization and efficiency are needed at the clinic and shopping levels to increase program satisfaction and participation rates. New technologies, such as electronic benefits transfer (EBT), online nutrition education, and mobile apps, can provide opportunities to improve the WIC experience for participants. Objective: This formative study applies user-centered design principles to inform the layout and prioritization of features in mobile apps for low-income families participating in the WIC program. Methods: To identify and prioritize desirable app features, caregivers (N=22) of the children enrolled in WIC participated in individual semistructured interviews with a card sorting activity. Interviews were transcribed verbatim and analyzed using constant comparative analysis for themes. App features were ranked and placed into natural groupings by each participant. The sum and average of the rankings were calculated to understand which features were prioritized by the users. Natural groupings of features were labeled according to participant descriptions. Results: Natural groupings focused on the following categories: clinics/appointments, shopping/stores, education/assessments, location, and recipes/food. Themes from the interviews triangulated the results from the ranking activity. The priority app features were balance checking, an item scanner, and appointment scheduling. Other app features discussed and ranked included appointment reminders, nutrition training and quizzes, shopping lists, clinic and store locators, recipe gallery, produce calculator, and dietary preferences/allergies. Conclusions: This study demonstrates how a user-centered design process can aid the development of an app for low-income families participating in WIC to inform the effective design of the app features and user interface