title: A group randomized controlled trial integrating obesity prevention and control for postpartum adolescents in a home visiting program.
abstract: BACKGROUND
  Adolescence represents a critical period for the development of overweight that tracks into adulthood. This risk is significantly heightened for adolescents that become pregnant, many of whom experience postpartum weight retention. The aim of this study was to evaluate Balance Adolescent Lifestyle Activities and Nutrition Choices for Energy (BALANCE), a multicomponent obesity prevention intervention targeting postpartum adolescents participating in a national home visiting child development-parent education program.
  
  
  METHODS
  A group randomized, nested cohort design was used with 1325 adolescents, 694 intervention and 490 control, (mean age = 17.8 years, 52 % underrepresented minorities) located across 30 states. Participatory methods were used to integrate lifestyle behavior change strategies within standard parent education practice. Content targeted replacement of high-risk obesogenic patterns (e.g. sweetened drink and high fat snack consumption, sedentary activity) with positive behaviors (e.g. water intake, fruit and vegetables, increased walking). Parent educators delivered BALANCE through home visits, school based classroom-group meetings, and website activities. Control adolescents received standard child development information. Phase I included baseline to posttest (12 months); Phase II included baseline to follow-up (24 months).
  
  
  RESULTS
  When compared to the control group, BALANCE adolescents who were ≥12 weeks postpartum were 89 % more likely (p = 0.02) to maintain a normal BMI or improve an overweight/obese BMI by 12 months; this change was not sustained at 24 months. When compared to the control group, BALANCE adolescents significantly improved fruit and vegetable intake (p = .03). In stratified analyses, water intake improved among younger BALANCE teens (p = .001) and overweight/obese BALANCE teens (p = .05) when compared to control counterparts. There were no significant differences between groups in sweetened drink and snack consumption or walking.
  
  
  CONCLUSIONS
  Prevention of postpartum weight retention yields immediate health benefits for the adolescent mother and may prevent the early development or progression of maternal obesity, which contributes to the intergenerational transmission of obesity to her offspring. Implementing BALANCE through a national home visiting organization may hold promise for promoting positive lifestyle behaviors associated with interruption of the progression of maternal obesity.
  
  
  BACKGROUND
  Clinical Trials Registry NCT01617486 .
authors.affiliation: Washington University in St. Louis, The Brown School of Social Work and Public Health, and The School of Medicine, 1 Brookings Dr, St. Louis, MO, 63130, USA. djoshu@wustl.edu.
authors.forename: Debra L
authors.initials: DL
authors.lastname: Haire-Joshu
authors.affiliation: Washington University in St. Louis, The Brown School of Social Work and Public Health, and The School of Medicine, 1 Brookings Dr, St. Louis, MO, 63130, USA. cschwarz@wustl.edu.
authors.forename: Cynthia D
authors.initials: CD
authors.lastname: Schwarz
authors.affiliation: Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA. speskoe@fas.harvard.edu.
authors.forename: Sarah B
authors.initials: SB
authors.lastname: Peskoe
authors.affiliation: Washington University in St. Louis, The Brown School of Social Work and Public Health, and The School of Medicine, 1 Brookings Dr, St. Louis, MO, 63130, USA. ebudd@wustl.edu.
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Budd
authors.affiliation: Washington University in St. Louis, The Brown School of Social Work and Public Health, and The School of Medicine, 1 Brookings Dr, St. Louis, MO, 63130, USA. rbrownson@wustl.edu.
authors.forename: Ross C
authors.initials: RC
authors.lastname: Brownson
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21218, USA. cjoshu1@jhu.edu.
authors.forename: Corinne E
authors.initials: CE
authors.lastname: Joshu
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D015992:Body Mass Index; D002648:Child; D004032:Diet / Q000592:standards; D004326:Drinking; D005247:Feeding Behavior; D005260:Female; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D006699:Home Care Services; D006801:Humans; D008019:Life Style; D009765:Obesity / Q000517:prevention & control*; D050177:Overweight / Q000517:prevention & control; D010290:Parents / Q000193:education; D063766:Pediatric Obesity / Q000517:prevention & control; D049590:Postpartum Period; D011247:Pregnancy; D015430:Weight Gain