Research: Current Research
Stages of change for weight management in postpartum women☆

This work was presented at the Food & Nutrition Conference & Exhibition, Philadelphia, PA, in 2002.
https://doi.org/10.1016/j.jada.2004.04.022Get rights and content

Abstract

Objective

This study examined factors related to stages of change for weight-management behaviors in postpartum women.

Design

Cross-sectional data, collected at baseline, are reported from the Mothers’ Overweight Management Study (MOMS), a randomized, controlled trial conducted in postpartum women who participated in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

Subjects/Setting

Subjects were a sample of WIC recipients (N=151) older than 18 years of age with a child younger than 2 years.

Statistical analysis

The dependent variables were the stages of change for weight-management behaviors (losing weight, avoiding high-fat foods, eating a high-fiber diet, and exercising). Demographic, health, and psychosocial variables were examined as independent variables. One-way analysis of variance was used to compare means, and χ2 was used for proportions.

Results

Whereas 55% of women were in the action stage for weight loss, fewer women were in the action stage for the following weight management behaviors: avoiding high-fat foods (24%), increasing fiber (19%), and exercising three times per week (29%). Identifying pros for weight management was related to stages for losing weight, high-fat food avoidance, and exercise (F=13.4, P<.001; F=10.5, P<.001; F=3.7, P<.007, respectively). Self-efficacy for choosing a low-fat restaurant meal or using food labels was positively related to later stages for avoiding high-fat foods and increasing fiber intake (χ2=16.4, P=.003; χ2=11.7, P=.02).

Conclusions

Emphasizing the pros for weight-management behaviors, decreasing the cons for exercising, increasing confidence to select low-fat restaurant choices, and improving skills for using food labels are four strategies that nutrition professionals can use to help women become more ready to change behaviors for weight management.

Section snippets

Subjects

The sample (N=151) was recruited from WIC participants in four northern West Virginia clinics to participate in the Mothers’ Overweight Management Study (MOMS). The purpose of MOMS was to determine the effectiveness of the facilitated group discussion method (22) for weight management. To be eligible, a woman had to be 18 years of age or older, a WIC recipient, a mother with a child younger than 2 years, and able to converse in English. Of the 423 women with initial contact, 368 were screened,

Sample characteristics

The sample consisted of 151 women age 18 to 41 years (mean=27±5.4 years). Reflective of the state’s population, the women were predominantly white (91%) with a high school level of education (64%). Because the women were WIC recipients, all lived in low-income households. Sixty-five percent were homemakers. The mean weeks postpartum reported was 30 weeks±23.59 (range 1 to 107 weeks); 34% were breastfeeding. Most (67%) were nonsmokers.

The mean BMI was 30.2±6.9 with 24% classified as normal, 28%

Discussion

This study examined the cross-sectional relationship between demographic, health, and psychosocial characteristics and stages of change for weight-management behaviors in postpartum women who enrolled in a weight-management trial. Previous findings have shown that predictors of weight gain over a 3-year period included fat intake (positive) and frequency of physical activity (negative) (23). We queried women on their stages of change for losing weight, avoiding high-fat foods, increasing fiber

Conclusion

By emphasizing the pros and decreasing the cons for weight management, women may be able to change their behaviors to promote better weight management. Strategies highlighted in our study were increasing the women’s confidence in their ability to select low-fat restaurant choices, discussing the importance of reading food labels, and discussing the pros/cons for weight management. By using these strategies, nutrition professionals may be able to facilitate clients’ movements into the action

Acknowledgements

The authors acknowledge the following individuals, who made this study possible: all the participants and staff at WIC offices; WIC nutritionists: Anne MacBride, Brenda Fisher, Roberta Dorazio, Darla Retton, Gina Coleman, Sue Evenson; graduate students: Jenni Jones, Airi Naoi, Cindie Mick, Thein Shwe, Michael Subit; and office staff: Jennifer Farmer and Carol Morris. The authors also thank Linda Lilly, MA, for editorial assistance.

D. A. Krummel is an associate professor, E. Semmens is a research dietitian, and J. Boury is a research assistant, Department of Community Medicine, and P. Gordon is an associate professor, Department of Human Performance and Exercise Science, West Virginia University School of Medicine, Morgantown.

References (45)

  • B.H. Marcus et al.

    Tailoring interventions to promote physically active lifestyles in women

    Womens Health Issues.

    (1998)
  • S. Nitzke et al.

    Stages of change for reducing fat and increasing fiber among dietitians and adults with a diet-related chronic disease

    J Am Diet Assoc.

    (1999)
  • S. Ounpuu et al.

    Defining stage of change for lower-fat eating

    J Am Diet Assoc.

    (2000)
  • K.M. Flegal et al.

    Prevalence and trends in obesity among US adults, 1990–2000

    JAMA

    (2002)
  • A.H. Mokdad et al.

    Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001

    JAMA

    (2003)
  • P.N. Pastor et al.
  • E.P. Gunderson et al.

    Epidemiology of gestational weight gain and body weight changes after pregnancy

    Epidemiol Rev.

    (1999)

  • Weight management

    J Am Diet Assoc.

    (2002)
  • A.H. Mokdad et al.

    The continuing epidemics of obesity and diabetes in the United States

    JAMA.

    (2001)
  • J.O. Prochaska et al.

    The transtheoretical model and stages of change

  • J.O. Prochaska et al.

    Stages of change and decisional balance for 12 problem behaviors

    Health Psychol.

    (1994)
  • C.R. Nigg et al.

    Stages of change across ten health risk behaviors for older adults

    Gerontologist.

    (1999)

    • Cited by (0)

    D. A. Krummel is an associate professor, E. Semmens is a research dietitian, and J. Boury is a research assistant, Department of Community Medicine, and P. Gordon is an associate professor, Department of Human Performance and Exercise Science, West Virginia University School of Medicine, Morgantown.

    K. T. Larkin is a professor, Psychology Department, Eberly College of Arts and Sciences, West Virginia University, Morgantown.

    ☆

    The project was supported by a grant awarded to Dr. Krumme from the National Institute of Child Health and Human Development, National Institutes of Health (RO1 HD39102).

    View full text
    Copyright © 2004 American Dietetic Association. Published by Elsevier Inc. All rights reserved.