Healthy Weight in Women of Reproductive Age Action Learning Collaborative

1. Healthy Weight in Women of Reproductive Age Action Learning Collaborative Salt Lake Valley/Utah Department of Health Team Audrey Stevenson, Iliana MacDonald

2. The Healthy Weight ActionLearning Collaborative • Aim to build state and local capacity to help women of reproductive age achieve healthy weight before, during, and after pregnancy • Utah, one of eight states who applied for and was awarded the opportunity to participate in the ALC

3. Utah’s Team Comprised of partners from: • Utah Department of Health, • University of Utah Center Of Excellence in Women’s Health • Salt Lake Valley Health Department • WIC Program staff; both state and local offices

4. Healthy Weight in Women of Reproductive Age in Utah According to 2005 Utah BRFSS Data • 42.3% of reproductive aged women reported their BMI as overweight or obese • 26.4% of reproductive aged women report eating 5 or more servings of fruits/vegetables per day • 59.8% report meeting recommendations for moderate or vigorous physical activity • 83.5% report having no leisure time activities in the past month

5. Healthy Weight in Women of Reproductive Age in Utah According to WIC PNSS, 2004 • 39.5% of women enrolled in WIC had an overweight/obese prepregnancy BMI –an increase of 30% since 1994 • Less than half of WIC enrollees are at a normal BMI prior to conception.

6. Healthy Weight in Women of Reproductive Age in Utah According to 2004 Utah Vital Records data • 34.7% of women with a live birth were overweight or obese before pregnancy • An increase of 30% since 1994 • 67.5% of overweight/obese women exceeded the Institute of Medicine’s recommendations for weight gain during pregnancy

7. Healthy Weight in Women of Reproductive Age in Utah According to a recently published analysis by LaCoursierre et al • Among women who delivered via cesarean section, 1 in 7 is attributable to being overweight or obese prior to pregnancy • Data also showed an increase in preeclampsia rates over the same interval Am J Obstet Gynecol. 2005 Mar;192(3):832-9.

8. Healthy Weight in Women of Reproductive Age in Utah Recent Utah PRAMS data found that women who were obese prior to pregnancy were at increased risk of developing: • diabetes or hypertension, • delivering a macrosomic infant, • having labor induced, • having their infant admitted to the newborn intensive care unit, • reporting postpartum depression

9. Healthy Weight in Women of Reproductive Age in Utah Utah PRAMS data also shows that overweight and obese women were more likely to have: • lower education levels, • to be multiparous, • to be below 200% of the federal poverty level, and • to be enrolled in WIC during pregnancy.

10. Healthy Weight in Women of Reproductive Age in Utah • An analysis of infant deaths in Utah from 1995 to 1998 due to perinatal conditions found that obese women had significantly higher rates of infant death when compared to normal weight women.

11. Utah’s Short-term goals • Establishment of strong collaborative relationships among appropriate public health organizations and agencies to increase Utah’s capacity to help women of reproductive age achieve healthy weight before, during, and after pregnancy

12. Utah’s Short-term goals • Development of a strategic plan which incorporates evidenced based and/or promising interventions to address the increasing prevalence of overweight/obesity among women of reproductive age in Utah

13. Utah’sLong-term (5-yrs plus) Vision • Reversal of the increasing percentages of women with unhealthy pre-pregnancy weight and inappropriate weight gain during pregnancy by implementing system and program changes that impact weight status and weight retention among pregnant and lactating Utah women.

14. Utah’s Long term goals • Establishment of ongoing, sustainable collaboration between key partners • Implementation and evaluation of promising interventions in Salt Lake County WIC clinics to help women of reproductive age achieve healthy weight before, during, and after pregnancy • Expansion of successful interventions to WIC clinics and other appropriate populations throughout Utah to help women of reproductive age achieve healthy weight before, during, and after pregnancy • Implementation and evaluation of reproductive health care provider system changes e.g., provider education and tools to assist them in identifying high risk women and delivering a healthy weight message during provider visits • Reversal of the trend of increasing rates of overweight/obesity among women of reproductive age in Utah

15. Next Steps • Key informant surveys of WIC staff to ID barriers to counseling • Focus groups (3-5) with pregnant, postpartum, interconceptional overweight and obese women to ID assets/barriers to healthy weight • Chart reviews to ascertain provider practices r/t ID and addressing overweight/obesity during prenatal • Bright Futures for Women’s Health and Wellness Program Implementation

16. Next Steps: Key Informant survey • 25 surveys distributed, 23/25 = 92% return rate • Dietitian/Nutrition Assistants Salt Lake County WIC clinics

17. Key Informant Results Question 1: What challenges do you face, if any, in addressing healthy weight among the WIC clients you counsel?

18. Key Informant Results Question 2: What training/education does WIC need to provide to staff in order for you to adequately address healthy weight with WIC clients?

19. Key Informant Results Question 3:Is the WIC program doing enough to address healthy weight among clients? If not, what recommendations can you make that will help WIC improve in this area? • Yes (10) 43% • No (12) 52%

20. Key Informant Results Question 4: What barriers prevent you from discussing overweight/obesity issues with clients?

21. Key Informant Results Question 5:In your opinion, do you feel supported bycommunity health care providers in addressingoverweight/obesity issues? Some respondents checked both yes and no on this item.

22. Key Informant Results Question 6: How receptive are clients about receiving healthy weight information? Some respondents answered both positively and negatively for this question.

23. Key Informant Results Question 7:How comfortable are you in discussing healthy weight issues? Please elaborate further on your answer.

24. Key Informant Results Question 8:What resources is WIC providing for clients that you use during counseling of healthy weight?

25. Key Informant Results Question 9:What additional resources would be helpful to you during counseling?

26. Key Informant Results Question 10: What types of counseling strategies or information do you usually discuss with clients when addressing the issue of healthy weight?

27. Key Informant Results Question 11: What types of counseling techniques do you find to be most effective?

28. Focus Groups • Focus groups (3-5) with pregnant, postpartum, interconceptional overweight and obese women to ID assets/barriers to healthy weight • Funding secured from Region VIII OWH to provide incentives, daycare and light healthy refreshments • English and Spanish facilitators

29. Focus Groups Discussion themes: • Explore knowledge/beliefs around relationship between healthy weight and pregnancy outcomes • Explore knowledge/beliefs around relationship between healthy weight and prevention of chronic disease • Explore cultural beliefs/traditions/lifestyle issues that contribute to unhealthy weight

30. Focus Groups • Explore knowledge/beliefs around importance of “5-a-day” • Explore knowledge/beliefs around physical activity recommendations (@ least 30 min./day most days of week) • Explore knowledge/beliefs about role of breastfeeding in maintaining a healthy weight • Brainstorm interventions that would promote healthy weight

31. Chart review project • Prenatal medical record review (University of Utah and SLVHD clinics) assessing: • Provider’s demographic info • Pre-pregnancy height and weight recorded • BMI calculated • If BMI > 30, listed on problem list

32. Project Implementation • The Bright Futures program will be implemented at two clinics (South Main Public Health Center, Ellis Shipp Public Health Center) • Women who receive MCH services at these two sites also participate in WIC • Project will be evaluated after one year

33. Bright Futures • My Bright Future: Physical Activity And Healthy Eating Guide for Adult Women • Getting Started: Questions to answer on your own and talk about with your health care provider. • Healthcare Provider: Ideas on how to start a conversation with your health care provider and examples of questions you can ask. • My Healthcare visit: Section for your health care provider to fill out during your visit. • Setting My goals: Charts for setting goals with your health care provider (or on your own). • What I Should Know: Information and ideas to help you reach your goals. • Hints For Reaching My Goal: More ideas to help you meet your goals. • Getting More Information: Other resources to help you.

34. ABOUT THE BRIGHT FUTURES FOR WOMEN’S HEALTH AND WELLNESS INITIATIVE • The Bright Futures for Women’s Health and Wellness (BFWHW) initiative is a project of the U.S. • Department of Health and Human Services’ Health Resources and Services Administration (HRSA), • Office of Women’s Health. • The mission of BFWHW is to plan, develop, implement, and evaluate a variety of culturally competent consumer, provider, and community-based products for all women across their lifespan—including underserved and minority women. • The Bright Futures materials • help to promote women’s physical, emotional, social, and spiritual health and well-being.

35. Bright Futures http://www.hrsa.gov/womenshealth/toolkit/menu.html

36. Focus group recruitment Keeping partners engaged Maintaining flexibility needed to revise interventions Acquiring incentive monies for focus groups Challenges

37. Questions?

38. Contact information • astevenson@slco.org • imacdonald@slco.org