Evaluation of a program aimed to reduce

Obesity in pregnant women

Dr. Marcia Erazo

In late years …

Health problems in the population have changed….

DEFICIT EXCESS

87 89 91 93 95 97 99 1 3

10

15

20

25

30

35

UnderW Obesity

Prevalence rates undernourished

and obese pregnant women 1987-2002

%

+ 159 %

- 48%

Fuente: MINSAL

Advisory in healthy lifestyle.

More controls

Strict surveillance Nutritional status during

pregnancy

Stimulating exclusive breast-feeding (6 mo)

Create more support nets

Evaluate this strategy.

NUTRITIONAL INTERVENTION

THROUGH VITAL CYCLE

Advisory in healthy life

Promote healthy conducts and change habits.

Stimulate self-care.

Multi-level design

Ministry of Health

H. S.

P. C. C. X

Population

Level 2

Level 1

Table 1. Population characteristics

Característica Control

P50 (p25 – p75)

Intervention

P50 (p25 – p75)

Age (y.o) 27 (22 -32) 24 (19.7 – 31)

Income (USD) 302 (175 – 350) 336 (191 – 438)

School (tears) 12 (9-12) 12 (10 -12)

Chilbirth (N°) 2 (1 -3) 2 (1 – 2)

Nutritional status beginning

pregnancy

- Underweighted

- Normal

- Overweighted

- Obesity

0.8

47.3

38.6

13.3

1.3

53.4

31.4

13.9

Nutritional status at month 6.

- Underweighted

- Normal

- Overweighted

- Obesity

1.2

37.6

41.1

20.2

0.5

32.1

40.3

27

Calories (kcal) 2151 (1397 – 2670) 2807 (2088 – 3427)

Physical activity (hrs) 2.6 (2-4.5) 4.6 (3.2-5.3)

Table 2. Weight gain during pregnancy and at month 6

Nutritional status

Control Media (sd)

Intervention Media (sd)

P value *

Underweight Ganancia (Kg) 11, 5 (2,12) 6,8 (0) 0,03

Retención (Kg) 4,00 (4,24) 9,00 (8,48) 0,05

Normal Ganancia (Kg) 12,22 (4,38) 12,8 (3,81) 0,35

Retención (Kg) 2,13 (4,87) 6,6 (5,66) <0,001

Overweight Ganancia (Kg) 19,16 (7,9) 12,07 (4,53) 0,05

Retención (Kg) 2,30 (5,42) 5,55 (5,22) <0,001

Obesity Ganancia (Kg) 7,28 (3,51) 8,90 (5,25) 0,241

Retención (Kg) 2,61 (5,76) -0,52 (6,71) 0,05

Total Ganancia (Kg) 14,19 (4,93) 12,01 (4,48) 0,55

Retención (Kg) 2,27 (5,16) 5,32 (6,11) <0,001

Tabla 3. Factores de riesgo de no recuperación del estado nutricional al sexto mes post parto.

P value OR 95% CI

Low High

Age ,034 ,960 ,925 ,997

Nutritional status end pregnancy ,000 32,006 13,207 77,567

Nutritional status beginning * Intervention

,005 ,406 ,218 ,757

Intervention ,000 31,810 5,392 187,662

Nutritional status beginning ,000 ,066 ,027 ,160

-2 Log likelihood=432,112.

Ministry of Health Statistics, 2010

What happened with advisory?

NOTHING!!!!

Not prepared: Health system: Have neither time nor human resources for advisory People: They want that professionals tell them what is wrong and what is right!!

Causal model of obesity and Ministerial

programatic approach

Results

Diverse interventions and key aspects

Target Population Intervention Key aspects

Diverse population

(Elderly, women, children)

Community agents to

support families

Permanent support to make healthy

choices (food and physical activities)

Schoolchildren Environmental

modification

1 year (or more) of constant

intervention

Healthy food supply at school

Families and educative community

involved

Workers Education and

psychological support

Results improve with an incentive

programme.

Key aspects to improve Ministerial

Programs

To stimulate higher number of contacts. Use of e-

health.

To educate properly the professionals that will be

involved in the new intervention.

To incorporate the family (community), their thoughts,

culture, fears and expectations in the design of the

strategy (program).

Give clear and understandable indications.

Offer peer-support to those who are been intervened

Opportunities to improve public policies

aimed to reduce obesity

Program / Strategy Recommendation

Health promotion -National

Strategy

At school level:

At least 1 year of intervention

Involve parents and educational community

Incorporate feeding-nutrtional education and physical activity as a curricular

activity

Increase fruit and vegetable supply

At community level:

Promote community agents that help families to make healthy choices.

Life course intervention aimed

to prevent and control obesity

Stimulate higher number of contacts. Use e-health tools.

Educate properly the professionals that are involved in the intervention.

Give clear and understandable indications.

National childhood Program Incorporate parents. Give them clear and simple instructions about healthy

life-style.

Incorporate healthy living counselling, motivation and support, specially to

families with overweighted children

Visit families at home, understand the culture and the environment where

children live.

Work with community agents

Use e-Health toools to increase the number of contacts with your family.

We ourselves feel that what we are doing is just a

drop in the ocean, but the ocean would be less

because of that missing drop.

Mother Teresa of Calcutta