Intended for healthcare professionals

CCBYNC Open access
Research

A low intensity, community based lifestyle programme to prevent weight gain in women with young children: cluster randomised controlled trial

BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c3215 (Published 13 July 2010) Cite this as: BMJ 2010;341:c3215
  1. Catherine Lombard, senior research fellow1,
  2. Amanda Deeks, senior research fellow1,
  3. Damien Jolley, associate professor in biostatistics2,
  4. Kylie Ball, associate professor in behavioural epidemiology3,
  5. Helena Teede, professor in women’s health14
  1. 1The Jean Hailes Research Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
  2. 2School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
  3. 3School of Exercise and Nutritional Sciences, Deakin University, Melbourne, Australia
  4. 4Diabetes Research Unit, Southern Health, Melbourne, Australia
  1. Correspondence to: H Teede helena.teede{at}med.monash.edu.au
  • Accepted 26 March 2010

Abstract

Objective To develop and evaluate the effectiveness of a community behavioural intervention to prevent weight gain and improve health related behaviours in women with young children.

Design Cluster randomised controlled trial.

Setting A community setting in urban Australia.

Participants 250 adult women with a mean age of 40.39 years (SD 4.77, range 25-51) and a mean body mass index of 27.82 kg/m2 (SD 5.42, range 18-47) were recruited as clusters through 12 primary (elementary) schools.

Intervention Schools were randomly assigned to the intervention or the control. Mothers whose schools fell in the intervention group (n=127) attended four interactive group sessions that involved simple health messages, behaviour change strategies, and group discussion, and received monthly support using mobile telephone text messages for 12 months. The control group (n=123) attended one non-interactive information session based on population dietary and physical activity guidelines.

Main outcome measures The main outcome measures were weight change and difference in weight change between the intervention group and the control group at 12 months. Secondary outcomes were changes in serum concentrations of fasting lipids and glucose, and changes in dietary behaviours, physical activity, and self management behaviours.

Results All analyses were adjusted for baseline values and the possible clustering effect. Women in the control group gained weight over the 12 month study period (0.83 kg, 95% confidence interval (CI) 0.12 to 1.54), whereas those in the intervention group lost weight (−0.20 kg, −0.90 to 0.49). The difference in weight change between the intervention group and the control group at 12 months was −1.13 kg (−2.03 to −0.24 kg; P<0.05) on the basis of observed values and −1.11 kg (−2.17 to −0.04) after multiple imputation to account for possible bias created by missing values. Secondary analyses after multiple imputation showed a difference in the intervention group compared with the control group for total cholesterol concentration (−0.35 mmol/l, −0.70 to −0.001), self management behaviours (diet score 0.18, 0.13 to 0.33; physical activity score 0.24, 0.05 to 0.43), and confidence to control weight (0.40, 0.11 to 0.69). Regular self weighing was associated with weight loss in the intervention group only (−1.98 kg, −3.75 to −0.23).

Conclusions Weight gain in women with young children could be prevented using a low intensity self management intervention delivered in a community setting. Self management of health behaviours improved with the intervention. The response rate of 12%, although comparable with that in other community studies, might limit the ability to generalise to other populations.

Trial registration Australian New Zealand Clinical Trials Registry number ACTRN12608000110381.

Footnotes

  • We thank Melanie Gibson-Helm, who assisted with data collection and entry, Eldho Paul, who provided statistical advice, and Janet Michelmore, who assisted in securing funding. We also thank participating schools and the women who took part in this study, and Melbourne Pathology for the collection and analysis of blood samples.

  • Contributors: CL, HT, and DJ designed the study. CL and DJ analysed the results. KB and AD contributed to the psychological and behavioural aspects of the intervention and contributed to the interpretation of results and drafts of this paper. CL was responsible for the study design, recruiting schools and participants, delivering the intervention, arranging and supervising collection of data, analysing the data, and writing the manuscript. HT supervised CL and provided intellectual input into all aspects of the study design and data collection, analysis, and reporting. All authors interpreted the results and contributed to writing revisions and approved the final manuscript.

  • Funding: HT is supported by a National Health and Medical Research Council Research Fellowship (ID 545888), KB is funded by a National Health and Medical Research Council Senior Research Fellowship (ID 479513), and CL was awarded a PhD scholarship by VicHealth, Victoria, Australia and a postgraduate writing award by Monash University, Melbourne, Australia. Research costs were funded by a project grant from the William Buckland Foundation, Melbourne, Australia. The researchers were independent of the funder. The organisation responsible for funding had no role in the design or conduct of the study, or in collection, analysis, and interpretation of data or preparation, review, or approval of this manuscript. The authors had full access to all data and had final responsibility for the decision to submit for publication.

  • Competing interests: All authors have completed the Unified Competing Interests form available at www.icmje.org/col.pdf (available on request from the corresponding author) and declare that: 1) HT is supported by a National Health and Medical Research Council Research Fellowship (ID 545888), KB is funded by a National Health and Medical Research Council Senior Research Fellowship (ID 479513), and CL was awarded a PhD scholarship by VicHealth, Victoria, Australia and a postgraduate writing award by Monash University, Melbourne Australia. All authors declare: (2) no financial relationships with commercial entities that might have an interest in the submitted work; (3) no spouses, partners, or children with relationships with commercial entities that might have an interest in the submitted work; and (4) no non-financial interests that may be relevant to the submitted work.

  • Ethical approval: Approval was granted by the Southern Health Human Research Ethics Committee 05187C. All participants signed consent before participation.

  • Data sharing: No additional data available.

  • Accepted 26 March 2010

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

View Full Text