Sara M. Lindberg’s research while affiliated with University of Wisconsin–Stout and other places

Background/Significance: Obesity rates have increased dramatically, especially among children and disadvantaged populations. Obesity is a complex issue, creating a compelling need for prevention efforts in communities to move from single isolated programs to comprehensive multisystem interventions. To address these issues, we have established a childhood Obesity Prevention Initiative (Initiative) for Wisconsin. This Initiative seeks to test community change frameworks that can support multisystem interventions and provide data for local action as a means for influencing policies, systems, and environments that support individuals’ healthy eating and physical activity. Approaches/Aims: The Initiative is comprised of three components: (1) infrastructure to support a statewide obesity prevention and health promotion network with state- and local-level public messaging and dissemination of evidence-based solutions (healthTIDE); (2) piloting a local, multisetting community-led intervention study in 2 Wisconsin counties; and (3) developing a geocoded statewide childhood obesity and fitness surveillance system. Relevance: This Initiative is using a new model that involves both coalition action and community organizing to align resources to achieve health improvement at local and state levels. We expect that it will help lead to the implementation of cohesive and sustainable policy, system, and environment health promotion and obesity prevention strategies in communities statewide, and it has the potential to help Wisconsin become a national model for multisetting community interventions to address obesity. Addressing individual-level health through population-level changes ultimately will result in reductions in the prevalence of childhood obesity, current and future health care costs, and chronic disease mortality.

Importance: Weight gain during pregnancy affects obesity risk in offspring. Objective: To assess weight gain among UW Health prenatal patients and to identify predictors of unhealthy gestational weight gain. Methods: Retrospective cohort study of women delivering at UW Health during 2007-2012. Data are from the UW eHealth Public Health Information Exchange (PHINEX) project. The proportion of women with excess and insufficient (ie, unhealthy) gestational weight gain was computed based on 2009 Institute of Medicine guidelines. Multivariable logistic regression was used to identify risk factors associated with excess and insufficient gestational weight gain. Results: Gestational weight gain of 7,385 women was analyzed. Fewer than 30% of prenatal patients gained weight in accordance with Institute of Medicine guidelines. Over 50% of women gained excess weight and 20% gained insufficient weight during pregnancy. Pre-pregnancy weight and smoking status predicted excess weight gain. Maternal age, race/ethnicity, smoking status, and having Medicaid insurance predicted insufficient weight gain. Conclusions and relevance: Unhealthy weight gain during pregnancy is the norm for Wisconsin women. Clinical and community interventions that promote healthy weight gain during pregnancy will not only improve the health of mothers, but also will reduce the risk of obesity in the next generation.

Importance: Weight gain during pregnancy affects obesity risk in offspring. Objective: To assess weight gain among UW Health prenatal patients and to identify predictors of unhealthy gestational weight gain. Methods: Retrospective cohort study of women delivering at UW Health during 2007-2012. Data are from the UW eHealth Public Health Information Exchange (PHINEX) project. The proportion of women with excess and insufficient (ie, unhealthy) gestational weight gain was computed based on 2009 Institute of Medicine guidelines. Multivariable logistic regression was used to identify risk factors associated with excess and insufficient gestational weight gain. Results: Gestational weight gain of 7,385 women was analyzed. Fewer than 30% of prenatal patients gained weight in accordance with Institute of Medicine guidelines. Over 50% of women gained excess weight and 20% gained insufficient weight during pregnancy. Pre-pregnancy weight and smoking status predicted excess weight gain. Maternal age, race/ethnicity, smoking status, and having Medicaid insurance predicted insufficient weight gain. Conclusions and relevance: Unhealthy weight gain during pregnancy is the norm for Wisconsin women. Clinical and community interventions that promote healthy weight gain during pregnancy will not only improve the health of mothers, but also will reduce the risk of obesity in the next generation.

Importance: Obesity before and during pregnancy increases risk among mothers for poor health outcomes, such as diabetes, high blood pressure, and cardiovascular disease. Objective: To describe trends in pre-pregnancy obesity rates among women in Wisconsin. Methods: Cross-sectional data from Wisconsin birth certificates were analyzed. Prevalence of pre-pregnancy obesity (defined as body mass index ≥ 30) among Wisconsin women who gave birth from 2011 through 2014 was compared across demographic and geographic dimensions. Results: Overall, 27.8% of Wisconsin women who gave birth during 2011-2014 were obese. Obesity rates were highest among 40- to 44-year-old women (31.8%), women with a high school/ GED diploma (32.8 %), American Indian/Alaska Native women (43.9%), and women with 5 or more pregnancies (35.4%). Obesity rates varied by county of residence (highest in Forest County, 45.2%) and city of residence (highest in the city of Racine, 34.8%). Conclusions: There are significant socioeconomic, racial, and geographic disparities in pre-pregnancy obesity among women who give birth in Wisconsin.

Importance: Obesity before and during pregnancy increases risk among mothers for poor health outcomes, such as diabetes, high blood pressure, and cardiovascular disease. Objective: To describe trends in pre-pregnancy obesity rates among women in Wisconsin. Methods: Cross-sectional data from Wisconsin birth certificates were analyzed. Prevalence of pre-pregnancy obesity (defined as body mass index = 30) among Wisconsin women who gave birth from 2011 through 2014 was compared across demographic and geographic dimensions. Results: Overall, 27.8% of Wisconsin women who gave birth during 2011-2014 were obese. Obesity rates were highest among 40- to 44-year-old women (31.8%), women with a high school/GED diploma (32.8 %), American Indian/Alaska Native women (43.9%), and women with 5 or more pregnancies (35.4%). Obesity rates varied by county of residence (highest in Forest County, 45.2%) and city of residence (highest in the city of Racine, 34.8%). Conclusions: There are significant socioeconomic, racial, and geographic disparities in pre-pregnancy obesity among women who give birth in Wisconsin.

Importance: A comprehensive obesity surveillance system monitors obesity rates along with causes and related health policies, which are valuable for tracking and identifying problems needing intervention. Methods: A statewide obesity dashboard was created using the County Health Rankings model. Indicators were obtained through publicly available secondary data sources and used to rank Wisconsin amongst other states on obesity rates, health factors, and policies. Results: Wisconsin consistently ranks in the middle of states for a majority of indicators and has not implemented any of the evidence-based health policies. Conclusions and relevance: This state of obesity report shows Wisconsin has marked room for improvement regarding obesity prevention, especially with obesity-related health policies. Physicians and health care systems can play a pivotal role in making progress on obesity prevention.

Background/significance: Obesity rates have increased dramatically, especially among children and disadvantaged populations. Obesity is a complex issue, creating a compelling need for prevention efforts in communities to move from single isolated programs to comprehensive multisystem interventions. To address these issues, we have established a childhood Obesity Prevention Initiative (Initiative) for Wisconsin. This Initiative seeks to test community change frameworks that can support multisystem interventions and provide data for local action as a means for influencing policies, systems, and environments that support individuals' healthy eating and physical activity. Approaches/aims: The Initiative is comprised of three components: (1) infrastructure to support a statewide obesity prevention and health promotion network with state- and local-level public messaging and dissemination of evidence-based solutions (healthTIDE); (2) piloting a local, multisetting community-led intervention study in 2 Wisconsin counties; and (3) developing a geocoded statewide childhood obesity and fitness surveillance system. Relevance: This Initiative is using a new model that involves both coalition action and community organizing to align resources to achieve health improvement at local and state levels. We expect that it will help lead to the implementation of cohesive and sustainable policy, system, and environment health promotion and obesity prevention strategies in communities statewide, and it has the potential to help Wisconsin become a national model for multisetting community interventions to address obesity. Addressing individual-level health through population-level changes ultimately will result in reductions in the prevalence of childhood obesity, current and future health care costs, and chronic disease mortality.

Importance: A comprehensive obesity surveillance system monitors obesity rates along with causes and related health policies, which are valuable for tracking and identifying problems needing intervention. Methods: A statewide obesity dashboard was created using the County Health Rankings model. Indicators were obtained through publicly available secondary data sources and used to rank Wisconsin amongst other states on obesity rates, health factors, and policies. Results: Wisconsin consistently ranks in the middle of states for a majority of indicators and has not implemented any of the evidence-based health policies. Conclusions and relevance: This state of obesity report shows Wisconsin has marked room for improvement regarding obesity prevention, especially with obesity-related health policies. Physicians and health care systems can play a pivotal role in making progress on obesity prevention.

Objective To examine whether an electronic medical record “best practice alert” previously shown to improve antenatal gestational weight gain patient education resulted in downstream effects on service delivery or patient health outcomes. Methods This study involved secondary analysis of data from an intervention to improve provider behavior surrounding gestational weight gain patient education. Data were from retrospective chart reviews of patients who received care either before (N = 333) or after (N = 268) implementation of the intervention. Pre-post comparisons and multivariable logistic regression were used to analyze downstream effects of the intervention on health outcomes and obesity-related health services while controlling for potential confounders. Results The intervention was associated with an increase in the proportion of prenatal patients who gained weight within Institute of Medicine guidelines, from 28 to 35 % (p < .05). Mean total gestational weight gain did not change, but variability decreased such that post-intervention women had weight gains closer to their gestational weight gain targets. The intervention was associated with a 94 g decrease in mean infant birth weight (p = .03), and an increase in the proportion of overweight and obese women screened for undiagnosed Type 2 diabetes before 20 weeks gestation, from 13 to 25 % (p = .01). Conclusions for Practice The electronic medical record can be leveraged to promote healthy gestational weight gain and early screening for undiagnosed Type 2 diabetes. Yet most patients still need additional support to achieve gestational weight gain within Institute of Medicine guidelines.