Healthy Eating Active Living for Pregnant Women, Mothers & Babies Select dropdown arrow next to “New Slide” for additional slide layouts.

Early Lifecycle Approach to Obesity Prevention (Childhood Obesity 2012:8,3) Figure 1 designed by Terry Huang Ph D and R Hammond Ph D Developmental and intergenerational effects of obesity. Significant interstage events include: 1, Intrauterine programming; 2, breastfeeding, early food exposure, attachment stage; 3, early childhood growth, child care, habit formation; 4, brain maturation, self-management, puberty, health behavior change, increased salience of peer effects and school effects; 5, independence, increasing life stress; 6, preconceptual health, parental health status, prenatal care. Overweight adolescents have LGA babies who become overweight infants and toddlers who become overweight school age and adolescents and the cycle continues. Overweight adults have LGA babies who become overweight infants and toddlers who become overweight school age and adolescents and the cycle continues.

Healthy Eating-Active Living formula “One-on-one” session with a dietitian 5 weeks group sessions Health literacy+ Cooking and Exercise + Produce Distribution

HEAL primary behavioral targets Patients are more likely to follow provider recommendations. Provider engagement is the key to program success. Three steps: HEAL program awareness Patient eligibility and referral to the program (HEAL is embedded within the EMR) Prescription to HEAL

“Very exciting and I wish I knew about this my last 4 kids” “I love the heal program and so does my partner, Thank you”

Demographic variables Preliminary Results Demographic variables n mean SD Age (year) 91 29.6 6.2 Gestational age 20.9 6.5 Weight before pregnancy, self-reported (lb) 76 189.15 46.3 Height (inches) 90 64.24 3.1 Weight at baseline (lb) 203.85 43.7 Distance to clinic (km) 65 20.24 10.6 Distance to group session (km) 19.47 10.4 Items % increase P Peaches and nectarines 14.78 0.02 Apples 15.39 <0.01 Oranges 15.56 0.01 Plums 11.24 0.05 Carrots 22.73 Greens (collards, spinach) 17.05 Potatoes Corn 13.34 Peas 15.11 Tomatoes Beans 20.73

Preliminary Results – Behavior changes Significant increase in: n Z-score p Daily fruit intake (times per week) 92 -3.203 <0.01 Daily fruit intake (servings per day) 82 -2.057 0.04 Daily vegetable intake (times per week) 90 -2.202 0.03 Daily vegetable intake (servings per day) 83 -3.542 Time spent in physical activity for >30 minutes per day -2.245 Time spent in physical activity for at least 10 minutes at a time 73 -3.52 Perceived benefit of breastfeeding 91 -2.924 Attitude toward benefits of breastfeeding -2.638 Significant decrease in: n z-score p Sugar sweetened beverages 92 2.855 <0.01 Fried potatoes 2.143 0.03 Potato chips 2.682 Fried chicken 89 2.223 Pizza 2.214 Processed meat 2.279 0.02 Heat and serve boxed food 3.719

What this project will show: Feasibility of evidence-based early life systems approach in a Medicaid population Family acceptance and enthusiasm Meaningful outcomes Behavioral, environmental changes – improved diet, physical activity behaviors in mother and child, increased opportunities for healthy eating and active living, breastfeeding Individual health outcomes: Measures of system changes Cost-effectiveness Abnormal weight gain during pregnancy Abnormal glucose levels Gestational diabetes Pre-term delivery Infant birth weight and weight gain trajectory Mother’s return to healthy weight (post-partum)

THANK YOU Project lead: Shreela Sharma, PhD, RD, LD - Associate Professor of Epidemiology Email: Shreela.V.Sharma@uth.tmc.edu Project Manager: Melisa Danho, MPH, RD, LD Email: Melisa.P.Danho@uth.tmc.edu UTHealth | The University of Texas Health Science Center at Houston School of Public Health Michael & Susan Dell Center for Healthy Living 1200 Hermann Pressler | RAS E603 | Houston, TX 77030 www.msdcenter.org