1. Healthy Eating Active Living for Pregnant Women, Mothers & Babies
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2. 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.

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

4. 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

5. “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”

6. 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

7. 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

8. 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)

9. THANK YOU
Project lead: Shreela Sharma, PhD, RD, LD - Associate Professor of Epidemiology Project Manager: Melisa Danho, MPH, RD, LD 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