Weight gain during pregnancy and postpartum are important causes of long-term weight gain and the development of obesity-related diseases among women. A new, interdisciplinary study from Washington University in St. Louis finds providing a home-based lifestyle intervention effectively minimizes excess maternal weight gain during pregnancy and through 12 months postpartum in underserved African-American women with obesity.
“We’ve found that lifestyle interventions delivered through Parents as Teachers, a national home visiting organization, provide sustainable, scalable and effective weight management for underserved African-American women with overweight or obesity issues,” said first author Debra Haire-Joshu, the Joyce Wood Professor at the Brown School and an expert on interventions to reduce obesity and prevent diabetes among underserved women and children.
The findings were published March 22 as the Editor’s Choice article in the April issue of the journal Obesity.
This study was conducted at one site of the Lifestyle Interventions for Expectant Moms (LIFE-Moms) Consortium.
Analysis was conducted involving 185 African-American women with a Body Mass Index (BMI) of 25 to 45 at the onset of pregnancy. The study evaluated group differences between the standard Parents as Teachers curriculum and Parents as Teachers Plus, a lifestyle intervention embedded within the standard curriculum prenatally and for 12 months postpartum.
“Compared with the standard Parents as Teachers group, we found that the lifestyle intervention group gained less weight and was more likely to return to baseline weight from baseline to one year postpartum with minimal additional cost,” Haire-Joshu and colleagues wrote.
The authors noted that the prevalence of being overweight and obese is high among African-American women, particularly those who are underserved and socioeconomically disadvantaged. “Women with obesity are at risk of excessive gestational weight gain during pregnancy and have greater weight retention one year after delivery, thereby increasing the severity of their obesity and the risk of obesity-related medical issues,” the study said.
Although lifestyle intervention is recommended for pregnant women with obesity to prevent excessive gestational weight gain and postpartum weight retention, providing effective real-world therapy for socioeconomically disadvantaged women is difficult because of the many barriers to program participation related to parenting responsibilities, costs, limited transportation and other stressors.
“Excessive weight gain during pregnancy can have adverse long-term effects on child health,” said senior author Samuel Klein, the William H. Danforth Professor of Medicine and Nutritional Science and director of the Division of Geriatrics and Nutritional Science at Washington University School of Medicine in St. Louis. “Additional studies are needed to determine whether minimizing gestational weight gain in women who are already obese has beneficial effects on their children.”
Haire-Joshu noted that Parents as Teachers, which has more than 3,200 sites across the United States, provides a sustainable and scalable program that helps provide effective weight management intervention for this high-risk population.
Haire-Joshu D, Cahill AG, Stein RI, Cade WT, Woolfolk CL, Mathur A, Schwarz CD, Schechtman KB, Klein S. Randomized controlled trial of home-based lifestyle therapy on postpartum weight in underserved women with overweight/obesity. Obesity, March 22, 2019.
This study was supported by the National Institutes of Health (NIH), grants DK94416, DK56341 (Nutrition Obesity Research Center); DK20579 (Diabetes Research Center); and RR024992 (Clinical and Translational Science Award). LIFE-Moms is supported by the NIH through the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), U01 DK094418, U01 DK094463, U01 DK094416, 5U01 DK094466 (RCU); the National Heart, Lung, and Blood Institute, U01 HL114344, U01 HL114377; the Eunice Kennedy Shriver National Institute of Child Health and Human Development, U01 HD072834; the National Center for Complementary and Integrative Health; the NIH Office of Research in Women’s Health; the Office of Behavioral and Social Science Research; the Indian Health Service; and the Intramural Research Program of the NIDDK.
With more than 2 million Americans suffering from an opioid use disorder and the escalating rate of deaths from opioid overdoses reaching about 130 per day, efforts to date have had little impact in curbing this crisis across the country.
As a result, a committee of the National Academies of Sciences, Engineering and Medicine released on March 20 a list of conclusions to deploy the use of life-saving, evidence-based medications with maximum effect.
“This is an outstanding committee that was both scientifically diligent and efficient with addressing America’s opioid epidemic,” said David Patterson Silver Wolf, associate professor at the Brown School at Washington University in St. Louis and part of the committee that wrote the consensus study report.
“The committee’s final report and the conclusions generated must be acted on by all concerned, from our federal agencies down to every system where an individual suffering from an opioid use disorder might enter,” he said.
The committee’s statement of task was to support the dissemination of accurate, patient-focused information about treatments for addiction, and to help provide scientific solutions to the current opioid crisis.
People who suffer from an opioid use disorder (OUD), which is caused by the prolonged use of prescription opioids and/or heroin, are at a 20-fold greater risk of early death due to overdose, untreated infectious diseases, trauma and suicide.
The committee found that OUD is a chronic brain disease resulting from persistent opioid use on brain structures and functioning. The altered brain can be treated with life-saving, FDA-approved medications.
These medications — methadone, buprenorphine, and extended-release naltrexone — are not available to most of the people who need them. By alleviating withdrawal symptoms and/or reducing opioid cravings, the medications help individuals to restore their functionality and save lives, Patterson Silver Wolf said.
The committee’s report indicated: “Curbing the epidemic will require an ‘all hands on deck’ strategy across every sector — health care, criminal justice and beyond — because no sector alone will be able to resolve the crisis. Making access to medications much broader and more equitable is a high priority for making meaningful progress in saving lives of those with OUD.”
The committee developed seven conclusions:
- Opioid use disorder is a treatable chronic brain disease.
- FDA-approved medications to treat opioid use disorder are effective and save lives.
- Long-term retention on medications to treat opioid use disorder is associated with improved outcomes.
- A lack of availability of behavioral interventions is not a sufficient justification to withhold medications to treat opioid use disorder.
- Most people who could benefit from medication-based treatment for opioid use disorder do not receive it, and access is inequitable across subgroups of the population.
- Withholding or failing to have available all classes of FDA-approved medication for the treatment of opioid use disorder in any care or criminal justice setting is denying appropriate medical treatment.
- Confronting the major barriers to the use of medications to treat opioid use disorder is critical to addressing the opioid crisis.
Patterson Silver Wolf is the chief research officer at the CAPA Clinic, a new partnership between the Brown School and Preferred Family Healthcare, a substance use disorder treatment program in St. Louis.
“It is our intention to follow the committee’s conclusions, along with leveraging the latest science and technologies,” he said.
“This is my 30th year of sustained recovery from alcohol and drugs,” he said. “The stigma associated with addiction and the lack of science-based practices has not changed much since I entered treatment in 1989. I hope this committee’s report, along with new technology tools, will be the mechanisms that finally begins to change our treatment industry.”
The National Academies’ consensus study was undertaken by the Committee on Medication-Assisted Treatment for Opioid Use Disorder, and was sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA) and National Institute on Drug Abuse (NIDA) of the National Institutes of Health.
Members of the Brown School community will be honored with awards from the Congressional Research Institute for Social Work and Policy (CRISP) at the 5th Annual Social Work Day on the Hill on Wednesday, March 20, 2019.
The day will bring together social workers dedicated to policy change and celebrate the contributions they have made and are continuing to make in the U.S. Congress and the federal government.
At the evening reception, Brown School community awardees will include:
Outstanding Individual in Academia: Mary M. McKay, Neidorff Family and Centene Corporation Dean of the Brown School
Dean McKay joined the Brown School at Washington University in St. Louis in 2016, continuing the School’s legacy of creating vital knowledge, initiating social change, and preparing leaders to address social and health challenges both locally and globally. Dean McKay has long advocated for social policies and legislation that improve the lives of children and families, and she recognizes that social justice and racial equity must be advanced through the development of evidence-based policy. To that end, during her tenure the School has increased its policy leadership and focus, furthering expanding its Master of Policy dual degree, the Clark-Fox Policy Institute and policy-related student experiences and events.
Outstanding Congressional Social Worker of the Year:
Elisabeth Coates, MSW ’18, Staff Assistant, U.S. Senate Committee on Appropriations
Coates, a recent Brown School graduate, is now working for the Senate Appropriations Committee focusing on urban development, housing, justice, commerce, transportation, and science issues. Her first taste of Capitol Hill began where she held a part-time internship in the Senate Finance Committee. There she was able to utilize her research and policy training from the Brown School to embed herself in the federal policy process. She immediately fell in love with operating on a congressional level and knew that “Hill life” – ideally Senate – was the place for her to begin her professional journey. “On Senate Appropriations, it’s a swath of topics in a contentious committee,” Coates said. “But my ability to understand federal policy’s impact from the macro to the micro level placed me as the best candidate for the position.”
Outstanding Student of the Year:
Robert Sagastume, Clark-Fox Policy Institute Scholar, MSW/MSP ’19
Sagastume was selected among thousands of applicants to attend the 11th annual Clinton Global Initiative University (CGIU) this fall. CGIU seeks to bring together student leaders to develop concrete steps toward solving global issues. Sagastume received this honor based upon his “commitment to action” proposal, which came from an idea he had while serving as co-director of an undocumented youth-led group known as the Kansas/Missouri Dream Alliance. “It includes a program where undocumented/DACA students mentor other immigrant and non-immigrant students so they can achieve postsecondary education,” he explained. Sagastume was born and raised in Honduras until age 12 before migrating to the United States, navigating through society as a DACA immigrant. Sagastume is a Clark-Fox Policy Scholar, which provides graduate students with a rigorous and immersive experience that helps Brown School students understand the formation of social policy as a high-impact tool for positive social change.
Outstanding Individuals in Philanthropy:
Maxine Clark and Bob Fox
After enjoying highly successful careers as innovative entrepreneurs, civic leaders Maxine Clark and Bob Fox founded the Clark-Fox Family Foundation in 2004. The Clark-Fox Family Foundation supports the economic development of the St. Louis metropolitan region through program development and investments in K-12, higher education, public health, immigration, social justice, community leadership, and entrepreneurship. Building on a legacy of generous support to Washington University in St. Louis, Maxine Clark and Bob Fox pledged funding for a new forum facility and policy-related programming at the Brown School. In recognition of their commitment, the Brown School Policy Forum was renamed the Maxine Clark and Bob Fox Policy Institute.
About Social Work Day
Social Work Day on the Hill is held in conjunction with the Clark-Fox Policy Institute at the Brown School of Social Work at Washington University in St. Louis, highlighting the work and accomplishments of the 12 Grand Challenge for Social Work networks.
In addition to the awards reception, the event offers a Policy and Politics Forum on child development accounts at the National Press Club, featuring Brown School Professor Michael Sherraden and Dean Mary M. McKay; and a panel of social work students and early career social workers to address the question: Can Social Work Help Save Democracy?
An internship with the St. Louis Board of Aldermen is the newest opportunity for Brown School social work, public health, and social policy students. Developed in partnership with the Office of Field Education and the Masters of Social Policy (MSP) program, the Board offers students real-world experience in the art of local policymaking.
“This is my democracy at work,” said Kate Polokonis, a second-year MSW/MSP student specializing in policy and one of the first two students to intern with the Board. She’s helping analysts look into the possibility of establishing a city-run bank to provide banking services for underserved city residents.
Another MSW/MSP student, Jodie Goodman, is researching the proposal to privatize Lambert St. Louis International Airport. In addition to their research, the student interns have attended Board of Aldermen meetings and had a personal meeting with St. Louis Mayor Lyda Krewson.
The internship was launched as a partnership between the MSP program; Office of Field Education; the 0ffice of Board President Lewis Reed; and Gerard Hollins, board financial analyst and an adjunct professor at Washington University.
The initial internship started in January and will run through May. In the future, part-time opportunities during the semester will feed into full-time opportunities the summer after students complete their MSP course work. The internships are available to non-MSP students as well.
“Opening this opportunity to all Brown School students is a great example of how social work, public health and social policy intersect and align in the classroom and a variety of settings, including City Hall,” said Dan Ferris, assistant dean for policy initiatives.
“Working with the Board of Aldermen gives Brown School students a unique opportunity to be part of the policymaking process here in St. Louis and gain experience that can be applied wherever their future careers may lead,” Ferris said.
Not only is the experience a good one for the students, it benefits a cash-strapped city, said Mary Ries, Reed’s legislative director.
“One of our biggest issues is a lack of resources,” she said. “Brown School interns are an awesome addition to the Board. It’s a win-win for everybody.”
The Board passes more than 300 municipal laws per session and students will be able to work from a variety of policy areas, from gun laws to court reform. Ries said the Board will be flexible in the research preferences of students. “If there’s a piece of legislation they’re particularly interested in, they can take a dive into it and create their own path.”
“It’s real life work. It’s information we need and use when we make large decisions,” Ries explained. “It’s going to make a difference. They’re working for the city at a transformative time; there’s a big spotlight on the city and they’re playing a big role.”
For Polokonis, the internship hits home in other ways as well. She grew up in the city, and her father ran for alderman when she was 4 years old.
“This is my home, it’s where I live,” she said. “I’m so grateful for this opportunity.”
Jacob Eaton, a PhD student in Public Health at the Brown School, recently authored a literature review, published in the Cochrane Database of Systematic Reviews, to explore if a diet that contains animal-source foods supports growth and development in small children.
Animal-source foods have been shown to improve both growth and cognitive functions in school-aged children. Fewer controlled trials, however, have been done on their effects in the diets of children between the ages of 6 months and 5 years old, when nutrition is especially important for growth and development.
Eaton—with co-author Lora Ionnatti, associate professor at the Brown School—examined six studies from across the globe that focused on the effects of animal-source foods on 3,036 children from 6 months to 5 years old. The goal was to compare the effects of animal-based protein interventions with both cereal-based foods and what happened when children received no nutritional intervention.
All of the studies lasted a year or less; some studies had issues that made it complicated to draw conclusions.
“There was not a lot of consistency, and there was high bias based on funding sources,” Eaton explained, citing industry-sponsored research. In some small studies children fed animal-source foods grew better than those receiving no intervention or a fortified cereal snack, but in larger trials there was no difference between groups.
Ultimately, the review found that the existing evidence is inconclusive and more studies are needed.
Eaton, who became interested in how nutrition can affect health while working in Kenya, hopes that his research will spur additional studies. “Future findings are very likely to change our confidence in the effects of animal-source foods on growth and weight gain,” he stated.
“We spend a lot of money on healthcare to address diseases, and we can do better when it comes to leveraging nutrition.”
As Walmart Inc. plans to eliminate its greeter position in some 1,000 stores by late April, store managers need to work diligently to find other jobs for greeters, many of whom have disabilities, says a public health expert at Washington University in St. Louis.
“While it is unfortunate that Walmart will be eliminating many of these jobs, it is a great opportunity to advocate for the employment of persons with disabilities,” said Jean-Francois Trani, associate professor at the Brown School who studies efforts to improve the well-being of persons with disabilities.
Walmart told greeters around the country last week that their positions would be eliminated later this spring in favor of an expanded, more physically demanding “customer host” role. To qualify, they will need to be able to lift 25-pound packages, climb ladders and stand for long periods.
Disabled workers who fill many of those jobs say they’re being treated unfairly by the decision.
“One of the key non-discrimination aspects of Title I ‘Employers’ Responsibilities’ of the Americans With Disabilities Act is the requirement to provide reasonable accommodations for employees and job seekers with disabilities,” Trani said. “One accommodation is to avoid having to carry heavy weight for someone with a mobility or physical limitation, for instance.”
There are many positions in a Walmart store, including positions such as customer adviser providing advice to customers, that could be filled by a person with disabilities, with or without accommodation, depending on their specific limitation, Trani suggested.
Such positions might require some training, which Wal-Mart should be willing to do.
“If greeters are no longer a requested position by customers, the company should think through training opportunities for greeters so that they become ready to fulfill different positions required by the company,” Trani said. “Persons with disabilities are like anyone committed to their company and their job; they are able to learn and adapt to new positions, especially when their company invests in their skills and shows support.”