{"id":15231,"date":"2018-04-09T09:14:46","date_gmt":"2018-04-09T15:14:46","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=15231"},"modified":"2021-07-08T11:41:10","modified_gmt":"2021-07-08T17:41:10","slug":"losing-baby-weight-with-help-from-technology","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/losing-baby-weight-with-help-from-technology\/","title":{"rendered":"Lose baby weight with help from technology"},"content":{"rendered":"<div style=\"margin-top: 0px; margin-bottom: 0px;\" class=\"sharethis-inline-share-buttons\" ><\/div><p><strong>\u00a0<\/strong><\/p>\n<figure id=\"attachment_15233\" aria-describedby=\"caption-attachment-15233\" style=\"width: 640px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-large wp-image-15233\" src=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/04\/09030310\/EXT_031918_Lohmillers.jpgeee.webp\" alt=\"The Lohmiller family is pictured with Katie, Jason and fraternal twins.\" width=\"640\" height=\"427\" srcset=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/04\/09030310\/EXT_031918_Lohmillers.jpgeee.webp 1200w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/04\/09030310\/EXT_031918_Lohmillers.jpgeee-300x200.webp 300w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/04\/09030310\/EXT_031918_Lohmillers.jpgeee-1024x683.webp 1024w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/04\/09030310\/EXT_031918_Lohmillers.jpgeee-768x512.webp 768w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/04\/09030310\/EXT_031918_Lohmillers.jpgeee-150x100.webp 150w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/04\/09030310\/EXT_031918_Lohmillers.jpgeee-200x133.webp 200w\" sizes=\"auto, (max-width: 640px) 100vw, 640px\" \/><figcaption id=\"caption-attachment-15233\" class=\"wp-caption-text\">Katie Lohmiller with husband Jason and fraternal twins Marley (left) and Tate. Lohmiller participated in a pilot study of an app developed at CU to help post-partum women manage their weight safely.<\/figcaption><\/figure>\n<p>A little more than two years ago, Katie Lohmiller and her husband, Jason, got an early Christmas present: a baby girl and boy, Marley and Tate, who arrived on Christmas Eve, 2015 at <a href=\"https:\/\/www.uchealth.org\/locations\/uchealth-university-of-colorado-hospital-uch\/\">UCHealth University of Colorado Hospital<\/a>. The babies were healthy and so was Katie, but the birth delivered a nagging worry many new mothers share: how to shed the weight \u2013 about 45 pounds \u2013 she had gained during her pregnancy?<\/p>\n<p>\u201cI felt I was on track with my weight before having kids, but I felt nervous about getting back to where I was,\u201d said Lohmiller, now 33, of Denver.<\/p>\n<p>She got some help from that fixture of the modern world, her smartphone. During her prenatal visits at UCH, Lohmiller signed up to be a candidate for studies related to pregnancy. After she delivered, she was recruited for a research study led by Dr. Jacinda Nicklas, an internal medicine specialist with the University of Colorado School of Medicine. The goal: use mobile technology to help new moms lose post-partum weight and establish healthy habits to keep it off.<\/p>\n<p>Lohmiller joined the four-week pilot study, receiving a Fitbit to help her keep track of her weight, physical activity, diet and other measures of health. In addition, her phone regularly buzzed with health-related information delivered through an app Nicklas worked with clinical and tech colleagues to develop. If Lohmiller needed a human voice to supplement the information from her Fitbit and phone, she had one in the form of a health coach she could call, email or text.<\/p>\n<figure id=\"attachment_15234\" aria-describedby=\"caption-attachment-15234\" style=\"width: 300px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-15234 size-medium\" src=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/04\/09030455\/EXT_031918_Jacinda-Nicklas.jpgeee.webp\" alt=\"Dr. Jacinda Nicklas, who leads the Fit after Baby trial, is pictured.\" width=\"300\" height=\"295\" srcset=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/04\/09030455\/EXT_031918_Jacinda-Nicklas.jpgeee.webp 300w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/04\/09030455\/EXT_031918_Jacinda-Nicklas.jpgeee-150x148.webp 150w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/04\/09030455\/EXT_031918_Jacinda-Nicklas.jpgeee-200x197.webp 200w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-15234\" class=\"wp-caption-text\">Dr. Jacinda Nicklas leads the Fit after Baby trial, which is testing the effectiveness of mobile technology in encouraging women to lose weight and follow healthy behaviors after pregnancy.<\/figcaption><\/figure>\n<p>The combination of electronic and human support was effective, Lohmiller said. Having twins, she\u2019d especially worried about balancing the need to lose weight with supplying the twins with enough calories while she nursed.<\/p>\n<p>\u201cI was able to verify if what I was doing was correct,\u201d Lohmiller said. \u201cThe [program] targeted the things I was most concerned with and gave me support outside of my family. They are sometimes going to tell you what you want to hear.\u201d<\/p>\n<p><strong>Forum for fitness<\/strong><\/p>\n<p>The pilot study led to a one-time focus group with Lohmiller and other participants who gave Nicklas feedback for her next step, which is now underway. The <a href=\"https:\/\/www.clinicaltrials.gov\/ct2\/show\/NCT03215173?term=fit+after+baby&amp;rank=1\">Fit after Baby study<\/a> builds on the principles of the pilot, but with more features in the app, created with Comprendo, a developer of cloud-based digital platforms based in Santa Barbara, Calif.<\/p>\n<p>A team of physicians and public health experts developed the content, Nicklas said. For example, <a href=\"http:\/\/www.ucdenver.edu\/academics\/colleges\/PublicHealth\/Academics\/departments\/CommunityBehavioralHealth\/About\/Faculty\/Pages\/BullS.aspx\">Sheana Bull<\/a> and <a href=\"http:\/\/www.ucdenver.edu\/academics\/colleges\/PublicHealth\/Academics\/departments\/CommunityBehavioralHealth\/About\/Faculty\/Pages\/LeifermanJ.aspx\">Jenn Lieferman,<\/a> both of the Colorado School of Public Health\u2019s Department of Health and Behavioral Sciences, contributed to integrating behavioral theory and content into the app \u2013 a key to Comprendo creating a tool that women will use. Bull also directs the department\u2019s mHealth Impact Laboratory, which works to bridge technology to end users looking for apps that can help them manage and improve their health.<\/p>\n<p>\u201cWe do the science; Comprendo built the app,\u201d said Nicklas. \u201cWe all collaborated through an iterative process to transform the science into an engaging and user-friendly mobile app.\u201d<\/p>\n<p>The Fit after Baby trial aims at more than encouraging weight loss. It might be thought of as electronically aided early risk-reduction intervention. It targets women diagnosed with gestational diabetes, gestational hypertension, or pre-eclampsia \u2013 a combination of hypertension and elevated levels of protein in urine, an indication of kidney damage \u2013 as well as those who deliver infants who are preterm (32 to 37 weeks) or small (less than the 10<sup>th<\/sup> percentile for their age). All of these factors are linked to increasing women\u2019s risk for diabetes, hypertension and heart attack after pregnancy.<\/p>\n<figure id=\"attachment_15235\" aria-describedby=\"caption-attachment-15235\" style=\"width: 169px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-15235 size-medium\" src=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/04\/09030627\/EXT_031918_Activity-Tracker.pngeee.webp\" alt=\"Picture shows how activity is tracked on app.\" width=\"169\" height=\"300\" srcset=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/04\/09030627\/EXT_031918_Activity-Tracker.pngeee.webp 400w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/04\/09030627\/EXT_031918_Activity-Tracker.pngeee-169x300.webp 169w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/04\/09030627\/EXT_031918_Activity-Tracker.pngeee-85x150.webp 85w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/04\/09030627\/EXT_031918_Activity-Tracker.pngeee-200x354.webp 200w\" sizes=\"auto, (max-width: 169px) 100vw, 169px\" \/><figcaption id=\"caption-attachment-15235\" class=\"wp-caption-text\">Women in the Fit after Baby trial download an app built by Comprendo, in collaboration with Nicklas and her clinical colleagues. The app delivers custom content to the women\u2019s smartphones and enables them to keep track of key measures, like their calorie consumption and activity.<\/figcaption><\/figure>\n<p>Safely losing post-partum weight could help to lessen the danger, Nicklas said, but many women need help and support. \u201cIf they don\u2019t lose the weight in the first six to 12 months, they tend to retain it,\u201d she said. \u201cThe first year is the critical window for taking off the baby weight. We haven\u2019t been addressing that early enough.\u201d Nicklas also noted that shedding post-partum weight also decreases a woman\u2019s risk for developing gestational diabetes and hypertension in future pregnancies.<\/p>\n<p><strong>Phoning it in<\/strong><\/p>\n<p>Enter the app, which delivers health-related content to the study group via their iPhones or iPods (it\u2019s not yet available for Android devices). Comprendo provides the platform that enables clinicians like Nicklas to create and deliver customized content, or \u201chealth pathways,\u201d through patients\u2019 smartphones, said the company\u2019s president and CEO Dean Hovey.<\/p>\n<p>When a new mom enrolled in the Fit after Baby trial downloads the app interface to her phone, she receives the pathway content stored on the cloud. In turn, when she interacts with the app \u2013 recording her activity or what she\u2019s eaten, for example \u2013 the data flows back to the cloud, where a coach can review it and provide encouragement to the mom or make suggestions for improvement. As the trial progresses, moms receive new content, interact with the app, and the cycle continues, Hovey explained.<\/p>\n<p>\u201cWhat makes these interactions so powerful is the system is continuously accumulating data and learning what interactions \u2014what we call nudges \u2014 are most helpful to support the desired behaviors and outcomes,\u201d Hovey said in an email.<\/p>\n<p>The control group will receive general information about healthy behaviors through text messages two or three times a week. Both groups will have their weight, waist circumference and a battery of blood labs measured at baseline, six months and 12 months to assess the results.<\/p>\n<p><strong>Interactive info<\/strong><\/p>\n<p>The two approaches are very different, Nicklas said. For example, the study group receives daily content structured around weekly themes, such as controlling saturated fats in the diet. The content includes quizzes, educational resources and rewards for meeting goals, while wrist-worn Fitbit Flex 2s help women track their progress with activity, diet, sleep and weight and feeds the data back to the app. The app also addresses strategies to reduce stress \u2013 a yoga curriculum includes new poses delivered twice a week \u2013 and points women to resources to confront depression.<\/p>\n<p>Meanwhile, Kristen Frie, a registered dietitian and nutritionist, monitors and tracks each woman\u2019s progress and coaches those who need it by phone or electronically. For many women, losing weight after giving birth requires more than mere willpower, Frie said in an email. Many of them face not only the considerable challenge of caring for an infant \u2013 or more than one \u2013 but also meeting the needs of their larger family, getting back to work, and so on.<\/p>\n<p>\u201cLife is busy, especially with a newborn. I receive many questions about finding that appropriate balance and adequate energy to spend time with their family, while eating well and fitting in exercise,\u201d Frie said.<\/p>\n<p>The new app provides plenty of information and suggestions for losing weight safely. However, Frie said her role is not to lecture women about what they should do but rather to reinforce and encourage their successes and to help them find intrinsic reasons for making healthy choices.<\/p>\n<p>\u201cThe core of behavior change is identifying internal motivation to make the changes, so I use motivational interviewing techniques with the participants to try and understand what motivates them and build from that,\u201d she said.<\/p>\n<p><strong>The upside of me time<\/strong><\/p>\n<p>Those conversations can help change the point of view of women who might be reluctant to spend time on themselves, Nicklas said.<\/p>\n<figure id=\"attachment_15236\" aria-describedby=\"caption-attachment-15236\" style=\"width: 170px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-15236 size-medium\" src=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/04\/09030749\/EXT_031918_Hunger-Tracker.pngeee.webp\" alt=\"Picture shows the Hunger Tracker app.\" width=\"170\" height=\"300\" srcset=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/04\/09030749\/EXT_031918_Hunger-Tracker.pngeee.webp 400w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/04\/09030749\/EXT_031918_Hunger-Tracker.pngeee-170x300.webp 170w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/04\/09030749\/EXT_031918_Hunger-Tracker.pngeee-85x150.webp 85w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/04\/09030749\/EXT_031918_Hunger-Tracker.pngeee-200x353.webp 200w\" sizes=\"auto, (max-width: 170px) 100vw, 170px\" \/><figcaption id=\"caption-attachment-15236\" class=\"wp-caption-text\">The app helps women stay aware of their hunger \u2013 an important part of managing their diet.<\/figcaption><\/figure>\n<p>\u201cIt can be a big challenge to find time for exercise,\u201d she said, especially for women who might already feel guilty about going back to work. \u201cBut we want women to know it\u2019s okay to take time for getting help to make sure you\u2019re staying healthy in the future, so you can be there for your family.\u201d<\/p>\n<p>Hovey believes the app could play an important role in encouraging that thinking. \u201cIt is often the case that &#8216;Mom&#8217; is the chief operations and medical officer for the family,\u201d he said.\u00a0\u201cHelping her establish personal healthy habits naturally rubs off on the family. Helping mom is a strategic and cost-effective way to help establish a family&#8217;s lifelong healthy lifestyle.\u201d<\/p>\n<p><strong>Electronic helping hands<\/strong><\/p>\n<p>The Fit after Baby study is a companion of sorts to the <a href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT02744300\">BABI2 (Balance after Baby Intervention for Women with Recent Gestational Diabetes) study<\/a>, in which Nicklas is collaborating with Ellen Seely, MD, of Brigham and Women\u2019s Hospital in Boston. That study aims to help post-partum women lose weight to decrease their risk of Type 2 diabetes. Women also have access to a \u201clifestyle coach,\u201d but they get additional information and resources from a website rather than through an app.<\/p>\n<p>That study follows a 2012 pilot trial of the concept that Nicklas participated in with Seely as a fellow at Harvard Medical School. The two were co-authors of a 2014 <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4401073\/\"><em>Obstetrics &amp; Gynecology <\/em>article<\/a> detailing the findings of the pilot, which concluded that a \u201cweb-based lifestyle modification program\u201d decreased weight retention in women recently diagnosed with gestational diabetes.<\/p>\n<p>Pushing similar information to women through a mobile device app seemed the next logical step for Nicklas. But the most important measure of success will be how it serves patients. Three years ago, there were an estimated <a href=\"https:\/\/www.imedicalapps.com\/2015\/09\/ims-health-apps-report\/\">165,000 mobile health apps available for download, but only about 1 in 10 accounted for 90 percent of the downloads<\/a>. Two years later, <a href=\"https:\/\/research2guidance.com\/325000-mobile-health-apps-available-in-2017\/\">the number of apps doubled<\/a>, but the question of how many can demonstrate value to patients has yet to be answered.<\/p>\n<figure id=\"attachment_15237\" aria-describedby=\"caption-attachment-15237\" style=\"width: 170px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-15237 size-medium\" src=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/04\/09030927\/EXT_031918_Women-Like-Me.pngeee.webp\" alt=\"Picture shows content on Women Like Me screen.\" width=\"170\" height=\"300\" srcset=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/04\/09030927\/EXT_031918_Women-Like-Me.pngeee.webp 400w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/04\/09030927\/EXT_031918_Women-Like-Me.pngeee-170x300.webp 170w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/04\/09030927\/EXT_031918_Women-Like-Me.pngeee-85x150.webp 85w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/04\/09030927\/EXT_031918_Women-Like-Me.pngeee-200x353.webp 200w\" sizes=\"auto, (max-width: 170px) 100vw, 170px\" \/><figcaption id=\"caption-attachment-15237\" class=\"wp-caption-text\">Content about prenatal and post-partum risk factors arrive to women\u2019s phones via the app.<\/figcaption><\/figure>\n<p>For that reason, Nicklas said she and her colleagues will rely heavily on feedback from the Fit after Baby study participants. \u201cThey will be helping us to figure what will help women,\u201d she said.<\/p>\n<p>Katie Lohmiller, who is currently finishing up her doctorate in public health, is glad to see the pilot study she joined continuing as a larger trial. She said that by the kids\u2019 first birthday, she had returned to her pre-pregnancy weight \u2013 and she gives the smartphone technology a bit of credit for that.<\/p>\n<p>\u201cI have missed having the app lately. You go through times when you\u2019re really doing great and others where you really need to figure out, \u2018Have I eaten a vegetable in a week?\u2019,\u201d she said. \u201cI appreciated that it got me off to a really good start after having [the babies]. I think I didn\u2019t feel like a year or two later I\u2019m still working on losing weight after kids or getting back to being active. It made me feel like that this is what you are able to do and are supposed to do, so you need to get on it.\u201d<\/p>\n<p><em>The Fit after Baby study is now recruiting. For more information, contact Danielle Cook at <\/em><a href=\"mailto:303-724-8998\/Danielle.Cook@ucdenver.edu\"><em>303-724-8998\/Danielle.Cook@ucdenver.edu<\/em><\/a><em> or Jacinda Nicklas <\/em><a href=\"mailto:Jacinda.Nicklas@ucdenver.edu\"><em>Jacinda.Nicklas@ucdenver.edu<\/em><\/a><em>. <\/em><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u00a0 A little more than two years ago, Katie Lohmiller and her husband, Jason, got an early Christmas present: a baby girl and boy, Marley and Tate, who arrived on Christmas Eve, 2015 at UCHealth University of Colorado Hospital. The babies were healthy and so was Katie, but the birth delivered a nagging worry many [&hellip;]<\/p>\n","protected":false},"author":2143,"featured_media":15233,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[2635,3273,309,212],"class_list":["post-15231","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","tag-diabetes-management","tag-innovative-medical-technologies","tag-pregnancy","tag-womens-care"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.4 (Yoast SEO v27.4) - 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