Using the ORBIT Model to Design an Intervention Promoting Healthy Weight Gain During Pregnancy: the Value of an Iterativ
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COMMENTARY
Using the ORBIT Model to Design an Intervention Promoting Healthy Weight Gain During Pregnancy: the Value of an Iterative and Incremental Approach to Intervention Development Susan M. Czajkowski 1
# International Society of Behavioral Medicine 2019
“Take a method and try it. If it fails, admit it frankly, and try another. But by all means, try something.”—Franklin D. Roosevelt
Introduction As behavioral scientists attempting to design behavior change interventions that can prevent or mitigate chronic diseases, we often confront problems that seem to defy our capacity for altering human behavior. Tobacco use, poor diets, sedentary lifestyles, low adherence to life-saving medications—all are behaviors that contribute substantially to the burden of chronic diseases in the USA and worldwide, and all represent continuing challenges that have met with varying degrees of success as we attempt to design effective interventions, especially in medically underserved and high-risk population subgroups. It is tempting to yearn for a “behavioral statin,” a strategy or intervention that can produce dramatic change in these and other behavioral risk factors across a wide variety of contexts and sociodemographic groups. Yet, the key to effectively tackling these complex behavioral problems may lie in our ability to stay the course, to understand the problems deeply and in all their complexity, and to use that knowledge to devise and conduct long-term, incremental, and progressive approaches to behavior change that approach failure as an opportunity to learn and improve and that require equal measures of creativity and patience to succeed.
* Susan M. Czajkowski [email protected] 1
Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, MSC 9761, Room 3E108, Bethesda, MD 20892-9761, USA
Obesity is an example of a highly ubiquitous and challenging public health problem that is known to increase risk for cancers, cardiovascular diseases (CVD), diabetes, and many other chronic health conditions [1, 2]. Over the past several decades, increases in rates of obesity have occurred across the lifespan, in both men and women, and in all sociodemographic groups [3, 4], but are significantly higher in African-American and Latino populations and for those with lower incomes [5]. Excessive weight gain also poses special risks to women during pregnancy, with increased risks of obstetrical and neonatal complications as well as type 2 diabetes and CVD later in life [6–8]. As with obesity in general, these risks are exacerbated for low-income women of color [9], who often face a myriad of stressors in their daily lives, including lack of access to or difficulty affording medical care, poverty, discrimination, violence, lack of available healthy food and affordable housing, and many others. Research has shown that stress is associated in animal and human studies with non-homeostatic eating of high-calorie, unhealthy “comfort” foods, which results in e
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