Background Poor lifestyle, including suboptimal diet, physical inactivity, and tobacco use are leading causes of preventable diseases globally. Although even modest population shifts in risk substantially alter health outcomes, the optimal population-level approaches to improve lifestyle are not well established. Methods and Results For this American Heart Association Scientific Statement, the writing group systematically reviewed and graded the current scientific evidence for effective population approaches to improve dietary habits, increase physical activity, and reduce tobacco use. Strategies were considered in 6 broad domains: (1) media and education campaigns; (2) labeling and consumer information; (3) taxation, subsidies, and other economic incentives; (4) school and workplace approaches; (5) local environmental changes; and (6) direct restrictions and mandates. The writing group also reviewed the potential contributions of healthcare systems and surveillance systems to behavior change efforts. Several specific population interventions that achieved a Class I or IIa recommendation with grade A or B evidence were identified, providing a set of specific evidence-based strategies that deserve close attention and prioritization for wider implementation. Effective interventions included specific approaches in all 6 domains evaluated for improving diet, increasing activity, and reducing tobacco use. The writing group also identified several specific interventions in each of these domains for which current evidence was less robust, as well as other inconsistencies and evidence gaps, informing the need for further rigorous and interdisciplinary approaches to evaluate population programs and policies. Conclusions This systematic review identified and graded the evidence for a range of population-based strategies to promote lifestyle change. The findings provide a framework for policy makers, advocacy groups, researchers, clinicians, communities, and other stakeholders to understand and implement the most effective approaches. New strategic initiatives and partnerships are needed to translate this evidence into action.

INTRODUCTIONIn the United States, the greatest increase in the incidence of obesity in women occurs during the childbearing years; consequently, ~ 45% of women enter pregnancy with excess body fat (1,2). The hazards of being an obese pregnant woman impact both the mother and child by increasing the risk of future obesity, diabetes, and cardiovascular disease (3). Furthermore, women with pregravid obesity retain more weight in the postpartum period creating a vicious cycle before the next pregnancy (4,5).Women of low socioeconomic status (SES) represent a high-risk group that can be targeted for weight management. Compared to women with average SES, women with low SES are less attentive about body weight, more tolerant of weight gain, and engage in fewer healthy weight-control practices (6). Accordingly, we chose participants in the Special, Supplemental Nutrition Program for Women, Infants, and Children (WIC) for this pilot project. The Mother's Overweight Management Study (MOMS) was a multidisciplinary, weightmanagement project developed to address the problem of weight retention in the postpartum period. Because the project shares challenges faced by those providing WIC nutrition education and interventions for weight management in postpartum women, the project and evaluation will be described followed by lessons learned that are applicable to many nutrition audiences.© 2010 Society for Nutrition Education. Published by Elsevier Inc. All rights reserved. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. women were randomized to control (self-guided) or intervention (peer-guided group) by a random number process. The self-guided group had one counseling session with a MOMS dietitian and received monthly newsletters. Thereafter, for the year, they were left to manage their weight on their own. The peer group also received the newsletters and counseling session. In addition, they were enrolled in a facilitated discussion group (10 sessions) and received monthly personalized feedback on self-monitoring records for nutrition and physical activity behaviors. NIH Public Access Participants and RecruitmentThe study was approved by the West Virginia University, School of Medicine Institutional Review Board. Informed consent was completed by each subject as the first step in the enrollment process. Passive (WIC bulletin board, newspaper/cable/radio ads, flyers at local businesses, church bulletins, mailings), and active recruiting methods (physicians, WIC staff [breast-feeding counselors, nutritionists], and MOMs staff [education classes, clinic days in waiting rooms] were used. Th...

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Women's Cardiovascular Health Network members representing 10 Prevention Research Centers completed a literature review of approximately 65 population-based studies focused on improving women's cardiovascular health through behavior change for tobacco use, physical inactivity, or diet. A framework was developed for conducting the search. Databases (Medline, Psychlit, Smoking and Health, Cumulative Index to Nursing and Allied Health Literature) of studies published from 1980 to 1998 were searched. The review was presented at a meeting of experts held in Atlanta, Georgia. Output from the meeting included identification of what has worked to improve cardiovascular health in women and recommendations for future behavioral research. Additional information is available at www.hsc.wvu.edu/womens-cvh. Cardiovascular health interventions geared toward women are scant. Based on the available studies, program components that emerged as effective included personalized advice on diet and physical activity behaviors and tobacco cessation, multiple staff contacts with skill building, daily self-monitoring, and combinations of strategies. Recommendations for community-based tobacco, physical activity, and diet interventions are discussed. A few overarching recommendations were to (1) conduct qualitative research to determine the kinds of interventions women want, (2) examine relapse prevention, motivation, and maintenance of behavior change, (3) tailor programs to the stage of the life cycle, a woman's readiness to change, and subgroups, that is, minority, low socioeconomic, and obese women, and (4) evaluate policy and environmental interventions. The effects of cardiovascular interventions in women have been inappropriately understudied in women. Our review found that few studies on cardiovascular risk factor modification have actually targeted women. Hence, adoption and maintenance of behavior change in women are elusive. Intervention research to improve women's cardiovascular health is sorely needed.

These data emphasize the need for stress management and other tools such as increasing activity levels to prevent or lessen depressive symptoms.