Abstract P644: Engagement With a Weight Loss Program for Postpartum Individuals at Elevated Cardiovascular Risk: A Qualitative Study

Background: Rising rates of postpartum obesity increase risk for cardiovascular (CV) disease, especially among individuals with adverse pregnancy outcomes. Engagement in weight loss programs (WLP) have not been well studied in the postpartum period. Our objective was to understand barriers to engagement in an online behavioral WLP among a racially diverse postpartum population with CV risk factors. Methods: We conducted a qualitative study of participants enrolled in a clinical trial. We identified individuals who were 3-12 months postpartum, had a body mass index ≥ 27 kg/m2, and had ≥1 of the following: chronic hypertension, hypertensive disorder of pregnancy, gestational or pre-gestational diabetes. We randomized 60 subjects 1:2 to usual care or online WLP based on the Diabetes Prevention Program. We conducted semi-structured virtual interviews with participants in the WLP who completed final assessments to understand barriers to and facilitators of program engagement. Interviews were recorded and transcribed, a codebook was developed iteratively with concurrent interrater reliability assessment, and themes were identified using content analysis. Results: Of 26 eligible participants, 20 completed interviews (77%). Mean age was 35 years and 45% were Black. Common barriers to program engagement were a lack of time due to competing life priorities and stressors, coupled with insufficient program personalization and peer support (see Table). In terms of facilitators, participants discussed intentionality, creating a routine to complete program requirements (e.g., daily morning weights) and specific aspects of the program structure (e.g., weekly feedback) as playing important roles in maximizing program engagement. Conclusion: Participants identified several opportunities to improve program engagement and weight loss success among postpartum individuals in future studies. These strategies will be critical to the implementation of future lifestyle interventions using remote technology in this population.