臺灣博碩士論文加值系統

本研究目的在發展及驗證以重要他人介入生活型態管理方案對孕產婦體重變化的成效，計劃於不同時期（孕期及產後）進行介入措施，以評價此介入措施對降低孕產婦體重留滯之成效。本研究採真實驗性設計（Experimental design），隨機取樣190位第二孕期的孕產婦為研究對象，依措施介入時間點分成對照組、孕期組及產後組三組；對照組接受常規照護，孕期組在第二孕期開始接受方案，產後組在產後坐月子開始接受方案，追蹤時間從第二孕期至產後三個月。
主要研究結果發現接受以重要他人介入生活型態管理方案後：（1）「孕期增加的體重」方面，孕期組顯著低於產後組及對照組（p＜.05）；「產後體重恢復狀態有達統計上顯著差異」方面，孕期組顯著低於產後組及對照組（p＜.01）；（2）三組在健康促進生活型態，健康控制信念及健康行為自我效能達顯著差異（p＜.01）；（3）「身體心像態度」方面孕期組顯著比產後組及對照組正向（p＜.01）；「社會支持程度」方面孕期組顯著高於產後組（p＜.01）；（4）社會支持與重要他人支持認知層面及健康促進生活型態達統計上顯著正相關（p＜.01），社會支持得分與孕期增加的體重達統計上顯著負相關（P＜.01）；（5）三組在憂鬱程度及健康促進行為的影響因素並未達顯著差異（p＞.05）。
本研究結果呈現出重要他人介入生活型態管理方案對孕產婦體重控制是及健康促進生活型態有成效的，可作為推動孕產婦體重控制之護理教學及臨床實務的參考，以提昇孕產婦健康促進生活型態。

This study aimed to develop and evaluation the life style management by significant others approach to pregnant and postpartum women’s weight change effect. The project was implemented in different periods of pregnancy (prenatal and postnatal) and its effect on expectant mothers’ weight control was observed at the same time. This study adopted experimental design and randomly sampled 190 expectant mothers in the second period of pregnancy as its subjects. According to the timing of intervention, the subjects were categorized into three groups: contrast group, prenatal group, and postnatal group. The contrast received standard care; instead, the prenatal and postnatal groups received the intervention project respectively in the second period of pregnancy and in the postnatal recuperation. Observation started from the second period of pregnancy to the third month after delivery.
The major findings of this study revealed with the significant others approach about women’s lifestyle management are : (1)In “weight gaining in pregnancy” the prenatal group is significance much lower than groups of postnatal group and contrast group (p<.05); In “postnatal weight retain situation achieve significance different in statistics” the prenatal group is much lower than the other groups clearly(p<.01); (2)the three groups showed statistical significance in the degree of healthy promotion lifestyle, health self-effected and health control believes (p<.01); (3)In “body image attitude” the prenatal group is much more satisfied than the other groups(p<.01); In “social support degree” the prenatal group significance much higher than the postnatal group(p<.01). (4)social support, intimate support, cognition, and healthy lifestyle showed positive correlation (p<.01); social support and weight gaining in pregnancy showed negative correlation (p<.01);(5) For all of these three groups, they showed no significance different effect elements at depression degrees and health attitudes (p>.05).
This study significantly verified the effect of intimate intervention on expectant mothers’ weight control, which could serve as reference for future nursing education and clinical experiments in the hope that the health of expect mothers could be improved

目 錄
指導教授推薦
口試委員會審定
博碩士論文授權書 iii
長庚大學博碩士指本論文授權書 iv
致謝 v
中文摘要 vi
英文摘要 vii
目錄 ix
表目錄 xii
圖目錄 xiv
第一章 緒論 1
1.1 研究重要性 1
1.2 研究動機 4
1.3 研究目的 6
1.4 研究假設 7
1.5 名詞解釋 8
第二章 文獻查證 10
2.1 肥胖相關議題 10
2.2 孕產婦女懷孕前至產後體重變化的相關議題 15
2.3 體重控制策略相關議題 18
2.4 健康促進生活型態及其相關研究 52
第三章 研究方法 57
3.1 研究設計 57
3.2 研究架構 59
3.3 研究場所及研究對象 61
3.4 資料蒐集過程 62
3.5 研究工具及信效度 77
3.6 資料分析 82
第四章 研究結果 84
4.1 描述性資料 84
4.2 生活型態管理方案介入措施之成效 100
第五章 研究討論 151
5.1 介入措施對孕產婦體重狀態的影響 151
5.2 介入措施對健康促進生活型態的影響 155
5.3 介入措施對身體心像態度的影響 157
5.4 介入措施對憂鬱的影響 159
5.5 介入措施對社會支持的影響 160
5.6 介入措施對健康促進行為影響因素及健康控制的影響 163
5.7 介入措施對健康行為自我效能的影響 165
第六章 結論與建議 167
6.1 研究結論 167
6.2 研究建議 170
6.3 研究限制 173
參考資料 175
附錄一 產後婦女體重變化、體重管理需求訪談指引 195
附錄二 接受訪談者基本人口學及理學資料 196
附錄三 健康促進生活型態量表 197
附錄四 身體心像態度量表 199
附錄五 貝氏憂鬱量表 200
附錄六 社會支持量表 201
附錄七 健康促進行為的影響因素問卷 202
附錄八 健康控制歸因量表 203
附錄九 健康行為自我效能量表 204
表 目 錄
表2-1-1 腰臀比標準表 12
表2-1-2 衛生署2002年制定的成人肥胖定義 13
表2-3-1 最大心跳率計算方法及運動時心跳率測量方法 22
表2-3-2 生活型態改變計劃的組成 29
表2-3-3 產後運動心跳率的原則 32
表2-3-4 國內外體重控制措施之相關研究 47
表3-1-1 研究設計：三組前後測設計 58
表3-4-1 資料蒐集流程說明 66
表3-4-2 身體質量指數〈BMI〉與成人肥胖定義之關係 68
表3-4-3 國人膳食營養素參考攝取量〈女性〉 69
表3-4-4 食物建議份量表 70
表3-4-5 卡路里換算表〈每一份〉 70
表3-4-6 最大心跳率計算方法及運動時心跳率測量方法 72
表3-4-7 運動內容 73
表3-4-8 方案手冊執行狀況評分表 76
表4-1-1 三組研究對象之社會人口學特性之比較 87
表4-1-2 三組研究對象懷孕前體重狀態之比較 88
表4-1-3 三組健康促進生活型態量表及次量表前測分析之比較 90
表4-1-4 三組身體心像態度量表前測分析之比較 91
表4-1-5 身體心像態度量表項目前測分析之比較 91
表4-1-6 三組貝氏憂鬱量表前測分析之比較 92
表4-1-7 三組貝氏憂鬱量表分析之比較 93
表4-1-8 三組社會支持量表前測分析之比較 94
表4-1-9 三組健康促進行為影響因素量表前測分析之比較 95
表4-1-10 三組多面向健康控制量表前測分析之比較 96
表4-1-11 三組健康行為自我效能量表前測分析之比較 97
表4-1-12 研究依變項與孕前體重值之皮爾森積差（r）相關矩陣 99
表4-2-1 三組健康促進生活型態量表後測之比較 102
表4-2-2 三組身體心像態度量表後測之比較 103
表4-2-3 三組貝氏憂鬱量表後測之比較 104
表4-2-4 三組社會支持量表後測之比較 105
表4-2-5 三組健康促進行為影響因素後測之比較 106
表4-2-6 三組多面向健康控制量後測之比較 107
表4-2-7 三組健康行為自我效能量表後測之比較 109
表4-2-8 三組懷孕時體重增加及產後三個月體重恢復狀態之比較 111
表4-2-9 三組孕產婦懷孕前及產後三個月體重變化之比較 111
表4-2-10 三組健康促進生活型態量表分析之比較 115
表4-2-11 三組健康促進生活型態運動次量表單項分析之比較 116
表4-2-12 三組健康促進生活型態營養次量表單項分析之比較 117
表4-2-13 三組身體心像態度量表分析之比較 122
表4-2-14 三組貝氏憂鬱量表分析之比較 123
表4-2-15 三組社會支持量表分析之比較 126
表4-2-16 三組健康促進行為的影響因素量表分析之比較 130
表4-2-17 三組多面向健康控制量表分析之比較 133
表4-2-18 三組健康行為自我效能量表分析之比較 136
表4-2-19 孕產婦生活型態管理方案認知、技能及態度層面之比較 144
表4-2-20 介入措施認知、技能及態度評值之皮爾森積差（r）相關矩陣 148
圖 目 錄
圖2-4-1 健康促進模式 56
圖3-2-1 研究架構圖 60
圖3-4-1 資料蒐集流程 65
圖4-2-1 三組孕產婦在不同時間體重之變化曲線圖 112
圖4-2-2 三組健康促進生活型態前後測之變化曲線圖 118
圖4-2-3 三組健康促進生活型態之自我實現前後測之變化曲線圖 118
圖4-2-4 三組健康促進生活型態之健康責任前後測之變化曲線圖 119
圖4-2-5 三組健康促進生活型態之運動前後測之變化曲線圖 119
圖4-2-6 三組健康促進生活型態之營養前後測之變化曲線圖 120
圖4-2-7 三組健康促進生活型態之人際支持前後測之變化曲線圖 120
圖4-2-8 三組健康促進生活型態之壓力處理前後測之變化曲線圖 121
圖4-2-9 三組身體心像態度前後測之變化曲線圖 122
圖4-2-10 三組憂鬱程度前後測之變化曲線圖 124
圖4-2-11 三組社會支持前後測之變化曲線圖 126
圖4-2-12 三組社會支持之實質性幫助前後測之變化曲線圖 127
圖4-2-13 三組社會支持之評價前後測之變化曲線圖 127
圖4-2-14 三組社會支持之自尊前後測之變化曲線圖 128
圖4-2-15 三組社會支持之歸屬感前後測之變化曲線圖 128
圖4-2-16 三組健康促進行為的影響因素前後測之變化曲線圖 130
圖4-2-17 三組健康促進行為的影響因素之自覺行為利益前後測之變化曲線圖 131
圖4-2-18 三組健康促進行為的影響因素之自覺行為障礙前後測之變化曲線圖 131
圖4-2-19 三組健康促進行為的影響因素之情境影響行為程度前後測之變化曲線圖 132
圖4-2-20 三組孕產婦前後測多面向健康控制量表平均數之變化曲線圖 134
圖4-2-21 三組孕產婦前後測內控型平均數之變化曲線圖 134
圖4-2-22 三組孕產婦前後測外在社會型平均數之變化曲線圖 135
圖4-2-23 三組健康行為自我效能前後測之變化曲線圖 137
圖4-2-24 三組健康行為自我效能之營養前後測之變化曲線圖 137
圖4-2-25 三組健康行為自我效能之心理安適前後測之變化曲線圖 138
圖4-2-26 三組健康行為自我效能之運動前後測之變化曲線圖 138
圖4-2-27 三組健康行為自我效能之健康責任前後測之變化曲線圖 139
圖4-2-28 孕期組及產後組執行飲食介入措施之認知層面之比較曲線圖 145
圖4-2-29 孕期組及產後組執行運動介入措施之認知層面之比較曲線圖 145
圖4-2-30 孕期組及產後組執行重要他人支持介入措施之認知層面之比較曲線圖 145
圖4-2-31 孕期組及產後組執行飲食介入措施之技能層面之比較曲線圖 146
圖4-2-32 孕期組及產後組執行運動介入措施之技能層面之比較曲線圖 146
圖4-2-33 孕期組及產後組執行重要他人支持介入措施之技能層面之較曲線圖 146
圖4-2-34 孕期組及產後組執行飲食介入措施之態度層面之比較曲線圖 147
圖4-2-35 孕期組及產後組執行運動介入措施之態度層面之比較曲線圖 147
圖4-2-36 孕期組及產後組執行重要他人支持介入措施之態度層面之比較曲線圖 147

參考資料
中文部份
方進隆（1992）‧規律運動與健康促進和疾病預防‧中華體育，5（4），1-7。
王潔雯（2000）‧我國國中補校教科書現代家庭科家庭概念之內容分析•未發表的碩士論文，台北：台灣師範大學。
王淑諒（2002）‧坐月子期間產婦之健康促進生活方式極其影響因素之探討‧未發表之碩士論文，台北：台北醫學大學。
王秀紅、王瑞霞、邱啟潤、李建廷（1992）‧婦女健康促進行為及其相關因素的探討﹘以高雄市三民區及屏東區高樹鄉居民為例‧公共衛生19（3），251-265。
行政院衛生署（1991）‧國民營養指導手冊‧台北：行政院衛生署。
行政院衛生署（1999）‧中華民國87年衛生統計‧台北：行政院衛生署。
江奇霙（2002）‧家庭支持對慢性病患遵醫囑行為的影響•未發表的碩士論文，台北：臺北醫學大學。
呂宏淵（2003）‧運動對懷孕期婦女的影響‧國民體育季刊，32（1），26-30。
吳慧嫻（1996）‧台北縣國中肥胖盛行率調查、體重控制相關研究•未發表的碩士論文，台北：陽明大學。
吳寧遠（1997）．由家庭支持談老人福利﹘以高雄市為例．社會建設，96，62-79。
李慧鶯（1996）‧國小學童體重控制介入計畫對肥胖指標及其相關因素之影響•未發表的碩士論文，台中：中山醫學院。
林月美、朱志良、洪清霖、黃伯超（1985）‧臺灣地區學齡青少年營養狀態評估，第一報：身高與體重‧中華營誌，10，91-105。
林正介、賴明美、劉秋松、李采捐（1998）‧台中市學童肥胖盛行率之分析：不同篩選指標‧中華營誌，8（3），134-142。
林盈慧、陳彰惠（1999）‧坐月子習俗與產婦的健康維護‧台灣醫學，3（6），728-732。
林瑞興（2002）‧運動訓練及飲食教育計畫介入對體重過重大學生的效果探討‧未發表的碩士論文，台北：台灣師範大學。
林秀娟（2004）‧縱貫性研究：孕產婦憂鬱之影響因素探討‧未發表之碩士論文，桃園：長庚大學。
孟儀華（2002）•「運動─飲食行為控制策略」對肥胖智障學生減重成效之研究•未發表的碩士論文，台北：臺灣師範大學。
徐禎美（2003）‧第三孕期婦女的壓力、社會支持與憂鬱‧未發表的碩士論文，高雄：高雄醫學大學。
高美丁、曾明淑、葉文婷、張瑛韶、潘文涵（1998）‧台灣地區居民體位及肥胖狀況‧國民營養現況 1993-1996 國民營養健康狀況變遷調查結果。pp. 143-171行政院衛生署。
洪偉欽（1995）孕婦運動經驗與分娩過程之相關研究•未發表的碩士論文，台北：台灣師範大學。
洪志秀（2001）•婦女在不同坐月子地點和時段之產後壓力及社會支持程度•公共衛生，28（3），241-253。
洪志秀、張素鳳、金繼春（1993）•產褥期婦女之壓力與其相關因素•公共衛生，20（1），29-45。
洪麗玲（1997）‧衛生教育介入對護專學生健康促進生活方式成效之研究‧未發表的碩士論文，桃園：私立長庚大學。
翁幸宜（1995）•中國傳統習俗、孕婦心理壓力與母子健康之前驅研究•未發表的碩士論文，台北：臺灣師範大學。
翁玲玲（1994）•麻油雞之外—婦女做月子的種種情事•台北：稻鄉出版社。
陳其南（1985）•房與傳統中國家族制度-兼論西方人類社會學的中國家族研究•漢學研究，1（3），127-184。
陳麗鳳（1994）‧肥胖兒童體重控制成效探討‧未發表的碩士論文，台北：陽明大學。
陳彰惠、劉瓊宇（1995）•中國文化和產後憂鬱症•護理雜誌，42（1），91-94。
陳麗麗、王純娟（2000）•產婦對於傳統醫療中有關產後調理的態度及行為研究•護理研究，8（1），49-57。
陳麗麗（1998）•影響產婦對於傳統醫療中產後調理態度及行為因素之探討•中國醫藥學院研究計劃CMC85079。
郭素珍（1994）•有早產現象產婦周期內家庭功能的改變•護理研究，2（2），106-115。
郭清輝（2000）•肥胖症•臨床醫學，46（3），200-204。
許淳森（1992）•實用產科學•台北：九州。
張水秀（2001）•社區成人體重控制班之成效分析•未發表的碩士論文，彰化：大葉大學。
黃伯欣（2002）•不同體重控制課程對肥胖婦女減重成效及相關因素之探討•未發表的碩士論文，台北：輔仁大學。
黃文峰（1991）•台灣（台南）地區生育禮俗之探討•未發表的碩士論文，台北：文化大學。
蔡錦雀（1996）•產後婦女與運動•國民體育季刊，25（3），54-59。
蔡沛婕（2000）•初為人媳角色轉換經驗之探討•未發表的碩士論文，嘉義：嘉義大學。
劉翠娟（1999）•社區肥胖婦女長期體重控制影響因子之探討•未發表的碩士論文，台北：輔仁大學。
劉倖吟（2001）•青春期體重過重女生體重控制介入措施之成效探討•未發表的碩士論文，台北：台北護理學院。
潘惠晴、朱佩玲、林淑娟、張翠樺、李幼華（1993）•中國傳統習俗對孕產婦健康維護行為之影響•榮總護理，10（3），247-251。
賴翠琪（2000）•台北縣某國中肥胖學生體重控制行為意向及其相關因素之研究•未發表的碩士論文，台北：臺灣師範大學。
顏兆熊、沈德昌（2002）•肥胖的治療•台灣醫界，45(12)，29-33。
簡凰珍（2000）•產後韻律的研發與介入成效之初探•未發表的碩士論文，台北：台北護理學院。
盧瓊枝（2000）‧自助團體與飲食運動知識的介入對大學生體重改變與成效維持之影響‧未發表之碩士論文，嘉義：國立中正大學。
戴芳台（2003）•產後婦女體重變化和健康促進生活型態之相關因素探討•未發表的碩士論文，桃園：長庚大學。
羅巧珍（2004）‧懷孕到產後飲食營養與體重變化之前瞻性研究‧未發表的碩士論文，台北：國立臺灣師範大學。
鍾寶玲（2001）‧老年糖尿病患健康促進生活型態及相關因素之探討‧未發表的碩士論文，高雄：高雄醫學大學。
英文部份
Abi-Said, D., Annegers, J. E., Combs-Cantrell, D., Frankowski, R. F., ＆ Willmore, L. J. (1995). Case-control study of the risk factors for eclampsia. American Journal of Epidemiology, 142, 437-441.
Achat, H., Kawachi, I., ＆ Levine, S. (1998). Social network, stress and health-related quality of life, Quality Life Research, 7, 735-750.
Agras, W. S., Berkowitz, R. I., Arnow, B. A., Telch, C. F., Marnell, M., Henderson, J., Morris, Y., & Wilfley, D. E. (1996). Maintenance Following a Very-Low-Calorie Diet. Journal of Consulting and Clinical Psychology, 64(3), 610-613.
Allen, J. K. (1996). Coronary risk factors modification in women after coronary artery bypass surgery. Nursing Research, 45(5), 260-265.
Biddle, S. J., ＆ Fox, K. R. (1998). Motivation for physical activity and weight management. International Journal Obesity Relation Metab Discord 22, S37-S39.
Black, D. R., Gleser, L. J., & Jooyers, K. J. (1990). A meta-analytic evaluation of couples weight loss programs. Health Psychologist, 9(3), 330-347.
Boutelle, K. N., ＆ Kirschenbaum, D. S. (1998). Further support for consistent self-Monitoring as a vital component of successful weight control. Obesity Research 6, 219-224.
Brown, P. J. (1993). Cultural perspectives on the etiology and treatment of obesity. In : A. J. Stunkard & T. A. Wadden (Eds.), Obesity, theory, and therapy, (2nd ed.). New York: Raven Press.
Brownell, K. D. (1998). The LEARN Program for Weight Control. (7th ed.). Dallas, TX : American Health Publishing Company.
Brownell, K. D. (1999). The central role of lifestyle change in long-term weight management. Clinical Cornerstone, 2(3), 43-51.
Cachelin, F. M., Striegel-Moore, R. H., Brownell, K. D. (1998). Beliefs about weight gain and attitudes toward relapse in a sample of women and men with obesity. Obesity Research 6, 231-237.
Callaghan, P. (1998). Social support and locus of control as correlates of UK nurses’ health-related behaviors. Journal of Advanced Nursing Research, 28(5), 1127-1133.
Cogswell, M. E., Serdula, M. K., Hungerford, D. W., ＆ Yip, R. (1995). Gestational weight gain among average-weight and overweight women : What is excessive? American Journal of Obstetrics and Gynecology, 172, 705-712.
Cohen, S., ＆ Syme S. L. (1985). Social Support and Health (pp. 310-357).Orlando: Academic press.
Dallow, C. B., ＆ Anderson. J. (2003). Using self-efficacy and a transtheoretical model to develop a physical activity intervention for obese women. American Journal of Health Promotion, 17(6), 373-381.
Deurenberg, p., Weststrate, J. A. ＆ Seidell, J. C. (1991). Body mass index as a measure of body fatness: Age and sex-specific prediction formulas. British Journal of Nutrition, 65, 105-114.
Dietz, W. H., ＆ Robinson, T. N. (1998). Use of the body mass index as a measure of overweight in children and adolescents. The Journal of Pediatrics, 132, 191-193.
Donna, C. (1998). Evaluation of two nondieting interventions for obese women. Western Journal of Nursing Research, 20(1), 119-133.
Dornelas, E. A., Wylie-Rosett, J., ＆ Swencionis, C. (1998). The DIET study : Long-term outcome of a cognitive-behavioral weight-control intervention in independent-living elders. Journal American Diet Association, 98, 1276-1281.
Duffy, M. E., Rossow, R., & Hernandez, M. (1996). Correlates of health- promotion activities in employed Mexican American women. Nursing Research, 45(1), 18-25.
Edwards, L. E., Hwellerstedt, W., Alton, I. R., Story, M., ＆Himes, J. H. (1996). Pregnancy complications and birth outcomes in obese and normal-weight women: Effects of gestational weight change. Obstetrics＆Gynecology, 87, 389-394.
Faith, M. S., Fontaine, K. P., Cheskin, L. J., ＆ Allison, D. B. (2000). Behavioral approaches to the problems of obesity. Behavior Modification, 24(4), 459-493.
Foryet, J. P. & Goodrick. G. K. (1993). Evidence for success of behavior modification in weight loss and control. Annals of Internal Medicine, 119, 698-701.
Foryet, J. P. & Goodrick. G. K. (1994). Attributes of successful approaches to weight loss and control. Applied Preventive Psychology,3, 209-215.
Foreyt J. P. ＆ Carlos Poston II W.S. (1998). The role of the behavioral counselor in obesity treatment. Journal of the American Dietetic Association. 98(10): Supply 2: S27-30, S63-4, S62.
Furnam, A. & Alibahai, N. (1983). Cross-cultural differences in the perception of female body shapes. Psychological Medicine, 13, 829-837.
Galtier-Dereure, F., Montpeyroux, F., Boulot, P., Bringer, J., ＆Jaffiol, C. (1995). Weight excess before pregnancy: Complications and cost. International, Journal of Obesity, 19, 443-448.
Gans, K. M., Assmann, S. F., Sallar, A., ＆ Laster, T. M. (1999). Knowledge of cardiovascular disease prevention: an analysis from two New England communities. Preventive Medicine 29(4): 229-237.
Gillis, A. J. (1993). Determinants of health-promoting lifestyle: An integrative review. Journal of Advanced Nursing, 18, 345-353.
Gillis, A. J. (1994). Determinants of health-promoting lifestyle in adolescent females. Canadian Journal of Nursing Research, 26(2), 13-28.
Goldstein, D. J. (1992). Beneficial health effects of modest weight loss. International Journal Obesity, 16, 397-415.
Gunderson, E. P., Abrams, B., ＆ Selvin, S. (2001). Does the pattern of postpartum weight change differ according to pregravid body size?. International Journal of Obesity, 25, 853-862.
Gutin, B., Cucuzzo, N. Islam, S., Smith, C. & Stachura, M. (1996). Physical training, lifestyle education, and coronary risk factor in obese girls. Medicine and Science in Sports and Exercise, 28(1), 19-23.
Harvey-Berno, J. (1998). The Efficacy of Dietary Fat vs. Total energy restriction for weight loss. Obesity Research, 6, 202-207.
Hood, D. D., ＆ Dewan, D. D. (1993). Anesthesia and obstetric outcome in morbidly obese parturient. Anesthesiology, 79, 1210-1218.
Hyman, F. N., Sempos, E., ＆ Saltsman, J. (1993).Evidence for success caloric striation in weight loss and control. Ann of International Medicine, 119(7), 681-687.
Isaacs, J. D., Magann, E. F., Martin, R. W., Chauhan, S. P., ＆Morrison, J. C. (1994). Obstetric challenges of massive obesity complicating pregnancy. Journal of Gerontology, ⅩⅣ, 10-14.
Jeffery,R.W., French,S.A.（1999）.Preventing weight gain in adults: the Pound of Prevention study. American Journal of Public Health, 89(5), 747-751.
Jirowong, S., Dunt, D., ＆ Goldsworthy, D. (1999). Social support and antenatal clinic attendance among Thai pregnant women in Hatyai, a city in southern Thailand. Journal of Advanced Nursing, 29(2), 395-406.
Jung, R. T. (1997). Obesity as a disease. British Medical Bulletin, 53, 307-321.
Kaplan, B. H., Cassel, J. C., & Gore, S. (1977). Social support and health. Medical Care, 25, 47-58.
Katz, D. L., Chan, W., Maura Gonzale, M., Larson, D., Nawaz, H., Abdulrahman, M., ＆ Yeh, M. (2002). Technical Skills for Weight Loss: Preliminary Data from a Randomized Trial. Preventive Medicine, 34, 608-615.
Kayman, S., Bruvold, W., & Stern, J. S. (1990). Maintenance and relapse after weight loss in women: behavioral aspects. American Journal of Clinical Nutrition, 52, 800-807.
Keller, C., Oveland, D., & Hudson, S. (1997). Strategies for weight control success in adults. Nurse Practitioner, 22(3), 33, 37-38.
Kieffer, E. C., Willis, S. K., Arellano, O., ＆ Guzman, R. (2002). Perspectives of pregnant and postpartum Latino Women on diabetes, physical activity, and health. Health Education ＆Behavior, 29(5), 542-556.
Klem, M. L., Wing, R. R., Simkin-Silverman, L., ＆ Kuller, L. H.（1997） The psychological consequences of weight gain prevention in healthy, premenopausal women. International Journal of Eating Disorder, 21(2), 167-74.
Kopelman, P. G. (1994). Causes and consequences of obesity. Medicine International, 22, 385-388.
Kuczmarski, R. J., Flegal, K. M., Campbell, S. M., ＆ Johnson, C. L. (1994). Increasing prevalence of overweight among U.S.adult: The National Health and Nutrition Examination Survey, 1960-1990. Journal of the American Medical Association, 272(3), 205-211.
Kumanyika, S. K., Van Horn, L., ＆ Bowen, D. (2000). Maintain acne on dietary behavior change. Health Psychology, 19, 42-56.
Lefebre, L. (1994). Epidemic of childhood obesity may cause major public health problem, doctor warns. Cancer Medicine Association Journal., 150(1), 78-81.
Lovelady, C. A., Lonnerdal, B., ＆ Dewey, K. G. (1990). Lactation Performance of Exercise Women. American Journal of Clinical Nutrition , 52,103-109.
Martens, M. G., Kolrud, B. L., Faro, S., Maccato, M., ＆ Hammill, H. (1995). Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. Journal of Reproductive Medicine, 40, 171-175.
Maynard, C. (1998). How to MA with Your Body. Current Health, 25 (1), 6-11.
McCarran, D. A., ＆ Resusser, M. E. (1996). Body weight and blood pressure regulation. American Journal of Clinical Nutrition, 63, S423-S425.
McCrory, M. A., Nommsen-Rivers, L. A., Mole, P. A., Lonnderdal, B., ＆ Dewey, K. G. (1999). Randomized trial of the short-term effects of dieting compared with dieting plus aerobic exercise on lactation performance. American Journal of Clinical Nutrition, 69(5), 959-967.
Miller, P. M. (1996). Redefine success in eating disorders. Addict Behav, 21(6), 745-754.
Morin, K. H. (1995). Obese and non-obese postpartum women: Complications, body image and perception of the intrapartal experience. Applied Nursing Research, 8, 81-87.
Morin, K. H. (1998). Perinatal Outcome of Obese Women: A Review of the Literature. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 27, 431-440.
Muscati, S. K., Graydonald, K., ＆ Koski, K. G. (1996). Timing of weight gain during pregnancy, promotion fetal growth and minimizing maternal weight retention. International Journal of Obesity Related Metabolic Disorders, 20, 526-532.
Must, A., Spadano, J., ＆ Coakley, E. H. (1999). The disease burden associated with overweight and obesity. Journal of American Medicine Association, 282 (16), 1523-1529.
National Task Force on the Prevention and Treatment of Obesity. (1993). Very low calorie diets. Journal of American Medicine Association, 270(8), 967-974.
Nicklas, B. J., Dennis, K. E., Berman, D. M., Sorkin, J., Ryan, A. S.,＆ Goldberg, A.P. (2003). Lifestyle intervention of hypocaloric dieting and walking reduces abdominal obesity and improves coronary heart disease risk factors in obese, postmenopausal, African-American and Caucasian women. Journals of Gerontology Series A-Biological Sciences & Medical Sciences, 58A(2), 181-189.
Nir, Z. & Neumann, L.（1991）. Self-esteem, internal- external locus of control, and their relationship to weight reduction. Journal of clinical psychology, 47（4）,568-575.
Nir, Z.（1995）. Relationship among self-esteem, internal-external locus of control, and weight change after participation in a weight reduction program. Journal of clinical psychology, 51（4）,482-490.
Oberrieder, H., Walker, R., Monroe, D., ＆ Adeyanju, M. (1995). Attitudes of dietetics students and registered dietitians toward obesity. Journal of American Dietetic Association, 95, 914-016.
Ohlin, A., ＆ Rossner, S. (1990). Maternal body weight develop-
ment after pregnancy. International Journal of Obesity, 14, 159-173.
Ohlin, A., ＆ Rossner, S. (1996). Factors related to body weight changes during and after pregnancy: The Stockholm pregnancy and weight development study. Obesity Research, 4, 271-276.
Parham, E. S. (1993). Enhancing social support in weight loss management groups. Journal of American Dietetic Association,93, 1152-1156.
Paxton, S. J., Wertheim, E. H., Gibbons, K., Szmukler, G. I., Hiller, L., ＆ Petrovich, J. L. (1991). Body Image Satisfaction, Dieting Beliefs, and Weight Loss Behavior in Adolescent Girls and Boys. Journal of Youth and Adolescence, 20(3), 361-379.
Peter, G. K. (2000). Obesity as a medical problem. Nature, 404, 635-643.
Phinney, S. (1992). Exercise in the treatment of obesity. Journal Florida Medicine Association, 79, 400-402.
Polomeno, V. (1996). Social support during pregnancy. International Journal of Childbirth Education, 11(2), 14-21.
Riebe, D., Greene, G. W., Ruggiero, L., Stillwell, K. M., Blissmer, B., Nigg, C. R., ＆ Caldwell, M. (2003). Evaluation of a Health-
Lifestyle Approach to Weight Management. Preventive Medicine, 36, 45-54.
Roberts, R. E., Kaplan, G. A., Shema, S. J., Strawbridge, W. J. (2000). Are the obese at greater risk for depression? American Journal of Epidemiology, 152(2), 163-170.
Ruchala, P. L., ＆ Halstead, L. (1994). The postpartum experience of low-risk woman: A time of adjustment and change. Maternal-Child Nursing Journal, 22(3), 83-89.
Sale, J. E. M., Mccargar, L. J., Crawford, S. M., ＆ Taunton, J. E. (1995). Effects of exercise modality on metabolic rate and body composition. Clinical Journal Sport Medicine, 5, 100-107.
Schaffer, M. A., ＆ Lia-Hoagberg, B. (1997). Effects of social support on prenatal care and health behaviors of low-income women. Journal of Obstetric, Gynecological and Neonatal Nursing, 26(4), 433-440.
Sheeshka, J. D. ＆ Woolcott, D. M. (1993). Social cognitive theory as a framework to explain intentions to practice healthy eating behaviors. Journal of Applied Social Psychology, 23(19), 1547-1573.
Sherwood, N. E., Jeffery, R. W., ＆ Wing, R. R. (2000). Binge status as a predictor of weight loss treatment outcome. International Journal Obesity Relation Metab Disorder, 23, 485-493.
Sibai, B. M., Gordon, T., Thom, E., Caritis, S. N., Klebanoff, M., McNellis, D., Paul, R. H., ＆ The National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. (1995). Risk factors for preeclampsia in healthy nulliparous women: A prospective multimember study. American Journal of Obsterics and Gynecology, 172, 642-648.
Skender, M. L., Goodrick, G. K., Junco, D. J. D., Reeves, R. S., Darnell, L., Gotto, A. M. ＆ Foreyt, J. P. (1996). Comparison of 2-years weight loss trends in behavioral treatment of obesity: Diet, exercise and combination interventions. Journal of American Dietetic Association, 96, 342-346.
Sohng, K., Sohng, S., ＆ Yeom, H. (2002). Health-promoting behaviors of elderly Korean immigigrants in the United States. Public Health Nursing, 19(4), 294-300.
Soltani, H., ＆ Fraser, R. B. (2000). .A longitudinal study of maternal anthropometric change in normal weight, overweight and obese women during pregnancy and postpartum. British Journal of Nutrition, 84, 95-101.
Solomon, C.G., Willett, W. C., Carey, V. J., Rich-Edwards, J., Hunter, D. J., Colditz, G. A., Stampfer, M. J., Speizer, F. E., Spiegelman, D., ＆ Manson, J. E. (1997). A prospective study of pregravid determinants of gestational diabetes mellitus. Journal of the American Medical Association, 278, 1078-1083.
Somvanshi, N. P. (2002). Preventing postpartum weight retention. American Family Physician, 66(3), 380-383.
Stetson, B., Schlundt. D.G., Sbrocco, T., Hill, J. O. Sharp, T., ＆ Pope, C. J. (1992). The effects of aerobic exercise on psychological adjustment: a randomized study of sedentary obese women attempting. Women ＆ Health, 19, 1-14.
Stevens, J. (1992). Applied multivariate statistics for the social sciences. (2nd ed.). pp.229.565. Hillsdale, NJ: Lawrence Erlbaum Associates.
Stone, J. L., Lockwood, C. J., Berkowitz, G. S., Alvarez, M., Lapinski, R., ＆ Berkowitz, R. L. (1994). Risk factors for preeclampsia. Obstetrics ＆ Gynecology, 83, 357-361.
Stuifbergen, A. K., & Becker, H. A. (1994). Predictors of health promoting lifestyles in persons with disabilities. Research in Nursing & Health, 17, 3-13.
Susser, M., Fine, L. J., Schupf, N, ＆ Stein, Z. A. (1993). Prenatal weight gain postpartum weight retention: A delicate balance. American Journal of Public Health, 83(8), 1082-1083.
Tarkka, M. T., ＆ Paunonen, M. (1996). Social support and its impact on mothers’ experiences of childbirth. Journal of Advanced Nursing, 23(1), 70-75.
Thompson, D., Edelsberg, J., ＆ Colditz, G. A. (1999). Lifetime health and economic consequences of obesity. Arch International Medicine, 159, 2177-2182.
Thombs, D. L., Rosenberg, J. M., Mahoney, C. A., ＆ Daniel, E. L. (1996). Weight-Loss Expectancies, Relative Weight, and Symptoms of Bulimia in Young Women. Journal of College Student Development, 37(4), 405-414.
Tomoda, S., Tamura, T., Sudo, Y., ＆ Ogita, S. (1996). Effects Of obesity on pregnant women: Maternal homodynamic change. American Journal of Gerontology, 13, 73-78.
Wadden TA, Foster GD and Leticia KA (1994) One-year behavioral treatment of obesity: comparison of moderate and severe caloric restriction and the effects of weight maintenance therapy. Journal of Consult Clinician Psychology, 62, 165-171.
Walker, M. (1995). Obesity, insulin resistance, and its link to non-insulin dependent diabetes mellitus. Metabolism, 44(9), 18-20.
Walker, L. O. (1996). Predictors of Weight gain at 6 and 18 months after childbirth: A pilot study. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 25, 39-48.
Walker, L. O. (1997). Weight and Weight-related distress after childbirth: Relations to stress, social support and depressive symptoms. Journal of Holistic Nursing, 25, 39-48.
Walker, L. O. (1998). Weight-related distress in the early months after childbirth. Western Journal of Nursing Research, 20(1), 30-44.
Walker, L. O., ＆ Freeland-Graves, J. (1998). Lifestyle factors related to postpartum weight gain and body image in bottle and breastfeeding women. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 27(2), 151-160.
Wallance, J. P., Ernsthausen, K., ＆ Inbar, G. (1992). The Influence of the Fullness of Milk in the Breasts on the Concentration of Lactic Acid in Postexercise Breast Milk. International Journal of Sport Medicine, 13(5),395-398.
Wierenga, M. E., ＆ Oldham, K. K. (2002). Weight control: a lifestyle-modification model for improving health. Nurse Clinical N American, 37, 303-313.
Williamson, D. F., Theodore, T. J., ＆ Thun, M. (2000). Intentional weight loss and mortality among overweight individuals with diabetes. Diabetes Care, 23(10), 1499-1504.
Williamson, D. F. (1995). Prevalence and demographics of obesity. Eating Disorders and Obesity, 391-395.
Wilson, P. D., Herbison, R. M., ＆ Herbison, G. P. (1996). Obstetric practice and the prevalence of urinary incontinence three months after delivery. British Journal of Obstetrics and Gynaecology, 103, 154-161.
Wing, R. R., Venditti, E., Jakicic, J. M., Polley, B.A., ＆ Lang, W. (1998). Lifestyle intervention in overweight individuals with a family history of diabetes. Diabetes Care, 21(3), 350-359.
Wing, R. R., ＆ Jeffery. R. W. (1999). Benefits of recruiting participant with friends and increasing social support for weight loss and maintenance. Joural Consult ＆ Clinician Psychology, 67, 132-138.
Wolfe, L. A., Brenner, I. K. M., ＆ Mottla, M. F. (1994). Materal Exercise, Fetal Well-Being and Pregnancy Outcome, Exercise and Sport Sciences Reviews, 22, 145-194.
Yamamoto, R., Inoue, S., Saito, M., Okamoto, M., Okamura, A., ＆ Takamura, Y. (1992). Very-low-calorie-diet therapy in severe obesity. American Journal of Clinical Nutrition, 56, 299S-302S.