No Easy Path To Dropping Pounds After PregnancyFriday, February 7, 2014
Gaining excessive weight during pregnancy and retaining much of it after delivery is ones of the most common drivers of adult obesity in women.
Emerging evidence supports the notion that both may well be detrimental to the health of mothers (and their kids).
Unfortunately, it appears that behavioural intervention during pregnancy to reduce long-term weight retention is a lot more challenging that one may expect.
This is the rather disappointing outcome of a randomised controlled trial by Suzanne Phelan and colleagues, published in the American Journal of Clinical Nutrition.
The trial included 400 US Women, half of who were overweight or obese, randomly assigned to a behavioural intervention or control group beginning around the 13th week into their pregnancy.
The intervention (Fit for Delivery) consisted of one face-to-face visit with an interventionist at the onset of treatment, the provision of body-weight scales, food records, and pedometers to promote adherence to daily self-monitoring, weekly postcards prompting healthy eating and exercise habits, personalized graphs of their weight gain with feedback, and supportive phone calls from the dietitian during the intervention. This intervention continued till delivery.
Four out of five of the participants completed the 12-mo assessment.
Overall the intervention did not increase the participants’ chances of achieving their prepregnancy weights. Even the completer analysis showed non-significant trends at best – this despite women in the intervention group reporting higher levels of dietary restraint and more frequent self-monitoring of body weight.
Thus, this level if intervention, which far exceeds usual care during pregnancy for most women, does not appear to effectively reduce post-pregnancy weight retention.
Incidentally, the only predictors of excessive weight retention were pre-pregnancy BMI and excessive gestational weight gain. Breastfeeding, age, parity, and delivery weeks were not.
Thus, although excessive pregnancy weight gain and post-pregnancy weight retention are common problems with significant negative health impacts on both mother and child, it will apparently take far more than an additional visit with a dietitian and exercise counsellor or postcards and telephone reminders to impact body weight.
I wonder if anyone else is not all too surprised by these findings?
Phelan S, Phipps MG, Abrams B, Darroch F, Grantham K, Schaffner A, & Wing RR (2014). Does behavioral intervention in pregnancy reduce postpartum weight retention? Twelve-month outcomes of the Fit for Delivery randomized trial. The American journal of clinical nutrition, 99 (2), 302-11 PMID: 24284438
Friday, February 7, 2014
As a dietitian and a mom myself, it is important to note that the first year following having a baby is a very difficult one to make significant lifestyle change. Time to care for yourself is much lower than it has been in the past, and the exhaustion common to new parents can impact food preparation and choices. If you exclusively breastfeed it limits time away from your baby. Going for walks or mom and baby exercise classes may not have an impact on remaining baby weight. I would like to see more support such as public health programs for moms at all stages regarding healthy lifestyles. As children get older parents often can gain more time and energy to focus on their own health. I do think pregnant women are a lot more aware of the importance of avoiding excessive weight gain then previous generations were.
Friday, February 7, 2014
Not surprised at all sadly. Women face so many challenges to lose weight following pregnancy as they adjust to life with a growing family, have less time, more stress and little sleep -all making successful weight loss very tricky!
Women need practical and realistic weight loss advice tailored to them at this unique time in their life. This must also support women who choose to breastfeed by ensuring they and their babies get all the nutrients they need.
Friday, February 7, 2014
I am not surprised at all. My first pregnancy, I followed the prenatal diet given to me (which by the way contained much more food than I was accustomed to eating). I didn’t binge on sugary or fatty foods, and exercised by walking two or three miles a day into my eighth month. Nonetheless, I gained 64 lb. (my daughter weighed 8.8 lb.). Second time around I ignored the letter of the prenatal diet, making sure I got all the recommended protein but decreasing the fat and especially the carbs. As my pregnancy went on, I began gaining weight like a runaway train, no matter how I reduced my calories. I gained 75 lb. by the end, and my baby weighed 9.10. I did not test positive for gestational diabetes. However, I was able to gradually reduce my post-partum weight back to normal after about three years. Unfortunately, later I gained all this weight back, and more. I have heard so many women complain, as I have, that they gain weight despite reducing their calories to a level where they should be losing (or, in the case of pregnancy, gaining at an appropriate weight). Why do so many doctors ignore us when we tell them this? Many seem to assume we’re either delusional or lying. It has always seemed to me that either I wring more calories from what I eat (is this possible?) or burn calories at a far slower rate than average.
Friday, February 7, 2014
Not surprised – women don’t need information to lose weight post-pregnancy, they need time! Time to cook, to exercise and to sleep.
Saturday, February 8, 2014
Why so pessimistic about the results ? 80 % were finishing the program, that’s a very good outcome ! Only one in three mothers reached their prepregnancy weight …but what about a mixed group of 100 normal weight and overweight non pregnant women : how many have the same weight after 12 months ? The same reasoning about gaining “only” a mean of 1.4 kg after 12 mnths … quid versus non pregnant women living in a small family ? I can’t read the full article, so what about the other parameters ? Is the “scale result” the most important outcome ? What about change in lifestyle of the whole young family ? what about selfesteem ? what about wellbeing ? what about feeling sure about feeding an infant and the rest of the family ? To me, the real challenge is the importance of this program as a “prevention act” : so what about the results in 2 and 5 years ? what about the outcome on these infants after 2, 3 and 10 years ? It’s a “a low intensity intervention” : why discontinuing at delivery ?? and I should add a “group education” in this concept if possible….sharing experience in a group of young mothers , guided by a health coach or dietitian, .. why not “as a preventive action” ?
Sunday, February 9, 2014
As a former obese woman who is now pregnant for the firsr time, articles like this get me thinking and produce some anxiety.
For 2 years in my early twenties I had obesity. (5’5″ 198 lbs BMI 31). I lost 55 lbs and have maintained a 45 lb weight loss for almost 4 years. I’ve always wondered: does the relatively short period of time spent being obese, together with my intervention at a “young” age affect my set point– the weight my body will fight to maintain? Or am I not any better off than others who were obese for decades and didn’t lose weight until middle age?
Furthermore concerning pregnancy, how does pregnancy weight gain affect set points? Even appropriate weight gain concerns me as a formerly obese pregnant woman. Will it be more difficult for me to shed baby weight gain?
Also, to maintain my weight loss I always had to maintain a calorie deficit. I’ve continued to do so throughout pregnancy and I feel this has been key, along with exercise, in keeping within weight gain guidelines. But I worry which is riskier, maintaining a calorie deficit despite pregnancy, or observing the calorie recommendations and gaining excess weight.
No one seems to have advice on what the behavior of a former obese pregnant woman should be doing to avoid extremes.
Monday, February 10, 2014
I am not surprised by these results. As Dr. Sharma says, over and over, weight is not about calories in and calories out. In my personal experience (as someone who is overweight but “loses weight” in pregnancy despite NOT reducing intake) and from the experiences that I hear of from other moms, it seems that the body will do what it will during pregnancy. This may not be true for all women but seems true for many.
Our bodies have genetics, an agenda during pregnancy, and a complex physiology with its own memory – and I think we barely understand bodies and weight let alone the pregnant body.
In the meantime, until we have a better understanding, would it be more helpful and do less harm to focus on eating well and improving fitness as positive ends on their own accord? Since we all know that we can only “control” behaviours but not the outcomes of those behaviours (particularly when it comes to an outcome so confounding as weight) might it not help to take the pressure off of an already stressful time for women (I think that stress is not good for us nor our babies…) and simply support women in taking good care of themselves – and ultimately their baby – without the guilt and shame related to not achieving a perhaps unattainable weight management goal? Perhaps we will learn that the moms and the babies of the moms who were in the intervention group do have healthier outcomes despite their moms not losing weight.
Also, could it be that, in general, weight is an outcome or a marker of other things in life that predict poor health – for moms and their babies? Stress, poverty, lack of a sense of control and power over one’s life and health, etc. When you compare an overweight but affluent mom with an equally overweight but financially struggling mom – who tends to have the better long-term health? Marmot (Whitehall) and others would suggest that it is about that and not the weight.
Before I sign off I want to thank you Dr. Sharma for all of your amazing work in this field and for encouraging conversation about the conundrums of behaviour change, weight, and health. Your voice has power and I appreciate you using it to support critical discourse in this field.