Research

Commentary

Postpartum Weight Control: A Vicious Cycle

Our aim was to evaluate obesity risk knowledge, weight misperception, and diet and health-related attitudes among women intending to become pregnant compared to those not intending to become pregnant.

We conducted a cross-sectional survey of health behaviors, including obesity risk knowledge, weight misperception, and diet and health-related attitudes among women (aged 16 to 40 years) attending reproductive health clinics in southeast Texas. Data were collected through self-administered questionnaires and chart review. Multivariable logistic regression analyses were performed to examine the association between pregnancy intention and obesity risk knowledge, weight misperception, and health-related attitudes after adjusting for age, race, income, and gravidity.

Overall, 1,726 women completed the survey, of which 1,420 responded to a question on pregnancy intention. Of these, 126 stated they were intending to become pregnant. Obesity risk knowledge (adjusted odds ratio=1.14; 95% confidence interval [CI] 0.74 to 1.77) and weight misperception (adjusted odds ratio=1.17; 95% CI 0.75 to 1.83) did not differ between women intending and not intending to become pregnant. In addition, diet and health-related attitudes did not differ between these two groups (P>0.05 for all). Among women intending to become pregnant, 51% had low obesity risk knowledge and 31% misperceived their body weight. Further, 76% of these women felt confused about what constitutes a healthy diet, although 47% believed that their current diet was healthy and saw no reason to change their current eating patterns. While weight misperception did not differ significantly between the two groups, overweight women intending to become pregnant were more likely to misperceive their weight than obese women intending to become pregnant (71% vs 10%; P<0.001).

There is a need for improved preconception counseling, especially for women intending to become pregnant, regarding the risks associated with being overweight or obese, misperception of body weight, and negative diet and health-related attitudes.

A pilot was conducted to test the feasibility and compare the effectiveness of a group approach (facilitated group discussions) to that of a self-guided approach (newsletters) to weight management in postpartum women enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (baseline n = 151; final n = 64). Mean group attendance was 3.6/10 sessions. Being older and meeting with the dietitian were related to greater attendance (P < .01). At 1 year, there were no significant differences in weight between groups. There is a critical need for weight-management interventions in the postpartum period. Lessons learned are presented.

Dietary modification to achieve weight loss during the postpartum period may be critical for prevention of obesity, particularly in low-income, minority women. The aim of this cross-sectional study was to develop and validate a measure to examine motivations to eat in low-income, minority women during early postpartum. A convenience sample of 179 triethnic women was recruited from the Special Supplemental Program for Women, Infants, and Children clinics from June 2004 to April 2007. Subjects made one visit to a study center where they completed the Eating Stimulus Index and questions regarding individual demographic characteristics including ethnicity, age, income, education, marital status, breastfeeding, and employment status. Weight and height were also measured during this visit and used to calculate body mass index (BMI; calculated as kg/m²). An additional sample of 31 women completed the Eating Stimulus Index on two occasions with 2 weeks between to establish test–retest reliability. The factor structure of the scale was examined with principal components analysis. Total scale scores and subscale scores were calculated and Pearson's correlation and multiple regression analysis examined relationships to BMI. Principal component analysis produced an eight-factor structure with loadings >0.40. Cronbach's α coefficients for each subscale ranged from .54 to .89. Subscales of Convenience Eating, Emotional Eating, and Dietary Restraint were related to BMI in mothers. African-American, exclusively formula-feeding, and older women were most vulnerable to convenience eating. White women and those with the highest level of education were most vulnerable to emotional eating. The Eating Stimulus Index is a valid and reliable instrument with the ability to discriminate by weight. It can be used to assess motivations to eat in order to facilitate development of tailored weight-loss messages during early postpartum.

To report the results of a comprehensive review of published intervention studies to identify the best evidence available for guiding weight management interventions in postpartum women.

Electronic searches were conducted of three electronic databases: Cumulative Index to Nursing and Allied Health Literature; Medline; and the Science Citation Index, Expanded, in the Web of Science from 1994 to May 2007. Keyword searches were conducted using the terms obesity, obese, overweight, postpartum, pregnancy weight, and weight management in postpartum women.

Six studies were selected that met the inclusion criteria of testing interventions and one that reported preintervention planning and targeted a weight management intervention for postpartum women.

All six interventions showed significant impact with diet and exercise or some combination on body composition in the targeted sample of women.

The strengths of previous studies include an emphasis on precision in outcome measures and experimental conditions; limitations were that the theoretical basis for the interventions was frequently omitted and limited attention given to the cultural, social, and contextual factors established in descriptive research.

Interventions need to target women early in their childbearing years to have the most significant long-term impact.