Weight Loss Barriers and Dietary Quality of Intermittent and Continuous Dieters in Women with a History of Gestational Diabetes.

Kristy L Gray,Jennifer B Keogh,Peter M Clifton

doi:10.3390/ijerph181910243

Abstract

Weight-loss after gestational diabetes (GDM) lowers the risk of type-2 diabetes (T2DM). Intermittent energy restriction (IER) produces comparable weight-loss to continuous energy restriction (CER), but long-term adherence remains difficult in this population. This exploratory secondary analysis of a 12-month trial comparing IER to CER following GDM examined weight-loss and dietary quality associated with barriers to weight-loss or T2DM risk perception as assessed in a Likert scale questionnaire at baseline. The participants had a median (IQR) BMI of 32.6 (9.4) kg/m2 and 3 (4) years postpartum (n = 121). Forty-five percent (n = 54) of the participants thought they were at a high risk of developing T2DM. Greater affordability of healthy food was related with greater weight-loss at 3 months (p = 0.044, n = 85). At 12 months, there was no significant relationship between weight-loss and the barriers to weight-loss (p > 0.05). CER had superior improvement in dietary quality at 12 months (CER 11 ± 10, IER 6 ± 5.6, n = 42, p = 0.05). Under the Theoretical Domains Framework, the barriers were predominantly related to behavioral regulation (n = 83, 69%; n = 76, 63%) and environmental context and resources (n = 67, 56%). Interventions for diabetes prevention in this population should include behavioral regulation strategies, consider the family home environment, and ensure that the risk of T2DM is conveyed. Women choosing IER may benefit from education to improve their dietary quality.

Highlights

Women with a history of gestational diabetes (GDM) have a nearly 10-fold risk of developing type-2 diabetes (T2DM) compared with women with no GDM in pregnancy, making GDM one of the highest single risk factors for T2DM development [1]
Research to date suggests that Intermittent energy restriction (IER) can achieve comparable but not superior weight loss and metabolic improvements to continuous energy restriction (CER), but long-term adherence does not appear to be improved in intermittent dieters compared with continuous dieters [10,12,13]
The barriers to weight-loss were centered around behavioral regulation and environmental context and resources, which was apparent despite high levels of self-reported motivation and family support

Summary

Introduction

Women with a history of gestational diabetes (GDM) have a nearly 10-fold risk of developing type-2 diabetes (T2DM) compared with women with no GDM in pregnancy, making GDM one of the highest single risk factors for T2DM development [1]. Women with a history of GDM who are overweight can significantly reduce their risk of developing T2DM through lifestyle changes resulting in weight-loss [6,7]. They face multifaceted barriers to achieving weight-loss, and family responsibilities interfering with weight-loss attempts and motivation are often at the forefront of this [2,8,9]. Intermittent energy restriction (IER) has become a popular weight-loss strategy in recent years and may offer more flexibility in eating over the week compared with a continuous diet [10,11]. Research to date suggests that IER can achieve comparable but not superior weight loss and metabolic improvements to continuous energy restriction (CER), but long-term adherence does not appear to be improved in intermittent dieters compared with continuous dieters [10,12,13].

Methods

Results

Discussion

Conclusion