Healthy Weight Gain Research Articles

Pregnancy

Pregnancy is a time when women are at increased risk to gain substantial weight. It is also a time when women are more health conscious and may be more likely to engage in healthier behaviors. Because of these factors, women are primed to engage in lifestyle strategies to promote healthy weight gain during pregnancy. Similarly, mothers of newborns also have an increased readiness for change, making infancy an ideal time to begin obesity prevention efforts in families. Health care providers are encouraged to take advantage of the increased health awareness and the behavioral momentum that is present surrounding pregnancy in order to promote healthy lifestyle changes for both pregnant women and new mothers.

Barriers to and facilitators of nurse-parent interaction intended to promote healthy weight gain and prevent childhood obesity at Swedish child health centers.

BackgroundOverweight and obesity in preschool children have increased worldwide in the past two to three decades. Child Health Centers provide a key setting for monitoring growth in preschool children and preventing childhood obesity.MethodsWe conducted semi-structured interviews with 15 nurses working at Child Health Centers in southwest Sweden in 2011 and 2012. All interviews were tape recorded and transcribed verbatim and imported to QSR N’Vivo 9 software. Data were analyzed deductively according to predefined themes using content analysis.ResultsFindings resulted in 332 codes, 16 subthemes and six main themes. The subthemes identified and described barriers and facilitators for the prevention of childhood obesity at Child Health Centers. Main themes included assessment of child’s weight status, the initiative, a sensitive topic, parental responses, actions and lifestyle patterns. Although a body mass index (BMI) chart facilitated greater recognition of a child’s deviant weight status than the traditional weight-for-height chart, nurses used it inconsistently. Obesity was a sensitive topic. For the most part, nurses initiated discussions of a child’s overweight or obesity.ConclusionCHCs in Sweden provide a favorable opportunity to prevent childhood obesity because of a systematic organization, which by default conducts growth measurements at all health visits. The BMI chart yields greater recognition of overweight and obesity in children and facilitates prevention of obesity. In addition, visualization and explanation of the BMI chart helps nurses as they communicate with parents about a child’s weight status. On the other hand, inconsistent use and lack of quality assurance regarding the recommended BMI chart was a barrier to prevention, possibly delaying identification of overweight or obesity. Other barriers included emotional difficulties in raising the issue of obesity because it was perceived as a sensitive topic. Some parents deliberately wanted overweight children, which was another specific barrier. Concerned parents who took the initiative or responded positively to the information about obesity facilitated prevention activities.

The effectiveness of interventions to promote healthy weight gain in infants and young children from socioeconomically disadvantaged and indigenous families: A systematic review

Background and aims: Early childhood is an important period for establishing behaviours that will affect weight gain and health across the life course. Children from disadvantaged families including those from low socio-economic backgrounds and indigenous families have significantly higher rates of obesity, making early intervention particularly important in these groups. Little is known however, about the most effective intervention approaches in these populations. This study will report the findings of a systematic review of the effectiveness of interventions to promote healthy weight gain in children 0—5 years from socioeconomically disadvantaged and indigenous families. Methods: Searches of major electronic databases were undertaken to identify intervention studies promoting healthy weight gain in children aged 0—5 years from low socio-economic and indigenous families. Articles published in the last 20 years reporting on feeding practices, anthropometric, diet, physical activity or sedentary behaviour outcomes were included. A total of 4144 unique citations were identified and a screening of titles, abstracts resulted in 83 papers to be reviewed to identify studies meeting the eligibility criteria. Data on included studies are to be extracted by one reviewer and verified by a second reviewer. Internal and external validity will also be assessed using standard quality rating tools. Results: The review will assess overall effectiveness of the interventions using meta-analysis (if possible) and narrative synthesis. The review will also report on the reach of the interventions, the most important intervention targets, the effectiveness of various intervention strategies and delivery modes as well as the generalizability of the studies. Significance: This review will provide important new information about the best bets in obesity prevention interventions for socioeconomically disadvantaged and indigenous families, as well as identifying key gaps in knowledge to guide future research. To be considered for ‘late breaking abstracts’ with results to be updated.

Satiety responsiveness in toddlerhood predicts energy intake and weight status at 4 years of age

Background and aims: Early childhood is an important period for establishing behaviours that will affect weight gain and health across the life course. Children from disadvantaged families including those from low socio-economic backgrounds and indigenous families have significantly higher rates of obesity, making early intervention particularly important in these groups. Little is known however, about the most effective intervention approaches in these populations. This study will report the findings of a systematic review of the effectiveness of interventions to promote healthy weight gain in children 0—5 years from socioeconomically disadvantaged and indigenous families. Methods: Searches of major electronic databases were undertaken to identify intervention studies promoting healthy weight gain in children aged 0—5 years from low socio-economic and indigenous families. Articles published in the last 20 years reporting on feeding practices, anthropometric, diet, physical activity or sedentary behaviour outcomes were included. A total of 4144 unique citations were identified and a screening of titles, abstracts resulted in 83 papers to be reviewed to identify studies meeting the eligibility criteria. Data on included studies are to be extracted by one reviewer and verified by a second reviewer. Internal and external validity will also be assessed using standard quality rating tools. Results: The review will assess overall effectiveness of the interventions using meta-analysis (if possible) and narrative synthesis. The review will also report on the reach of the interventions, the most important intervention targets, the effectiveness of various intervention strategies and delivery modes as well as the generalizability of the studies. Significance: This review will provide important new information about the best bets in obesity prevention interventions for socioeconomically disadvantaged and indigenous families, as well as identifying key gaps in knowledge to guide future research. To be considered for ‘late breaking abstracts’ with results to be updated.

Perspectives on weight gain and lifestyle practices during pregnancy among women with a history of macrosomia: a qualitative study in the Republic of Ireland

BackgroundExcessive weight gain during pregnancy is a major risk factor for macrosomia (high birth weight delivery). This study aimed to explore views about weight gain and lifestyle practices during pregnancy among women with a history of macrosomia.MethodsA qualitative descriptive study was conducted. Twenty-one second-time mothers whose first infant was macrosomic (>4 kg) were recruited from a randomised trial in a large maternity hospital in the Republic of Ireland. Semi-structured interviews were conducted with participants at both 6 and 12 months after their second pregnancy. Inductive thematic analysis was used to identify distinct themes.ResultsThe mothers believed in following their prenatal food cravings to meet their baby’s needs, but this led some to eat excessively. Many of the women cut back heavily on physical activity during pregnancy due to perceived risks to the baby. Physical conditions and discomforts during pregnancy often limited maternal control over weight and lifestyle practices. The women were not particularly concerned about weight gain during pregnancy and most did not favour the notion of introducing weight gain guidelines into routine antenatal care. Common differences perceived by the women between their first and second pregnancy included: increased concern about weight gain in their second pregnancy due to prior difficulties with postpartum weight loss and increased time demands in their second pregnancy impeded healthy lifestyle practices. Most women did not alter their perspectives on weight gain and lifestyle practices in their second pregnancy in response to having a macrosomic infant in their first pregnancy.ConclusionsThis analysis exposed numerous barriers to healthy pregnancy weight gain. The findings suggest that women may need to be advised to follow their prenatal food cravings in moderation. Pregnant women with children already may benefit from education on time-efficient methods of integrating healthy eating practices and physical activity into their lifestyles. Women with a history of macrosomia may need information about the importance of avoiding high weight gain in subsequent pregnancies.

Healthy Weight Gain in Pregnancy: A Clinicians Tool for Individualized, Patient‐Focused Collaboration

Poster Presentation Purpose for the Program The purpose of this poster presentation is to share a tool developed by the Washington State Department of Health for prenatal clinicians to use to engage patients in developing goals and healthy behaviors, and provide individualized resources for healthy weight gain during pregnancy. Proposed Change Five obstetric (OB) practices were presented with the tool as a way to address healthy weight gain during the first prenatal (intake) exam. Previously, one of these practices did not formally address weight gain and the other four did not have a patient‐based tool. The goal was to get each clinic to use the tool. Implementation, Outcomes, and Evaluation In a pilot, five OB practices throughout the Southwest Region of Washington State were presented with the “Healthy Weight Gain in Pregnancy” tool, along with a “Clinician's Tool for Healthy Weight Gain in Pregnancy” to help clinicians with assessment, dialog, and monitoring. Represented were one urban, underserved OB access clinic; one urban family practice and residency practice; one urban OB practice; one suburban OB practice; and one rural OB practice. The clinician tools and patient tools were given to each practice (in laminated pad form) in three languages: English, Spanish, and Russian. After 3 months, each practice was queried regarding whether healthcare providers were using the tool, the patient interaction and success in engagement, and plans to continue the use of the tool. Of the five practices, only the rural practice did not embrace the tool—probably because of significant changes in staff, healthcare providers, and management. All others incorporated the tool in their OB intake process. The OB access clinic used the tool in their Centering/Group visit program and the other practices used the tool as part of their OB intake interview. Most successful in embracing the tool was the suburban practice, which used the tool and resources within the tool to develop plans that were incorporated into their electronic medical record (EMR) and monitor weight gain based on the goals developed. Implications for Nursing Practice The purpose of presenting this poster is genuinely to share this tool with others. Many healthcare providers are seeking a tool that will help engage patients and are eager to find something that has already been developed and can be used in their practices. This tool is a tangible, readily accessible way to involve patients and have them participate in healthy behaviors for healthy pregnancies and healthy birth outcomes.

THU0505 Associations Between Measures of Obesity over 10 Years and Patella Cartilage in a Population-Based Cohort of Young to Middle Aged, Asymptomatic Women

BackgroundOsteoarthritis most commonly affects the patellofemoral compartment of the knee, being a major cause of pain and disability. The structural changes that evolve prior to the onset of symptoms can...

Optimizing healthy gestational weight gain in women at high risk of gestational diabetes: A randomized controlled trial

Optimizing gestational weight gain (GWG) in early pregnancy is of clinical and public health importance, especially in higher risk pregnancies. In a robustly designed, randomized controlled trial, 228 pregnant women at risk of developing gestational diabetes mellitus (GDM) were allocated to either control (written health information only) or intervention (four-session lifestyle program). All women received standard maternal care. Measures were completed at 12-15 and 26-28 weeks gestation. Measures included anthropometrics (weight and height), physical activity (pedometer and International Physical Activity Questionnaire), questionnaires (risk perception), and GDM screening. The mean (SD) age [31.7 (4.5) and 32.4 (4.7) years] and body mass index [BMI; 30.3 (5.9) and 30.4 (5.6) kg/m(2) ] were similar between control and intervention groups, respectively. By 28 weeks, GWG was significantly different between control and intervention groups [6.9 (3.3) vs. 6.0 (2.8) kg, P < 0.05]. When stratified according to baseline BMI, overweight women in the control group gained significantly more weight compared to overweight women in the intervention group [7.8 (3.4) vs. 6.0 (2.2) kg, P < 0.05], yet in obese women, GWG was similar in both groups. Physical activity levels declined by 28 weeks gestation overall (P < 0.01); however, the intervention group retained a 20% higher step count compared to controls [5,203 (3,368) vs. 4,140 (2,420) steps/day, P < 0.05]. Overall, GDM prevalence was 22.8% [Corrected], with a trend toward less cases in the intervention group (P = 0.1). Results indicate that a low-intensity lifestyle intervention, integrated with antenatal care, optimizes healthy GWG and attenuates physical activity decline in early pregnancy. Efficacy in limiting weight gain was greatest in overweight women and in high-risk ethnically diverse women.

Pregnant women use an online healthy weight gain program as designed

Excessive gestational weight gain is linked to poor outcomes for both mother and infant. This study examined the consistency between the underlying theory of how participants would use features of an excessive weight gain prevention program and how they were actually used. A racially and ethnically diverse sample of about 950 pregnant women from a large urban area of upstate New York participated in the online and cell phone intervention promoting healthy lifestyle during pregnancy. Participants were encouraged to use the online doctors’ appointment reminder for prenatal care visits after which they could enter weights into an online weight gain tracker. Women who were gaining excessively were encouraged to engage in diet and physical activity goal‐setting and monitoring. On average, pregnant women entered 1 weight per month into the online weight gain tracker. Women who used the doctors’ appointment reminder 3 or more times were significantly more likely to enter weights into the weight gain tracker (p&lt;0.0001). Women who entered weights at 70% or greater of the recommended frequency were twice or more likely to set behavioral goals (p&lt;0.0001). 45% of the weights entered into the tracker were above the recommended range. Gaining above the range was positively associated with setting goals for diet and physical activity. Participants used the program as designed. Funded by Grant No. HL096760.

Associations between measures of obesity over 10 years and patella cartilage in a population-based cohort of young to middle aged, asymptomatic women

Purpose: Osteoarthritis most commonly affects the patellofemoral compartment of the knee, being a major cause of pain and disability. The structural changes that evolve prior to the onset of symptoms can be visualised using magnetic resonance imaging (MRI). There is little known about the role of obesity on the early structural changes in the patella cartilage in younger, asymptomatic adult females. Methods: 160 asymptomatic women (20-49years) participating in the Geelong Osteoporosis Study underwent knee MRI between 2006-8. Weight and body mass index (BMI) were measured 10 years prior (1994-7, baseline) and at the time of the MRI (current) with change over the period calculated (current-baseline). The relationships between the measures of obesity and patella cartilage volume and defects were examined. Results: After adjustment for age and patella bone volume, there was a reduction of 13 (95% CI -25.7, -0.55) microliters (mL) in patella cartilage volume for every 1 unit increase in current BMI and reduction of 27mL (95% CI -52.6, -1.5) per BMI unit increase over 10 years (p=0.04 for both). There was no significant association between baseline BMI and patella cartilage volume (p=0.16). Increased baseline and current weight and BMI were associated with increased prevalence of patella cartilage defects (all p<0.001). Conclusions: Obesity and weight gain over midlife are both associated with detrimental structural change at the patella in young to middle aged healthy women without clinical osteoarthritis. Maintaining a healthy weight, avoiding obesity and weight gain in younger asymptomatic women may be important in the prevention of patellofemoral osteoarthritis.

Recruitment and Retention of Pregnant Women for a Behavioral Intervention: Lessons from the Maternal Adiposity, Metabolism, and Stress (MAMAS) Study

IntroductionRecruiting participants for research studies can be challenging. Many studies fall short of their target or must prolong recruitment to reach it. We examined recruitment and retention strategies and report lessons learned in a behavioral intervention developmental trial to encourage healthy pregnancy weight gain and stress reduction in low-income overweight pregnant women.MethodsIn the San Francisco Bay area from February 2010 through March 2011, we used direct and indirect strategies to recruit English-speaking overweight and obese pregnant women who were aged 18 to 45, were in the early stages of pregnancy, and who had an annual household income less than 500% of the federal poverty guidelines. Eligible women who consented participated in focus groups or an 8-week behavioral intervention. We identified successful recruiting strategies and sites and calculated the percentage of women who were enrolled and retained.ResultsOf 127 women screened for focus group participation, 69 were eligible and enrolled. A total of 57 women participated in 9 focus groups and 3 women completed individual interviews for a completion rate of 87%. During recruitment for the intervention, we made contact with 204 women; 135 were screened, 33% were eligible, and 69.1% of eligible women enrolled. At 1 month postpartum, 82.6% of eligible women completed an assessment. Recruiting at hospital-based prenatal clinics was the highest-yielding strategy.ConclusionThe narrow window of eligibility for enrolling early stage pregnant women in a group intervention presents obstacles. In-person recruitment was the most successful strategy; establishing close relationships with providers, clinic staff, social service providers, and study participants was essential to successful recruitment and retention.

Phase II Study of Gemcitabine in Combination With Regional Arterial Infusion of Nafamostat Mesilate for Advanced Pancreatic Cancer

To evaluate the efficacy of regional arterial infusion of the synthetic serine protease inhibitor nafamostat mesilate combined with gemcitabine for the treatment of patients with unresectable locally advanced or metastatic pancreatic cancer. A single-arm, single center, institutional review board-approved phase II trial was conducted. Thirty-five of 38 consecutive patients were included in the study. Patients received nafamostat mesilate (4.8 mg/kg continuous regional arterial infusion) with gemcitabine (1000 mg/m intravenously) on days 1, 8, and 15. This treatment was repeated at 28-day intervals. The primary endpoints were to evaluate overall survival and 1-year survival rate. The secondary endpoints were to assess therapeutic response and clinical benefit response. Overall survival times were estimated by the Kaplan-Meier survival analysis. The median survival time was 10.0 months, and the 1-year survival rate was 40.0%. The response rate and disease control rate were 17.1% and 88.6%, respectively. A fraction of 25% of the patients who required opioids for cancer-related pain could reduce their opioid intake, and 37.1% of the patients showed healthy weight gain. Among the patients with metastatic pancreatic cancer, the median survival time was 9.0 months, and the 1-year survival rate was 32.0%. The proposed regimen offers an economic advantage compared with recent therapy regimens that have shown significant improvements in median survival over standard chemotherapy with gemcitabine. An alternative regimen for unresectable pancreatic cancer, especially for metastatic pancreatic cancer, is proposed based on acceptable survival time, clinical benefit, and cost advantage.

Moving beyond quantity of participation in process evaluation of an intervention to prevent excessive pregnancy weight gain

BackgroundFew lifestyle interventions have successfully prevented excessive gestational weight gain. Understanding the program processes through which successful interventions achieve outcomes is important for the design of effective programs. The objective of this study was to evaluate the effect of the quantity and quality of participation in a healthy lifestyle intervention on risk of excessive gestational weight gain.FindingsPregnant women (N = 179) received five newsletters about weight, nutrition, and exercise plus postcards on which they were asked to set related goals and return to investigators. The quantity of participation (dose) was defined as low for returning few or some vs. high for many postcards (N = 89, 49.7%). Quality of participation was low for setting few vs. high for some or many appropriate goals (N = 92, 51.4%). Fisher’s exact tests and multivariate logistic regression were used to analyze the effect of participation variables on the proportion with excessive weight gain. Quantity and quality of participation alone were each not significantly associated with excessive gestational weight gain, while quality of participation among those with high-levels of participation approached significance (p = 0.07). The odds of gaining excessively was decreased when women had both a high quantity and quality of participation (OR = 0.04, 95% CI = 0.005, 0.30).ConclusionsBoth quantity and quality of participation are important program process measures in evaluations of lifestyle interventions to promote healthy weight gain during pregnancy.

Use of the Pregnancy Physical Activity Questionnaire (PPAQ) to Identify Behaviors Associated With Appropriate Gestational Weight Gain During Pregnancy

The Pregnancy Physical Activity Questionnaire (PPAQ) assesses physical activity practices of pregnant women. The purpose of this study was to identify specific pregnancy practices that were associated with a healthy gestational weight gain (GWG). Associations between PPAQ scores, pedometer steps, energy intakes (EI), energy expenditures (EE), and rate of GWG were assessed for 61 pregnant women in their second or third trimester during a home visit. Principle component analyses (PCA) were used to cluster PPAQ questions into FACTORS associated with either rate or total GWG, physical activity (PA), EE, EI, and parity. PCA identified 3 FACTORS: Factor 1 associated EE with parity and child care; Factor 2 clustered several structured exercise activities; and Factor 3 grouped walking, playing with pets, and shopping with pedometer steps. Only Factor 3 clustered steps with weekly rate of GWG. EI was not associated with PA or GWG. PCA analysis identified 15 of 32 PPAQ questions that were related to increased physical activity in pregnant women, but only walking and pedometer steps were associated with GWG. Our analysis supports daily walking as the preferred PA for achieving a healthy rate of GWG.

A prospective study of pregnancy weight gain in Australian women

While weight gain during pregnancy is regarded as important, there has not been a prospective study of measured weight gain in pregnancy in Australia. This study aimed to prospectively evaluate pregnancy-related weight gain against the Institute of Medicine (IOM) recommendations in women receiving antenatal care in a setting where ongoing weight monitoring is not part of routine clinical practice, to describe women's knowledge of weight gain recommendations and to describe the health professional advice received relating to gestational weight gain (GWG). Pregnant women were recruited ≤20 weeks of gestation (n = 664) from a tertiary obstetric hospital between August 2010 to July 2011 for this prospective observational study. Outcome measures were weight gain from pre-pregnancy to 36 weeks of gestation, weight gain knowledge and health professional advice received. Thirty-six percent of women gained weight according to guidelines. Twenty-six percent gained inadequate weight, and 38% gained excess weight. Fifty-six percent of overweight women gained weight in excess of the IOM guidelines compared with 30% of those who started with a healthy weight (P < 0.001). At 16 weeks, 47% of participants were unsure of the weight gain recommendations for them. Sixty-two percent of women reported that the health professionals caring for them during this pregnancy 'never' or 'rarely' offered advice about how much weight to gain. The prevalence of inappropriate gestational weight gain in this study was high. The majority of women do not know their recommended weight gain. The advice women received from health professionals relating to healthy weight gain in pregnancy could be improved.

Míranos!Look at Us, We Are Healthy! An Environmental Approach to Early Childhood Obesity Prevention

Background: Obesity prevention research is sparse in young children at risk for obesity. This study tested the effectiveness of a culturally tailored, multicomponent prevention intervention to promote healthy weight gain and gross motor development in lowincome preschool age children. Methods: Study participants were predominantly Mexican-American children (n = 423; mean age = 4.1; 62% in normal weight range) enrolled in Head Start. The study was conducted using a quasi-experimental pretest/posttest design with two treatment groups and a comparison group. A center-based intervention included an age-appropriate gross motor program with structured outdoor play, supplemental classroom activities, and staff development. A combined center- and home-based intervention added peer-led parent education to create a broad supportive environment in the center and at home. Primary outcomes were weight-based z-scores and raw scores of gross motor skills of the Learning Achievement Profile Version 3. Results: Favorable changes occurred in z-scores for weight (one-tailed p < 0.04) for age and gender among children in the combined center- and home-based intervention compared to comparison children at posttest. Higher gains of gross motor skills were found in children in the combined center- and home-based (p < 0.001) and the center-based intervention (p < 0.01). Children in both intervention groups showed increases in outdoor physical activity and consumption of healthy food. Process evaluation data showed high levels of protocol implementation fidelity and program participation of children, Head Start staff, and parents. Conclusion: The study demonstrated great promise in creating a health-conducive environment that positively impacts weight and gross motor skill development in children at risk for obesity. Program efficacy should be tested in a randomized trial.

A Qualitative Study of Factors Affecting Pregnancy Weight Gain in African American Women

African Americans and overweight or obese women are at increased risk for excessive gestational weight gain (GWG) and postpartum weight retention. Interventions are needed to promote healthy GWG in this population; however, research on exercise and nutritional barriers during pregnancy in African American women is limited. The objective of this qualitative study is to better inform intervention messages by eliciting information on perceptions of appropriate weight gain, barriers to and enablers of exercise and healthy eating, and other influences on healthy weight gain during pregnancy in overweight or obese African American women. In-depth interviews were conducted with 33 overweight or obese African American women in Columbia, South Carolina. Women were recruited in early to mid-pregnancy (8-23 weeks gestation, n = 10), mid to late pregnancy (24-36 weeks, n = 15), and early postpartum (6-12 weeks postpartum, n = 8). Interview questions and data analysis were informed using a social ecological framework. Over 50 % of women thought they should gain weight in excess of the range recommended by the Institute of Medicine. Participants were motivated to exercise for personal health benefits; however they also cited many barriers to exercise, including safety concerns for the fetus. Awareness of the maternal and fetal benefits of healthy eating was high. Commonly cited barriers to healthy eating include cravings and availability of unhealthy foods. The majority of women were motivated to engage in healthy behaviors during pregnancy. However, the interviews also uncovered a number of misconceptions and barriers that can serve as future intervention messages and strategies.

Dietary patterns and 14-y weight gain in African American women

An inverse association between healthy dietary patterns and weight gain that has been shown in white populations is not evident in the few studies in African Americans, a population at high risk of obesity. We prospectively assessed dietary patterns in relation to weight gain in African American women. The study included 41,351 women aged 21-54 y at enrollment in 1995 in the Black Women's Health Study. Participants reported dietary intake in 1995 and 2001 and current weight every 2 y through mailed questionnaires. By using factor analysis, 2 major dietary patterns were identified: a "vegetables/fruit" pattern and a "meat/fried foods" pattern. Multivariable mixed linear regression models were used to estimate mean weight gain in 14 y of follow-up according to each dietary pattern. Among women who maintained similar dietary patterns in 1995 and 2001, the vegetables/fruit pattern was associated with significantly less weight gain over 14 y (10.88 and 11.94 kg in the highest and lowest quintiles, respectively; P for trend = 0.003), whereas the meat/fried foods pattern was associated with significantly greater weight gain (12.02 and 10.15 kg in the highest and lowest quintiles, respectively; P for trend < 0.001). The associations were stronger among women aged <35 y, whose weight gain was greatest. These findings are the first to indicate that African American women may be better able to achieve long-term weight maintenance by consuming a diet high in vegetables and fruit and low in red meat and fried foods.

Behavioural interventions for weight management in pregnancy: A systematic review of quantitative and qualitative data

BackgroundThere is a rising prevalence of excessive weight gain in pregnancy and an increasing number of pregnant women who are overweight or obese at the start of the pregnancy. Excessive weight gain during pregnancy is associated with adverse maternal and neonatal consequences and increases the risk of long-term obesity. Pregnancy therefore may be a key time to prevent excessive weight gain and improve the health of women and their unborn child. This systematic review sought to assess the effectiveness of behavioural interventions to prevent excessive weight gain in pregnancy and explore the factors that influence intervention effectiveness.MethodsWe undertook a systematic review of quantitative and qualitative evidence. This included a meta-analysis of controlled trials of diet and physical activity interventions to prevent excessive weight gain during pregnancy and a thematic synthesis of qualitative studies that investigated the views of women on weight management during pregnancy. A thorough search of eleven electronic bibliographic databases, reference lists of included studies, relevant review articles and experts in the field were contacted to identify potentially relevant studies.Two independent reviewers extracted data. RevMan software was used to perform the meta-analyses. Qualitative data was subject to thematic analysis. Both quantitative and qualitative data were aligned using a matrix framework.ResultsFive controlled trials and eight qualitative studies were included. The overall pooled effect size found no significant difference in gestational weight gain amongst participants in the intervention group compared with the control group (mean difference -0.28 95% CI -0.64 to 0.09). The study designs, participants and interventions all varied markedly and there was significant heterogeneity within this comparison in the meta-analysis (I2 67%). Subgroup and sensitivity analysis did not identify contextual elements that influenced the effectiveness of the intervention.In a thematic analysis of the qualitative studies, three major themes emerged relating to women's views of weight management in pregnancy: pregnancy as a time of transition and change, conflicting and contradictory messages and a perceived lack of control. When the results of both quantitative and qualitative data were aligned it was clear that some of the barriers that women described in achieving healthy weight gain in pregnancy were not addressed by the interventions evaluated. This may have contributed to the limited effectiveness of the interventions.ConclusionsDespite intense and often tailored interventions there was no statistically significant effect on weight gain during pregnancy. Inadequate and often contradictory information regarding healthy weight management was reported by women in qualitative studies and this was addressed in the interventions but this in itself was insufficient to lead to reduced weight gain. Multiple types of interventions, including community based strategies are needed to address this complex health problem.

Prevalence of overweight and obesity among Portuguese youth: A study in a representative sample of 10–18-year-old children and adolescents

The aim of this research was to report the prevalence of overweight and obesity in a representative sample of Portuguese youth. This was a school-based study performed in Portugal. A total of 22 048 children and adolescents aged 10-18 years were included in the study. The World Health Organization (WHO) and the International Obesity Task Force (IOTF) cut-offs were used to categorise overweight and obese participants. Using IOTF cut-offs the prevalence of overweight and obesity was 17.0 and 4.6% in girls, and 17.7 and 5.8% in boys, respectively (p < 0.001 for overweight and p > 0.05 for obesity), whereas WHO cut-offs resulted in overweight and obesity prevalence scores of 23.1 and 9.6% in girls, and 20.4 and 10.3% in boys, respectively (p < 0.001 for overweight and p >0.05 for obesity). With IOTF cut-offs, a lower prevalence of obesity and overweight was observed at higher ages, in both genders. With the WHO cut-offs, a lower prevalence of obesity and overweight was observed at higher ages, in boys. In girls, the prevalence of overweight and obesity increases from 10 to 12 years of age and decreases from the age of 13 to 18 years. The prevalence for overweight/obesity among Portuguese children and adolescents vary according to the cut-off points used and are also of concern requiring strategies to promote healthy weight gain among children and adolescents.