A diet and physical activity intervention for preventing weight retention among Taiwanese childbearing women: a randomised controlled trial

Abstract

Objective

to examine the effect of individual counselling on diet and physical activity from pregnancy to six months post partum, or from birth to six months post partum, on weight retention among Taiwanese women.

Design

a randomised controlled trial assigned participants to two experimental groups [from pregnancy to six months post partum (EP) and from birth to six months post partum (EPP)] and one comparison group.

Setting

a 3900-bed medical centre in northern Taiwan with around 3000 births annually.

Participants

a sample of 189 women who had regular check-ups during pregnancy and gave birth at the medical centre.

Interventions

the comparison group received the routine outpatient department obstetric educational programme. The EP group attended regularly scheduled clinic visits with individualised dietary and physical activity education plans from 16 gestational weeks to six months post partum, and received on brochure. The EPP group received the same educational intervention as the EP group from 24–48 hours after birth to six months post partum.

Measurements

body weight, body mass index, health-promoting behaviour and psycho-social variables (self-efficacy, body image, depression and social support).

Findings

average gestational weight gain was 14.02, 15.27 and 16.22 kg in the three EP, EPP and comparison groups respectively, and average weight retention at six months post partum was 2.34, 4.06 and 5.08 kg in the three groups, respectively.

Key conclusions

a diet and physical activity intervention from pregnancy is effective for reducing post-pregnancy weight retention.

Implications for practice

the findings of the present study should be taken into consideration when incorporating significant others and weight-loss maintenance strategies with interventions for a healthier family lifestyle.

Introduction

The increasing prevalence of overweight and obese individuals in the general population is a significant health concern in Taiwan (Department of Health, 2006). However, the National Nutritional Survey in Taiwan (Department of Health, 2002) reports that women are more likely than men to be overweight and obese (for those ⩾19 years, 42.0% vs 37.7%; for those ⩾45 years, 62.2% vs 43.0%, respectively). Furthermore, the prevalence of overweight and obese women of childbearing age is rising, with a large proportion of Taiwanese women gaining more than the recommended weight during pregnancy (Kac et al., 2004a, Kac et al., 2004b; Walker et al., 2005; Huang and Dai, 2007).

Recommended gestational weight gain (GWG) is associated with optimal fetal and maternal outcomes, whereas excessive weight gain increases the risk of pregnancy complications, infant macrosomia and caesarean birth (Abrams et al., 2000). Excessive GWG is also one of the main factors explaining high postpartum weight retention (Gunderson and Abrams, 2000; Siega-Riz et al., 2004; Huang and Dai, 2007; Kinnunen et al., 2007a, Kinnunen et al., 2007b; Huang et al., 2010). The GWG recommended by the Department of Health in Taiwan is 10–14 kg regardless of body size.

The transition to motherhood offers an opportunity to study weight concerns and weight management strategies during a period of weight fluctuation that is part of a life transition for many women. Pregnancy marks the beginning of a life stage in which women think not only of their nutritional needs and weight goals, but also of the needs of their child. During pregnancy, women were found to decrease their exercise and be more liberal with their diet, and during the postpartum period, they delayed returning to their pre-pregnancy diet and exercise practices (Devine et al., 2000).

In the postpartum period, weight retention has been associated with disappointment, surprise, symptoms of eating disorders, reduced self-esteem and depressive symptoms (Devine et al., 2000; Huang and Dai, 2007). Dissatisfaction with weight following childbirth has been positively associated with pre-pregnancy body mass index (BMI), GWG and postpartum BMI (Walker, 1998; Huang and Dai, 2007), as well as with greater long-term weight gain (Harris et al., 1997). Lifestyle factors related to excessive weight gain, eating behaviours and physical activity have played a major role in preventing and treating the overweight and obese (Wing et al., 2001). However, the role of diet and physical activity as determinants of GWG is still unclear (Siega-Riz et al., 2004; Kinnunen et al., 2007a, Kinnunen et al., 2007b). Nonetheless, behavioural interventions are needed to advise pregnant women on the recommended ranges of GWG, and to promote healthy diet and regular physical activity to prevent subsequent obesity and associated health problems (Siega-Riz et al., 2004; Huang and Dai, 2007; Kinnunen et al., 2007a, Kinnunen et al., 2007b; Huang et al., 2010). To reduce excessive weight gain in pregnancy and during the postpartum period, 15 intervention studies have been conducted in the past decade (Leermakers et al., 1998; Gray-Donald et al., 2000; Rae et al., 2000; Peterson et al., 2002; Polley et al., 2002; O’Toole et al., 2003; Olson et al., 2004; Stotland et al., 2005; Althuizen et al., 2006; Hui et al., 2006; Artal et al., 2007; Kinnunen et al., 2007a, Kinnunen et al., 2007b; Claesson et al., 2008; Onwude, 2008; Wolff et al., 2008). Of these studies, three provided postpartum interventions (Leermakers et al., 1998; Peterson et al., 2002; O’Toole et al., 2003), and only one study targeted all women (not only overweight/obese women) (Hui et al., 2006). Evidence to date does not clearly illustrate the most appropriate time to prevent weight retention. Furthermore, clinicians face the dilemma of whether to target women who are already overweight or obese, or those who are normal weight. The authors' previous findings indicated that women who were underweight before pregnancy were at risk of excessive GWG and weight retention (Huang and Dai, 2007). Therefore, GWG within the recommended range should be for all women, not just for those who are overweight or obese.

The aim of this study was to examine and compare the effect of individual counselling about diet and physical activity on childbearing women during two periods: from pregnancy through to six months post partum, and from birth through to six months post partum.