Diet Quality and Weight Change among Overweight and Obese

Postpartum Women Enrolled in a Behavioral Intervention Program

Spenser ParkerSeptember 20 2013

Wiltheiss et al., 2013 pp.54-62

AbstractThe prevalence of obesity has doubled and women

with excessive weight retention after giving birth are at a higher risk for being overweight and obese. 400 overweight/obese women from North Carolina participated in the KAN-DO-Kids and Adults Now Defeat Obesity randomized control trial. The objective was to promote healthy weight by improving dietary and physical activity habits in preschool children of overweight or obese mothers. Also to improve diet and physical activity habits of mothers to promote postpartum weight loss. Results included no difference between intervention and control group. Women with lower BMI, a higher income, and breastfeeding had a healthier diet quality during the early postpartum period.

BackgroundPrevalence of obesity more than doubled last 20

years

Women of childbearing years are particularly high risk for becoming overweight or obese

Almost of half of pregnant women gain more weight during pregnancy than recommended

Excessive weight gain during pregnancy is associated with higher postpartum weight retention

Excessive weight retention can lead to higher pregnancy weight, not breastfeeding, etc.

Wiltheiss et al., 2013 pp.54-62

Gore et al., 2003 pp.149-159

Review of ResearchGore et al reviewed role of pregnancy in the

effect of weight retention in postpartum women. Minority groups tended to have an increase in

weight retentionPre-pregnancy weight and excessive gestational

weight had the most effect on weight retentionOther factors like depression, family stress, low

income have shown to effect postpartum weight Interventions should focus on caloric restriction,

behavioral therapy, and exercise to be the most effective

Lyu et al., 2009 pp.1828-37

Review of ResearchLyu et al. examined dietary intake and weight

history from a prospective study from early pregnancy to 1 year postpartum

151 pregnant mothers from Taiwan participated

Gestational weight gain had a significant positive correlation with weight retention. (r 0.54 @ 6 months, r 0.44 @ 1 year p<.05)

Showed that women should control the amount of weight gain during gestational to decrease the weight retention in postpartum

Pruett et al. 2011, pp.100-30; Kim et al., 2008, pp.595-600; Hilton et al., 2001, pp.1430-37

Review of ResearchOther articles have stated:

Exercise is effective after postpartum in weight loss and should be started during pregnancy to create a habit.

Kim et al. suggested that initial BMI taken at first doctors visit, can be a predictor for postpartum weight retention up to 6 months.

Hilton & Olson showed that successful interventions will be those that increase behavior specific self-efficacy through mastery experiences. For example Dietitians can strengthen exercise self-

efficacy by helping postpartum mothers set realistic goals.

Wiltheiss et al., 2013 pp.54-62

ObjectiveKAN-DO (Kids and Adults Now-Defeat Obesity)

Primary aims of the study-promote healthy weight by improving dietary and physical activity habits in preschool children of overweight and obese mothers

Secondary aims were to improve diet and physical activity habits of mothers to promote postpartum weight loss.

Wiltheiss et al., 2013 pp.54-62

Participants400-Overweight/Obese postpartum mothers

Recruited from 14 counties in Piedmont region in North CarolinaCriteria to meet

Self-reported pre-pregnancy and baseline of >25 BMIHaving given birth in the last 6 monthsHaving another child age 2-5 yearsEnglish speaking18 years or olderNo medical conditions preventing daily physical activityAccess to telephone and mailing address

Wiltheiss et al., 2013 pp.54-62

MethodsHeight and weight was measured before and after

intervention (2-7 postpartum for entry and end of intervention which was approx. 10 months postpartum)

Lactation and Depression status addressed 0-24 scale on lactation Edinburgh Postnatal Depression Scale (score of 13)

Dietary recall Telephone interviews using multiple pass 24 hour recall

method In-person visit used drawings of food items to help identify

portion sizes

Wiltheiss et al., 2013 pp.54-62

InterventionParticipants randomly assigned to intervention

received eight monthly educational kits via mailKits included

Stress management and parentingPromoted positive healthy changes in the homeEncouraged healthy behaviors in mothers and

children3 kits focused on making changes related dietary

habits

Participants received a 20-30 minute telephone call from a trained health coach to review each kit and address motivation to change or barriers

Strength of ArticleThere was no bias in the study

The sample size in the study was large, but was only women that spoke english

There wasn’t strong evidence either way of a relationship or not

There could be some generalizability in the article.

I would give this article a grade Fair.

Wiltheiss et al., 2013 pp.54-62

Statistical Analysis Data was analyzed two ways

Cross-sectional analysis of baseline measurements Longitudinal analysis of those participants that completed the

full study

Analysis of variance was used to assess the relationships between dietary quality (HEI-healthy eating index 2005)

Pearson’s and Spearman’s correlation analyses was used to assess the relationship between weight change, HEI score, & lactation score

Change in HEI score between intervention and control was compared to find determine whether mothers in intervention significantly improved dietary quality.

Wiltheiss et al., 2013 pp.54-62

Results 392 of the 400 completed

3 significant predictors in HEI scores BMI Lactation Household income

Higher dietary quality at baseline correlated with a greater weight loss (p<.01)

Baseline energy intake and weight change (p<.01)

Women who breastfeed more intensity showed a significant higher energy intake at baseline (p<.002) but at follow up there was no change in groups

No difference between intervention and control group in dietary quality change

Wiltheiss et al., 2013 pp.54-62

DiscussionWomen in the intervention did not significantly

change dietary quality

Only BMI, lactation, and household income significantly impacted HEI scoresSuggests that those with higher income and

breastfeed choose healthy dietStill not fully clear

Women who stayed home lost less weight than those that worked full time

Wiltheiss et al., 2013 pp.54-62

ConclusionAmong overweight and obese women those with

higher income and breastfeed had a healthier diet quality.

Women who breastfeed with higher intensity or longer duration lost more than weight from birth to 5 months than other groups and consumed more energy than other groups

No differences between intervention and control arms in change in energy intake, diet quality, or weight from baseline to follow up

Wiltheiss et al., 2013 pp.54-62

To look aheadTo better assist women the focus should be on

reducing total energy intake

If overweight and obese women are encouraged to breastfeed then accurate information on how many extra calories are needed

This intervention focused on parenting, improving family dietary intake, and increasing physical activity and showed no significant findings.Results suggest that reduced energy intake may be

the best emphasis of future postpartum weight loss interventions.

Food for ThoughtWhat are ways to encourage women to not gain

excessive weight during pregnancy?

What would be your recommendation for a postpartum mother that wants to lose weight?How many calories would you decrease?

Where do you think the research should go from here?

References Gore, S. A., Brown, D. M., & West, D. S. (2003). The role of postpartum weight

retention in obesity among women: A review of the evidence. Annals of Behavioral Medicine, 26(2), 149-159.

Hilton, P. S., Olson, C. M. (2001). Postpartum exercise and food intake: The importance of behavior-specific self-efficacy. Journal of the American Dietetic Association, 101(12), 1430-37.

Kim, K.-H., Kim, Y. J., Lee, S., Oh, S. W., Lee, K., Park, Y., & Kim, H. J. (2008). Evaluation of plasma leptin levels & BMI as predictor of postpartum weight retention. Indian Journal of Medical Research, 128(5), 595-600.

Lyu, L.-C., Lo, C.-C., Chen, H.-F., Wang, C.-Y., & Liu, D.-M. (2009). A prospective study of dietary intakes and influential factors from pregnancy to postpartum on maternal weight retention in Taipei, Taiwan. British Journal of Nutrition, 102, 1828-37. doi:10.1017/S0007114509991243

Pruett, M. D., & Caputo, J. L. (2011). Exercise guidelines for pregnant and postpartum women. Strength and Conditioning Journal, 33(3), 100-03.

Wiltheiss, G. A., Lovelady, C. A., West, D. G., Brouwer, R. J. N., Krause, K. M. & Ostbye, T. (2013). Diet quality and weight change among overweight

and obese postpartum women enrolled in a behavioral intervention program. Journal of the Academy of Nutrition and Dietetics, 113(1), 54-62.