IntroductionObesity in Sweden has doubled to 14% over the last 20 years. New strategies for treatment and prevention are needed. Excessive gestational weight gain has been found to contribute substantially to obesity, and there is a consistent association between postpartum weight retention and obesity later in life. We aimed to explore what factors women perceive as reasons for having substantial postpartum weight retention, to identify areas for new and improved interventions.MethodsQualitative interview study (semi-structured) using an emergent design. Fifteen women, with a postpartum weight retention ≥ 10 kg, were interviewed by a trained cognitive therapist. Eight women had pre-pregnancy BMI below 30 kg/m2. Interviews were transcribed verbatim and data analysed using inductive manifest content analysis. Salient text passages were extracted, shortened, coded and clustered into categories.ResultsParticipants reported no knowledge of current gestational weight gain recommendations or of risks for adverse pregnancy outcomes with excessive weight gain or postpartum weight retention. Excessive eating emerged as a common strategy to provide relief of psychological, emotional and physical discomfort, such as depression and morning sickness. Women perceived medical staff as being unconcerned about weight, and postpartum weight loss support was scarce or absent. Some women reported eating more due to a belief that breastfeeding would automatically lead to weight loss.ConclusionThere is a need to raise awareness about risks with unhealthy gestational weight development and postpartum weight retention in women of childbearing age. The common strategy to cope with psychological, emotional or physical discomfort by eating is an important factor to target with intervention. The postpartum year is a neglected period where additional follow-up on weight and weight loss support is strongly indicated.

Purpose While bariatric surgery generally shows successful weight loss outcomes in patients with obesity, weight regain exists. The aim of this qualitative study was to improve understanding of how patients with substantial weight regain after bariatric surgery experienced the support from family, friends, and healthcare providers, and what kind of support they had preferred. Materials and Methods Qualitative data were collected from semi-structured interviews with 16 participants. Mean weight regain from surgery to interview was 36%. The transcribed interviews were analyzed with thematic analysis. Results Two main themes and seven sub-themes were formulated. The theme, A lonely struggle, illustrates patients’ feelings of abandonment and struggle during weight regain due to lack of support or unfavorable treatment. Participants commonly blamed themselves for re-gaining weight, and shame made them reluctant to engage in social activities or seek medical care. The theme, Others as sources of compassion and control, covers what support they desired, as well as had perceived to be helpful. Exercising or eating healthy with others was appreciated and felt supportive. Pro-active healthcare support and access to dietitians, physiotherapists, and psychological support were desired. Conclusion To optimize the effect of bariatric surgery, support may need to be individualized and lifelong. Since shame and self-blame in patients with weight regain may hinder seeking professional help, care providers may need to initiate follow-up visits. Empathetic and non-judgmental support, access to multidisciplinary healthcare team, as well as peer-support groups may be beneficial to counteract weight regain post-bariatric surgery.

IntroductionThe importance of helping pregnant women maintain a healthy lifestyle and prevent excessive gestational weight gain is well recognized, but pregnant women do not always perceive communication about body weight as respectful or helpful. Furthermore, fear of inducing shame or guilt can prohibit some midwives from talking about body weight, especially if the woman has obesity. We aimed to explore what women of reproductive age with obesity regard to be the most important and relevant aspects when discussing gestational weight management.MethodsQualitative interview study using focus groups and individual semi-structured interviews with 17 women of reproductive age (19–39 y) with obesity. Thematic analysis was used to analyze the data.ResultsWe identified three themes: 1) Importance of obtaining vital medical information; 2) A wish to feel understood and treated with respect; 3) Midwives’ approach is crucial in sensitive key situations, which include bringing up the subject of body weight, weighing, providing weight-related information, coaching lifestyle modification, dealing with emotional reactions and ending a conversation.ConclusionsA majority of the interviewed women wished to receive information about risks about obesity and gestational weight gain, and recommendations on weight management. However, the risk of midwives offending someone by raising the topic may be increased if the pregnant woman believe that gestational weight gain is uncontrollable by the individual. Also, several situations during maternity care meetings can be stigmatizing and make women less receptive to advice or support. Women suggest that a good working alliance is likely to be achieved if midwives have knowledge about the causes of obesity, take interest in the patients’ background, have a non-judgmental approach and refrain from giving unsolicited advice.