A Systematic Review Investigating Healthy Lifestyle Interventions Incorporating Goal Setting Strategies for Preventing Excess Gestational Weight Gain

Abstract

BackgroundExcess gestational weight gain (GWG) is an important risk factor for long term obesity in women. However, current interventions aimed at preventing excess GWG appear to have a limited effect. Several studies have highlighted the importance of linking theory with empirical evidence for producing effective interventions for behaviour change. Theorists have demonstrated that goals can be an important source of human motivation and goal setting has shown promise in promoting diet and physical activity behaviour change within non-pregnant individuals. The use of goal setting as a behaviour change strategy has been systematically evaluated within overweight and obese individuals, yet its use within pregnancy has not yet been systematically explored.Aim of reviewTo explore the use of goal setting within healthy lifestyle interventions for the prevention of excess GWG.Data collection and analysisSearches were conducted in seven databases alongside hand searching of relevant journals and citation tracking. Studies were included if interventions used goal setting alongside modification of diet and/or physical activity with an aim to prevent excess GWG. The PRISMA guidelines were followed and a two-stage methodological approach was used. Stage one focused on systematically evaluating the methodological quality of included interventions. The second stage assessed intervention integrity and the implementation of key goal setting components.FindingsFrom a total of 839 citations, 54 full-text articles were assessed for eligibility and 5 studies met the inclusion criteria. Among interventions reporting positive results a combination of individualised diet and physical activity goals, self-monitoring and performance feedback indicators were described as active components.ConclusionInterventions based on goal setting appear to be useful for helping women achieve optimal weight gain during pregnancy. However, overweight and obese women may require more theoretically-designed interventions. Further high quality, theoretically-designed interventions are required to determine the most effective and replicable components for optimal GWG.

Position of the Academy of Nutrition and Dietetics: Obesity, Reproduction, and Pregnancy Outcomes

“…The following supporting strategies are commonly utilized in effective studies: goal setting, regular weight monitoring, use of weight-gain graphs to visualize weight gain, verbal feedback on success toward goals, and self-monitoring of diet and PA through the use of food and/or PA records, pedometers, and food scales. 72 Increases in frequency of contact when failing to meet goals, either through phone contact, postcards, or in person, have been recommended to increase success. It has been suggested that obese women may respond to individualized goal setting more than approaches that include less-personal engagement.…”

“…It has been suggested that obese women may respond to individualized goal setting more than approaches that include less-personal engagement. 72 A randomized controlled trial of 425 pregnant women with a BMI !30 who were randomly assigned to one of two intervention groups or a control group assessed the primary outcome measure of gestational weight gain. 73 Secondary outcome measures of pregnancy complications and delivery and neonatal outcomes were also examined in this study.…”

“…93 Goal setting was found to be related to lower weight retention at 6 months postpartum. 72 The postpartum period can be a difficult time for women to participate in ongoing intervention studies, given the demands of motherhood. A review of postpartum weightintervention studies found that dropout rates ranged from 20% to >50% of enrolled participants.…”

Can a health coaching intervention delivered during pregnancy help prevent excessive gestational weight gain?

“…Several reviews have attempted to discern effective BCTs from GWG interventions, with provision of information on the consequences of behaviour to the individual, motivational interviewing, self-monitoring of behaviour, providing rewards contingent on successful behaviour (Hill et al, 2013a), and goal setting (Brown et al, 2012) potentially useful strategies to help women achieve optimal GWG. It is interesting to note that despite the inclusion of 11 BCTs in HIPP (see Skouteris et al, 2015), including BCTs that have previously been found to be effective, efficacy was not established in this study.…”

Use of a motivational interviewing-informed strategy in group orientations to improve retention and intervention attendance in a randomized controlled trial

“…The average retention rate across lifestyle intervention studies was $70% in various systematic reviews including intervention RCTs in primary care settings specifically [8][9][10][11]. The intervention attendance rates were not always reported in lifestyle intervention RCTs, although the information is critical for interpreting findings [11].…”