Attitudes and beliefs in Swedish midwives and obstetricians towards obesity and gestational weight management

Abstract

Background Gestational weight interventions are important in maternity care to counteract adverse pregnancy events. However, qualitative findings indicate potential obstacles in the implementation of interventions due to the sensitivity of the subject and existing obesity stigma. Pregnant women have reported disrespectful or unhelpful communication, while some midwives seem to avoid the topic, as not to upset women. This descriptive study aimed to provide knowledge about maternity care providers’ beliefs about obesity, and their attitudes towards gestational weight management. Method A web survey was emailed to Swedish maternity care clinics. Existing questionnaires, “Beliefs About Obese People” (BAOP), “Perceived weight bias in health care” and “Attitudes toward obese patients” was used, supplemented with questions formulated for this study. An open free-text question allowed participants to provide a deeper and more nuanced picture of the topic. Results 274 respondents (75% midwives and 25% obstetricians) participated. One third of respondents found obesity to be a more sensitive topic than smoking or alcohol habits, and 17% of midwives agreed to the statement: “I sometimes avoid talking about weight so as not to make the pregnant woman worried or ashamed”. Having had training in motivational interviewing seemed positively associated with midwives’ inclination to talk about body weight, especially with women with obesity (p = .001), whereas years of working experience were not associated. Having received obesity education increased confidence in providing adequate information, but still only 46% felt they had enough knowledge to provide diet and exercise advice to pregnant women with obesity. Qualitative data revealed great empathy for women with obesity, and a wish to have more obesity education and access to other professionals. Conclusion Swedish maternity care staff displayed empathy for women with obesity and found gestational weight interventions important, but almost one fifth of midwives sometimes avoid the subject of body weight for fear of upsetting women. Education about obesity facts, training in person-centered communication, i.e. motivational interviewing, and access to dieticians may facilitate gestational weight management implementation.

Predicting the earliest deviation in weight gain in the course towards manifest overweight in offspring exposed to obesity in pregnancy: a longitudinal cohort study

“…We found that among such obesity-associated factors, those relating to intrauterine overnutrition including excessive GWG contributed strongly to higher-than-normal BMI growth during the “plastic phase” of the first 2 years. Indeed, there is a need for women with obesity to be provided with more customized advice on dietary intake and physical activity to optimize gestational weight management [ 24 , 79 ]. For the subsequent time period of the preschool years, gestational smoking emerged as a relevant modulator of growth in offspring exposed to obesity in pregnancy in our study.…”

Exploring weight bias internalization in pregnancy

“…Causal factors of weight stigma in healthcare have included receiving judgement about excessive weight gain, getting generic advice about being physically activity and eating well, and sensing healthcare provider discomfort when having weight-related conversations [ 39 ]. Studies that have explored perspectives of maternal healthcare providers caring for patients who have obesity confirm that there is discomfort when measuring or discussing weight [ 23 , 40 ]. Interestingly, guidelines for GWG management and obesity in pregnancy largely ignore the potential role weight stigma may have on patient experience, and do not suggest evaluating or caring for WBI [ 19 ].…”

Drivers and facilitators of weight stigma among preconception, pregnant, and postpartum women: A systematic review

“…Of the 34 included studies, 26 studies used a qualitative study design and six studies were quantitative studies. 2,5,6,[59][60][61] One study was a survey with a qualitative data collection method, 62 and one was a framework synthesis of newsprint media. 31 The majority of the studies (n = 24) included either preconception, pregnant, or postpartum women as study participants, 2,5,6,33,34,36,38,39,41,42,[44][45][46][47][48][49][50][51][54][55][56][57]62,63 investigating perspectives of weight stigma either cross-sectionally or retrospectively.…”

“…31 The majority of the studies (n = 24) included either preconception, pregnant, or postpartum women as study participants, 2,5,6,33,34,36,38,39,41,42,[44][45][46][47][48][49][50][51][54][55][56][57]62,63 investigating perspectives of weight stigma either cross-sectionally or retrospectively. Six studies included health professionals, 37,40,52,58,59,61 and three studies included both preconception, pregnant, or postpartum women and health professionals. 35,53,60 Two studies reviewed news articles for weight stigma focused on pregnant or postpartum women living with obesity 6,31 (Table S8).…”