“…or else I close my ears” How women with obesity want to be approached and treated regarding gestational weight management: A qualitative interview study

Abstract

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.

Identifying Target Behaviors for Weight-management Interventions in Overweight Women during Pregnancy and the Postpartum Period: A Qualitative Study Informed by the Behaviour Change Wheel

“…This con ict could be due to overly general counseling or having too many issues to discuss during antenatal visits. Previous qualitative interview studies reported inconsistent advice on weight management and knowledge gaps in diet or exercise recommendations during pregnancy, similar to our ndings [12,28]. A lack of skills needed to cook healthy meals and follow a healthy lifestyle was also identi ed.…”

“…Besides support from family, motivation was considered the most important aspect of weight management. In line with previous ndings, pregnancy was considered an opportunistic and motivating time to undertake positive lifestyle changes [31,12]. [12].…”

“…In line with previous ndings, pregnancy was considered an opportunistic and motivating time to undertake positive lifestyle changes [31,12]. [12]. Although women knew the consequences of their actions and wanted a healthier lifestyle for their children, they still used pregnancy as an excuse for unhealthy eating and inadequate exercise, and they did not want to take responsibility for their weight gain or lifestyles.…”

“…Some of the women had negative experiences during previous health care encounters due to their being overweight. Previous studies also reported similar ndings; discussing weight during antenatal visits can be stigmatizing and can make women less receptive to advice or support [27,28]. These experiences might inhibit women from accepting any attempts to intervene in their weight situation or provide weight management support.…”

“…Many women lack the knowledge and skills to manage their weight effectively. However, overweight women want information about the risks of obesity, and they want more information about and support for weight management during pregnancy and the postnatal period [10,11,9,12]. Furthermore, researchers have identi ed a range of effective interventions for weight management during pregnancy and postpartum period, but these interventions are di cult to implement in clinical practice [13,14].…”