Pregnant Women with Obesity Have Unique Perceptions About Gestational Weight Gain, Exercise, and Support for Behavior Change

Abstract

Introduction Prepregnancy obesity and excessive gestational weight gain (GWG) pose health risks to woman and fetus, yet gestational weight management interventions are largely unsuccessful. Little research examines the perceptions of women with obesity about weight gain and exercise. Although women with obesity have different body habitus and life experiences, most studies combine overweight and obese women into one group. Methods We conducted 3 focus groups with pregnant women with obesity to determine perceptions of GWG, exercise, and a proposed behavioral intervention. Results Seventeen women participated in the focus groups including 6 at a birth center and 11 at a federally qualified health center. A key finding was that women with obesity felt stigmatized and perceived pregnancy as a refuge from fat shaming. Participants viewed risks associated with excessive GWG as exaggerated and instead deemed self‐assessments of how they feel and look as more reliable measures of maternal and fetal health. Participants reported that quality rather than quantity of food promotes pregnancy health and that restrained eaters put their fetuses at risk. Knowledge gaps emerged related to dissatisfaction with counseling about weight gain guidelines. Although physical activity was endorsed, participants voiced safety concerns about exercise during pregnancy and instead favored walking and routine daily activity. Goal setting, positive messaging, and positive reinforcement were identified as favorable aspects of the proposed behavioral intervention. Discussion Pregnant women with obesity share other pregnant women's perceptions about weight gain and exercise in pregnancy but also have unique perceptions. Pregnant women with obesity in this study reported feeling stigmatized and fearful of being shamed by their health care providers but paradoxically eager for guidance. The findings offer implications for health care counseling and GWG interventions for this population.

Physical Activity Counseling Received Throughout Pregnancy: Effect on Behaviors: A Quasi-experimental Study.

“…Our results are in line with recent ndings, notably the intervention effect in prenatal care and goal setting as favorable to physical activity behaviors in overweight women [23,24]. A signi cant difference in sedentary physical activity was observed in the pre-pregnancy overweight women.…”

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.…”

“…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.…”

Identifying target behaviors for weight management interventions for women who are overweight during pregnancy and the postpartum period: a qualitative study informed by the Behaviour Change Wheel

“…Some of the women spoke about negative experiences during previous health care encounters due to their being overweight. Previous studies have also reported similar findings; discussing weight during antenatal visits can be stigmatizing and can make women less receptive to advice or support [ 12 , 28 ]. These experiences might inhibit women from accepting any attempts to intervene in their weight situation or provide weight management support.…”