Supporting postpartum weight loss in women living in deprived communities: design implications for a randomised control trial

Abstract

BackgroundPregnancy is a life stage where excess weight gain may occur and the postpartum period is often characterised by weight retention. The aim of the current study was to evaluate the feasibility of undertaking a randomised controlled trial of a weight loss intervention (WeighWell) in postpartum women living in areas of social disadvantage.Subjects and methodsThe study aimed to recruit 60 women who were not pregnant, 6-18 months postpartum with a BMI >25kg/m2 living in areas of deprivation within Tayside, UK. Recruitment strategies focused on visits to community groups; writing directly to postpartum women living in areas of deprivation and primary care teams who covered the most deprived 15% of the population and advertising in community settings. The 12 week intervention used motivational interviewing techniques to promote an energy deficit diet and increased physical activity, delivered by 3 face to face consultations plus 3 structured telephone calls.ResultsOf 142 women screened, 63 were eligible and 52 (83%) were recruited and randomised to an intervention (n=29) or comparison group (n=23). Over the 12 week intervention, body weight changed significantly by −1.6 ± 2.0kg in the intervention group compared to +0.2 ± 2.2kg in the comparison group indicating the potential efficacy of the intervention. Loss to follow-up was 24% in the intervention group and 39% for the comparison group.ConclusionsThe findings support the development of a definitive trial that embraces personalised recruitment strategies and the development of approaches to improve retention over a clinically relevant intervention period.

The effects of physical activity and physical activity plus diet interventions on body weight in overweight or obese women who are pregnant or in postpartum: A systematic review and meta-analysis of randomized controlled trials

“…An intention-to-treat analysis was performed in three studies with pregnant women (Barakat et al, 2009; Phelan et al, 2011; Polley et al, 2002) and one study with postpartum women (Østby et al, 2009). Retention rates were less than 80% for one study (Guelincks et al, 2010) with pregnant women and three studies with postpartum women (Craigie et al, 2011; Østby et al, 2009; Walker et al, 2011). …”

“…Four studies of the 7 studies with pregnant women clearly reported methods used to generate the concealed allocation in the participant randomization assignment (Barakat et al, 2009; Nascimento, et al, 2011; Phelan,et al, 2011; Vinter, et al, 2011), and none of the 4 studies with postpartum women clearly described those procedures. Blinded assessment was done in two studies with pregnant women (Barakat et al, 2009; Phelan, et al, 2011) and one study with postpartum women (Craigie et al, 2011). An intention-to-treat analysis was performed in three studies with pregnant women (Barakat et al, 2009; Phelan et al, 2011; Polley et al, 2002) and one study with postpartum women (Østby et al, 2009).…”

Low rate of initiation and short duration of breastfeeding in a maternal and infant home visiting project targeting rural, Southern, African American women

“…However, the rates reported in the current study are similar to those reported in previous nutrition and/or physical activity interventions with postpartum women. Retention rates ranged from 69% in a 12-week counseling intervention [31] to 38% in a 12-month facilitated discussion group with personalized feedback on self-monitoring intervention [32]. …”

Identifying content-based and relational techniques to change behaviour in motivational interviewing

“…For example, a meta-analysis of 72 randomized controlled trials using MI in health related contexts revealed that it was more effective in improving both behavioral and health related outcomes relative to usual care in 80% of studies (Rubak et al, 2005). However, despite the evidence in support of MI interventions in changing health-related behavior, there are studies that have shown null findings on health behavior change for MI-based interventions (Craigie, Macleod, Barton, Treweek, & Anderson, 2011;Greaves et al, 2008). Resolving these inconsistencies presents a challenge to researchers attempting to evaluate the value of adopting MI as a possible approach to use when designing behavior change interventions and makes understanding of the exact processes and mechanisms that underpin MI's effectiveness an imperative.…”