To examine changes in intake across food groups during a weight loss trial that produced significant and sustainable weight loss in lactating women receiving dietary treatment.
At 10-14 wk postpartum, 61 overweight and obese lactating Swedish women were randomized to a 12-wk dietary (D), exercise (E), combined (DE), or control (C) treatment. Food intake was assessed by 4-d weighed diet records which were used to examine changes in intake across seven food groups from baseline to 12 wk and 1 y after randomization. Differences in changes in food choice between women receiving dietary treatment (D+DE) and no dietary treatment (E+C) were examined using multivariate linear regression.
At baseline, sweets and salty snacks contributed to 21±10 percent of total energy intake (E%). During the intervention period, women receiving dietary treatment reduced their E% from sweets and salty snacks and caloric drinks and increased their E% from vegetables more than did women not receiving dietary treatment (all P?
Pregnancy has been identified as a contributor to obesity. We have shown that a diet intervention postpartum produced a 2-y weight loss of 8%. Here, we present the impact of the diet intervention on cost-effectiveness and explore changes in quality of life (QOL).
A total of 110 postpartum women with overweight/obesity were randomly assigned to diet (D-group) or control (C-group). D-group received a 12-wk diet intervention within primary health care followed by monthly emails up to the 1-y follow-up. C-group received a brochure. Changes in QOL were measured using the 36-item Short Form Health Survey and EQ-5D. The analysis of cost-effectiveness was a cost-utility analysis with a health care perspective and included costs of intervention for stakeholder, quality-adjusted life-years (QALYs) gained and savings in health care. The likelihood of cost-effectiveness was examined using the net monetary benefit method.
The D-group increased their QOL more than the C-group at 12 wk. and 1 y, with pronounced differences for the dimensions general health and mental health, and the mental component summary score (all p?
Overweight and obesity among young, adult women are increasing problems in Sweden as in many other countries. The postpartum period may be a good opportunity to improve eating habits and lose weight in a sustainable manner. The aim was to make a cost-utility analysis of a dietary behavior modification treatment alongside usual care, compared to usual care alone, among lactating overweight and obese women.
This study was a cost-utility analysis based on a randomized controlled and longitudinal clinical diet intervention. Between 2007-2010, 68 women living in Sweden were, after baseline measurement at 8-12 weeks postpartum, randomly assigned to a 12-week dietary behavior modification treatment or control group. Inclusion criteria were: self-reported pre-pregnancy body mass index (BMI) 25-35 kg/m2, non-smoker, singleton term delivery, birth weight?>?2500 g, intention to breastfeed for 6 mo and no diseases (mother and child). The women in the intervention group received 1.5 hour of individual counseling at study start and 1 hour at follow-up home visits after 6 weeks of intervention, with support through cell phone text messages every two wk. Dietary intervention aimed to reduce dietary intake by 500 kcal/day. The control group received usual care. Weight results have previously been reported. Here we report on analyses carried out during 2012-2013 of cost per quality adjusted life years (QALY), based on the changes in quality of life measured by EQ-5D-3 L and SF-6D. Likelihood of cost-effectiveness was calculated using Net Monetary Benefit method.
Based on conservative assumptions of no remaining effect after 1 year follow-up, the diet intervention was cost-effective. Costs per gained QALY were 8 643 - 9 758 USD. The likelihood for cost-effectiveness, considering a willingness to pay 50 000 USD for a QALY, was 87-93%.
The diet intervention is cost-effective.
ClinicalTrials.gov Identifier: NCT01343238 Registered April 27, 2011.The regional ethics committee in Gothenburg, Sweden, approved the study on November 15, 2006.
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Current evidence suggests a combined treatment of postpartum weight loss of diet and exercise. However, to our knowledge, neither their separate and interactive effects nor long-term outcomes have been evaluated.
We evaluated whether a 12-wk dietary behavior modification (D) treatment to decrease energy intake, physical exercise behavior modification (E) treatment to implement moderate aerobic exercise, or combined dietary and physical exercise behavior modification (DE) treatment compared with control (usual care) (C) reduces body weight in lactating women measured at the end of treatment and at a 1-y follow-up 9 mo after treatment termination.
At 10-14 wk postpartum, 68 lactating Swedish women with a prepregnancy BMI (in kg/m²) of 25-35 were randomly assigned to D, E, DE, or C groups. Measurements were made at baseline, after the intervention, and again at a 1-y follow-up 9 mo later. A 2 × 2 factorial approach was used to analyze main and interaction effects of treatments.
Weight changes after the intervention and 1-y follow-up were -8.3 ± 4.2 and -10.2 ± 5.7 kg, respectively, in the D group; -2.4 ± 3.2 and -2.7 ± 5.9 kg, respectively, in the E group; -6.9 ± 3.0 and -7.3 ± 6.3 kg, respectively, in the DE group; and -0.8 ± 3.0 and -0.9 ± 6.6 kg, respectively, in the C group. The main effects of D treatment, but not of E treatment, on weight were significant at both times (P
Reproduction has been identified as an important factor for long-term weight gain among women. A previous efficacy trial has successfully produced postpartum weight loss; however, the effectiveness of this intervention needs to be established.
This study was designed to evaluate the short- and long-term effectiveness of a diet behavior modification treatment to produce weight loss in postpartum women within the primary health care setting in Sweden.
During 2011-2014, 110 women with a self-reported body mass index (BMI; in kg/m(2)) of =27 at 6-15 wk postpartum were randomly assigned to the diet behavior modification group (D group) or the control group (C group). Women randomly assigned to the D group (n = 54) received a structured 12-wk diet behavior modification treatment by a dietitian and were instructed to gradually implement a diet plan based on the Nordic Nutrition Recommendations and to self-weigh =3 times/wk. Women randomly assigned to the C group (n = 56) were given a brochure on healthy eating. The primary outcome was change in body weight after 12 wk and 1 y. The retention rate was 91% and 85% at 12 wk and 1 y, respectively.
At baseline, women had a median (1st, 3rd quartile) BMI of 31.0 (28.8, 33.6), and 84% were breastfeeding. After 12 wk, median weight change in the D group was -6.1 kg (-8.4, -3.2 kg) compared with -1.6 kg (-3.5, -0.4 kg) in the C group (P
The increase in overweight and obesity among women is a growing concern, and reproduction is associated with persistent weight gain. We have shown that dietary behavioural modification treatment, with or without exercise, results in weight loss and maintenance of weight loss. The aim of this study was to provide an explanatory model of how overweight and obese women achieve weight loss during, and after, participating in a post-partum diet and/or exercise intervention. Using Grounded Theory, we performed and analysed 29 interviews with 21 women in a 12-week Swedish post-partum lifestyle intervention with a 9-month follow-up. Interviews were made after the intervention and at the 9-month follow-up. To overcome initial barriers to weight loss, the women needed a 'Catalytic Interaction' (CI) from the care provider. It depended on individualised, concrete, specific and useful information, and an emotional bond through joint commitment, trust and accountability. Weight loss was underpinned by gradual introduction of conventional health behaviours. However, the implementation depended on the experience of the core category process 'Transformative Lifestyle Change' (TLC). This developed through a transformative process of reciprocal changes in cognitions, emotions, body, environment, behaviours and perceived self. Women accomplishing the stages of the TLC process were successful in weight loss, in contrast to those who did not. The TLC process, dependent on initiation through CI, led to implementation and integration of recognised health behaviours, resulting in sustainable weight loss. The TLC model, including the CI construct and definition of barriers, facilitators and strategies provides an explanatory model of this process.
We recently reported that a 12-week diet intervention among postpartum women produced a weight loss of 12% after 1 year, compared to 5% in controls. Here, we present 2-year results after 1 year of unsupervised follow-up. In total, 110 women with a self-reported body mass index of =27 kg/m2 at 6-15-week postpartum were randomized to diet group (D-group) or control group (C-group). D-group received a 12-week diet intervention by a dietitian followed by monthly e-mails up to the 1-year follow-up. C-group received a brochure on healthy eating. No contact was provided from 1 to 2 years to either group. Eighty-nine women (81%) completed the 2-year follow-up. Median (1st; 3rd quartile) weight change from 0 to 2 years was -6.9 (-11.0; -2.2) kg in D-group and -4.3 (-8.7; -0.2) kg in C-group. There was no group by time interaction at 2 years (p = .082); however, when women with a new pregnancy between 1 and 2 years were excluded, the interaction became significant (-8.2 vs. -4.6 kg, p = .038). From 1 to 2 years, women in D- and C-group gained 2.5 ± 5.0 kg and 1.1 ± 4.4 kg, respectively (p = .186). Women who gained weight from 1 to 2 years reported a decrease in self-weighing frequency compared to women who maintained or lost weight (p = .008). Both groups achieved clinically relevant 2-year weight loss, but the significant between-group-difference observed at 1 year was not maintained at 2 years in the main analysis. However, when women with a new pregnancy between 1 and 2 years were excluded, a significant weight loss effect was observed also at 2 years.