Friday, 13 March 2015

Overweight and obesity to perinatal women and their children

Jennifer Ohlendorf

I am an assistant professor in the Marquette University College of Nursing in Milwaukee, WI. Along with Dr Marianne Weiss and Dr Debra Oswald, I examined factors that are predictive of women participating in weight self-management behaviours after the birth of a baby (Olhedorf et al. 2015) in an article titled: ‘Predictors of engagement in postpartum weight self-management behaviours in the first 12 weeks after birth’ and published in JAN.

Risks of overweight and obesity to perinatal women and their children are well established. What is not well established is how providers can have an impact on that risk. Weight self-management is a process driven by a woman’s daily eating and physical activity behaviours. Providers cannot make daily choices for women, and thus must determine ways to exert influence over those behaviours during routine healthcare encounters.

In this study, we explored factors that might predict which women were more likely to engage in postpartum weight self-management (PPWSM) behaviours. Transitions Theory and the Integrated Theory of Health Behaviour Change guided selection of concepts for the study, including transition conditions and level of patient activation. Patient activation is a concept that measures one’s likelihood to actively manage a health condition – but has not been tested in a perinatal population to predict weight self-management behaviours.

Patients experiencing a difficult postpartum transition have lower activation levels; those with lower activation levels are less likely to engage in PPWSM behaviours. Providers should assess factors in women’s lives complicating their transition to motherhood, making them less able to actively engage in PPWSM behaviours. Next steps include testing whether activation-based interventions can be effective in promoting healthy PPWSM behaviours.

There are health risks for both mothers and babies that are associated with weight issues during pregnancy and during the postpartum period – In particular, there is good evidence that women who do not lose their pregnancy weight before the first postpartum year is up are more likely to be overweight or obese later in life. Our current models of prenatal care do not prioritize weight management among other health issues for all women; indeed, previous research I've done revealed that women were interested in weight management, but that their providers did not address it during their prenatal or postnatal care.

The U.S. Institute of Medicine has stated that all providers should be counselling all pregnant and postnatal women regarding healthy weight gain in pregnancy, and also about ways to prevent retention of weight gained after the birth of the baby. This research recognizes the fact that weight management is a self-management process—providers cannot directly manage this process because women make their own eating and physical activity choices each day. There are many programmatic studies looking at ways to help women lose their pregnancy weight, but there is a gap in the literature around processes women use to self-manage weight. Of particular interest to us is the possibility of developing effective ways that providers could influence the behaviours of women self-managing their weight to promote healthy eating and physical activity to ultimately have an effect on weight status.

In this study, we selected concepts from both Transitions Theory and the Integrated Theory of Health Behaviour Change in order to determine factors that would predict women’s engagement in healthy eating and physical activity behaviours after their baby was born. Included in the predictors was a concept – patient activation – which refers to an individual’s tendency to be an active participant in managing their health condition. Previously, patient activation had been used among adults with an illness to study. This was the first study examining patient activation in a healthy population to determine its relationship to health promotion behaviours.

We predicted that transition difficulty and patient activation would predict engagement in weight self-management behaviours, and that social support and social influence would moderate that relationship. Women (n=124) were enrolled during their post-birth hospitalization, and completed surveys that day and by phone 6 and 12 weeks.

We found that transition difficulty was negatively associated with patient activation – that is, that women with higher levels of difficulty were less activated for postpartum weight self-management; further, patient activation was positively associated with engagement in the behaviours – so, women with higher patient activation had healthier eating behaviours and reported more minutes of physical activity. Neither social support nor social influence moderated that relationship. Analysis of social influence in this sample revealed that women reported that their providers and hospital nurses were as influential over their health behaviours as their mothers and significant others.

Clinically, we now know that providers must consider a woman’s context if they intend to influence her weight self-management behaviours. It appears that nurses and providers must use their influence to address things that are making the postpartum transition difficult so that women will be able to spend energy on weight self-management behaviours.

Our next steps will be to test the interventions tailored to activation level to determine whether they can be effective in this population to promote engagement in weight self-management behaviours.

Jennifer M. Ohlendorf, PhD RN
Marquette University, Milwaukee, Wisconsin, USA


Ohlendorf JM, Weiss ME, Oswald D (2015) Predictors of engagement in postpartum weight self-management behaviours in the first 12 weeks after birth Journal of Advanced Nursing doi: 10.1111/jan.12640

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