• Postnatal women respond positively to attending commercial weight management groups, University of Warwick-led study finds
• Could help those who are overweight to lose weight in the first year after giving birth but further evidence is needed
• Many women struggle to lose weight gained before or during pregnancy
• Being overweight is associated with poorer health long-term for a woman and her baby and can impact likelihood of breastfeeding
• Researchers are now calling for a large-scale definitive clinical trial

Women who were overweight at the start of their pregnancy would welcome support after they have given birth in the form of commercial weight management groups, University of Warwick-led research has found.

The conclusions come from a feasibility study led by the Warwick Clinical Trials Unit and published in BJOG: An International Journal of Obstetrics and Gynaecology, which aimed to assess if commercial weight management groups could help women who were overweight (classed as a BMI of ≥25kg/m²) when they became pregnant to return to a more healthy weight after giving birth. This feasibility study, funded by the NIHR, aimed to determine whether it would be possible to recruit women to a future larger clinical trial of weight management programmes and if they were likely to see a benefit from attending.

The researchers found that women who attended weight management groups which they could start from 8 to 16 weeks after giving birth lost slightly more weight (around 3kgs) as assessed at 12 months postnatally, than those women not offered access to groups, with those who attended more of the 12 group sessions offered experiencing the greatest weight loss.

The researchers argue that this suggests that women could benefit in health terms from attending a commercially available weight management programme post pregnancy, and a larger clinical trial should now be conducted to determine the definitive health and other benefits of such a programme and the cost effectiveness to the health service.

To investigate whether a weight management programme could help women who’ve had a baby to better manage their weight, the researchers recruited 193 women with BMIs greater than 25 when they became pregnant and randomly assigned them to either a commercially available weight management group, in this case Slimming World, with a lifestyle information leaflet, or to receive standard NHS maternity care only. All women were recruited from a large inner city maternity unit in the South of England.

Lead author Professor Debra Bick, from the University of Warwick’s Clinical Trials Unit, said: “We now need to find out if commercial weight management programmes are both clinically effective and cost effective when offered to women who have given birth in the previous three to four months. While it is difficult to predict the economics in the long term, this could save money for the health service by preventing poor health in the long term. If we can confirm that commercial programmes are successful in a future clinical trial then this is an intervention that the NHS should seriously consider for women who are overweight or obese before pregnancy.”

Previous research has shown that commercial weight management programmes have been more effective in helping individuals with higher BMIs to lose weight than health service provided ones. In this study, the researchers made no changes to the weight management programme offered and found that the participants responded positively to the flexible timings, the opportunity to mix with other group attendees and the opportunity to take their babies with them. Women were able to attend 12 weekly sessions, with the support offered incorporating dietary advice suited to breastfeeding and promoting physical activity.

While women shouldn’t put pressure on themselves to lose weight after having a baby, we know that retaining weight is associated with poorer long-term health for the woman, and often leads to further weight gain in subsequent pregnancies. It is also known to reduce the likelihood of women breastfeeding and increase the likelihood of their child being obese*.

Professor Bick adds: “During pregnancy is the wrong time to attempt weight loss and post-pregnancy seems to be a better time to talk about women about their weight and longer term health. We found that women want advice and guidance on managing their weight after giving birth, but busy lifestyles make it difficult for lots of women. We also have to consider that weight management is not just a health issue – family commitments, food choices, budgets and need to return to paid employment are also factors which can influence women’s decisions about seeking support for weight management.

“If a postnatal woman is concerned about her weight, support is out there, including seeking advice from her GP. This feasibility trial has shown that we could recruit and follow up women who had higher BMIs to 12 months after giving birth. We also know more about how we could encourage women offered the intervention to attend all sessions offered as part of a weight management programme. A larger definitive trial will provide very important evidence on whether commercial weight management groups could be of benefit for women, their families and the NHS.”

Dr Cath Taylor, Reader in Healthcare Workforce Organisation and Wellbeing at the University of Surrey, said: “Maintaining a healthy diet and weight is important for all post-natal women, not only is it better for their overall wellbeing it enables them to be more active with their children and helps incorporate healthy habits and choices into their household.

“It is clear from our findings that weight management groups may be helpful for weight loss in postnatal women, which is beneficial to them and their families, however some are hesitant in starting and/or continuing with such programmes. We investigated the reasons for this and found that many barriers could be easily addressed, for example misconceptions about the safety of Slimming World whilst breastfeeding. We will address such barriers in our future study and thereby hope to further enhance uptake and retention, and thereby the benefits of the intervention.”

• ‘Lifestyle information and commercial weight management groups to support maternal postnatal weight management and positive lifestyle behaviour: the SWAN feasibility randomised controlled trial’ is published in BJOG: An International Journal of Obstetrics & Gynaecology, DOI: 10.1111/1471-0528.16043
• *’Breastfeeding experiences and support for women who are overweight or obese: A mixed-methods systematic review.’ Chang YS, Glaria AA, Davie P, Beake S, Bick D. Matern Child Nutr. 2019 Jun 25:e12865. doi: 10.1111/mcn.12865. [Epub ahead of print] Review

Ends

Notes to editors:

· Clinical guidance published by the Royal College of Obstetricians and Gynaecologists recommends that women lose weight before or after pregnancy, and particularly recommends between pregnancies to ensure the best possible outcomes: https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg72/

· Royal College of Obstetricians and Gynaecologists information leaflet for women on being overweight in pregnancy and after birth: https://www.rcog.org.uk/en/patients/patient-leaflets/being-overweight-pregnancy-after-birth/

 

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6 January 2020

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