Weight management in postpartum women - An Indian perspective

Spatial clustering of overweight/obesity among women in India: Insights from the latest National Family Health Survey

BACKGROUND

Overweight/obesity has become global health concern with increasing prevalence. This study examined district-level disparities and spatial clustering of overweight/obesity among women of reproductive age (WRA) in India using the latest National Family Health Survey-5 (2019-2021) data.

METHOD

Information of 623,656 women aged 15 to 49 from the NFHS-5 (2019-2021) were analysed in this study. The outcome variable was BMI as classified by the world health organisation (WHO). Utilising Global Moran's I, Anselin's Local Moran's I, and spatial regression models spatial clustering and associated factors were analysed.

RESULT

The study found that 24% (95% CI: 23.8-24.3) of WRA in India were overweight/obese in 2019-21. The prevalence was greatest in Punjab (41%) and lowest in Meghalaya (11%). Additionally, the Global Moran's I value for the outcome variable was 0.73, indicating a positive spatial autocorrelation in the overweight/obesity. Districts of Tamil Nadu, Andhra Pradesh, Karnataka, Kerala, Telangana, Punjab, Himachal Pradesh, Jammu & Kashmir, Haryana, and Delhi were hotspots of overweight/obesity. Several factors of overweight/obesity among WRA were identified, including place of residence (β: 0.034, p: 0.011), parity (β: 0.322, p: 0.002), social group (β: -0.031, p: 0.016), religion (β: -0.044, p: <0.001), household wealth status (β: 0.184, p: <0.001), mass-media exposure (β: 0.056, p: 0.031), and diabetes (β: 0.680, p: <0.001).

CONCLUSION

The study emphasizes the importance of targeted interventions and region-specific strategies, while also stressing the need to address associated factors to develop effective public health initiatives aimed at reducing overweight/obesity prevalence among WRA in India.

A Stepwise Approach to Prescribe Dietary Advice for Weight Management in Postpartum and Midlife Women

Weight retention and weight gain during the postpartum and midlife period subsequently increase the risk of chronic health conditions, thereby deteriorating the overall health. Dietary intervention is the pivotal component of sustainable weight management. However, in resource restricted settings, where dietitians may not be present, other healthcare professionals such as physicians, obstetricians, and paediatricians should play a vital role in providing timely weight management advice to these women. Therefore, this article provides dietary advice including the setting of realistic weight loss goals, identifying an individual's calorie needs, distribution of macronutrients and consideration of important micronutrients. Healthcare professionals can follow the stepwise approach to prescribe dietary advice to postpartum and midlife women for their weight management. Various dietary principles such as cultural and regional preferences of an individual, portion size, hypocaloric diets, nutrient-dense meals, eating habits, cultural beliefs and myths along with co-morbid conditions should be taken into consideration by healthcare professionals while providing the dietary prescription.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13224-022-01643-w.

Executive summary of evidence and consensus-based clinical practice guideline for management of obesity and overweight in postpartum women: An AIIMS-DST initiative

INTRODUCTION

Postpartum obesity is a public health concern. There is a need to counsel women about their postpartum weight management, accounting for various barriers they face. Limited literature in the Indian context underscored the need to develop the clinical practice guideline to be used by healthcare providers in Indian healthcare settings.

METHODS

The guideline was formulated by following the standardised methodology proposed by the National Health and Medical Research Council. Various steps such as identification of the patient population, assembly of the guideline development groups, identification of the key clinical questions, guideline development methods, grading the quality of evidence and recommendations and guideline translation were carried out to develop and validate the clinical practice recommendations.

RESULTS

The evidence and consensus-based clinical practice guideline has been developed, providing recommendations for key topics of interest for first-line treatment of obesity (lifestyle-related management). Recommendations focus on screening and initiating discussion with overweight and obese postpartum women as well as those who had normal pre-pregnancy body mass index but have retained excessive weight in the postpartum period. Recommendations highlight the evaluation and management of dietary, physical activity and breastfeeding behaviour. Recommendations also account for behavioural modification techniques to improve adherence to the prescribed weight management advice. Duration and frequency of follow-ups as well as the advice to be disseminated have also been discussed in the recommendations.

CONCLUSION

The guideline provides clinical practice points that can be used by healthcare providers, postpartum women and policymakers for opportunistic screening and management of postpartum obesity.