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Gaskin CJ, Cooper K, Stephens LD, Peeters A, Salmon J, Porter J. Clinical practice guidelines for the management of overweight and obesity published internationally: A scoping review. Obes Rev 2024; 25:e13700. [PMID: 38296655 DOI: 10.1111/obr.13700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 10/17/2023] [Accepted: 12/20/2023] [Indexed: 02/02/2024]
Abstract
With the increasing prevalence of obesity placing additional demands on healthcare systems, many jurisdictions and professional bodies have developed clinical practice guidelines to support practitioners in the management of people with overweight and obesity. This scoping review aimed to identify key features of contemporary guidelines for the clinical management of overweight and obesity. Searches of MEDLINE, Guidelines International Network's international guidelines library, and other grey literature sources identified 38 guidelines of 18 countries and one region published since 2010. Guidelines were developed by committees (n = 36, 95%) that comprised knowledgeable experts (n = 36, 95%) and were multidisciplinary (n = 33, 87%), with limited consumer representation (n = 11, 29%). Guideline documentation incorporated review questions (n = 23, 61%), systematic reviews (n = 25, 66%), evidence grading systems (n = 33, 87%), processes for reaching consensus (n = 19, 50%), and guideline review details (n = 28, 74%). Treatment approaches included in most guidelines were nutrition and physical activity (n = 38, 100%), psychology (n = 37, 97%), pharmacotherapy (n = 32, 84%), and bariatric surgery (n = 31, 82%). Most guidelines targeted populations based on age (n = 30, 79%). Guidelines contained recommendations for pregnancy (n = 12, 32%), older adults (n = 9, 24%), and people with eating disorders (n = 8, 21%). Future guidelines would benefit from involvement of consumers including groups known to be at increased risk of overweight and obesity, targeted guidance for at risk groups, and consideration of weight bias and stigma.
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Affiliation(s)
- Cadeyrn J Gaskin
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
- Institute for Health Transformation (IHT), School of Health and Social Development, Deakin University, Geelong, Australia
| | - Kelly Cooper
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Lena D Stephens
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
- Institute for Health Transformation (IHT), School of Health and Social Development, Deakin University, Geelong, Australia
| | - Anna Peeters
- Institute for Health Transformation (IHT), School of Health and Social Development, Deakin University, Geelong, Australia
| | - Jo Salmon
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Judi Porter
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
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Wang M, Ji Y, Chen S, Wang M, Lin X, Yang M. Effect of mode of delivery on postpartum weight retention: A systematic review and meta-analysis. Midwifery 2024; 132:103981. [PMID: 38574440 DOI: 10.1016/j.midw.2024.103981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE Retention of weight gained over pregnancy increases the risk of long-term obesity and related health concerns. While many risk factors for this postpartum weight retention have been examined, the role of mode of delivery in this relationship remains controversial. We carried out a systematic review and meta-analysis to determine the effect of mode of delivery on postpartum weight retention. METHODS Ten electronic databases including PubMed, Cochrane Library, EMBASE, Web of Science, MEDLINE, CINAHL, China National Knowledge Infrastructure (CNKI), Wan-Fang database, the VIP database and China Biology Medicine Database (CBM) were searched from inception through November 2022. Review Manager 5.4 was used to pool the study data and calculate effect sizes. For dichotomous data, the odds ratio and 95 % confidence interval were used to report the results. For continuous data, the mean difference (MD) and 95 % confidence interval were used to report the results. The outcomes were the amount of postpartum weight retention and the number or proportion of women who experienced postpartum weight retention. The Newcastle- Ottawa Scale (NOS) and GRADE Guidelines were used to assess the methodological quality of the included studies. FINDINGS A total of 16 articles were included in the systematic review and 13 articles were included in the meta-analysis. The results showed that the mode of delivery had a significant effect on postpartum weight retention, women who delivered by caesarean section were more likely to experience postpartum weight retention compared to those who delivered vaginally. Sensitivity analysis showed that the results were stable and credible. CONCLUSION Due to the limitations of this study, the findings need to be treated with caution. And, to better prevent the postpartum weight retention, future practice and research need to further focus on upstream modifiable factors.
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Affiliation(s)
- Meiyu Wang
- School of Nursing, Guangzhou University of Chinese Medicine, No.232, Waihuan East Road, Guangzhou University City, Panyu District, Guangzhou City, Guangdong Province 510006, China
| | - Yuting Ji
- School of Nursing, Guangzhou University of Chinese Medicine, No.232, Waihuan East Road, Guangzhou University City, Panyu District, Guangzhou City, Guangdong Province 510006, China
| | - Shanxia Chen
- Health Management & Biotechnology School, Guangdong Food and Drug Vocational College, No.321, Longdong North Road, Tianhe District, Guangzhou City, Guangdong Province, China
| | - Minyi Wang
- School of Nursing, Guangzhou University of Chinese Medicine, No.232, Waihuan East Road, Guangzhou University City, Panyu District, Guangzhou City, Guangdong Province 510006, China
| | - Xiaoli Lin
- School of Nursing, Guangzhou University of Chinese Medicine, No.232, Waihuan East Road, Guangzhou University City, Panyu District, Guangzhou City, Guangdong Province 510006, China
| | - Ming Yang
- School of Nursing, Guangzhou University of Chinese Medicine, No.232, Waihuan East Road, Guangzhou University City, Panyu District, Guangzhou City, Guangdong Province 510006, China.
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Huang J, Wu Y, Li H, Cui H, Zhang Q, Long T, Zhang Y, Li M. Weight Management during Pregnancy and the Postpartum Period in Women with Gestational Diabetes Mellitus: A Systematic Review and Summary of Current Evidence and Recommendations. Nutrients 2023; 15:5022. [PMID: 38140280 PMCID: PMC10746048 DOI: 10.3390/nu15245022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 11/29/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Weight management during pregnancy and the postpartum period is an important strategy that can be utilized to reduce the risk of short- and long-term complications in women with gestational diabetes mellitus (GDM). We conducted a systematic review to assess and synthesize evidence and recommendations on weight management during pregnancy and the postpartum period in women with GDM to provide evidence-based clinical guidance. METHODS Nine databases and eighteen websites were searched for clinical decisions, guidelines, recommended practices, evidence summaries, expert consensus, and systematic reviews. RESULTS A total of 12,196 records were retrieved and fifty-five articles were included in the analysis. Sixty-nine pieces of evidence were summarized, sixty-two of which focused on pregnancy, including benefits, target population, weight management goals, principles, weight monitoring, nutrition assessment and counseling, energy intake, carbohydrate intake, protein intake, fat intake, fiber intake, vitamin and mineral intake, water intake, dietary supplements, sugar-sweetened beverages, sweeteners, alcohol, coffee, food safety, meal arrangements, dietary patterns, exercise assessment and counseling, exercise preparation, type of exercise, intensity of exercise, frequency of exercise, duration of exercise, exercise risk prevention, and pregnancy precautions, and seven focused on the postpartum period, including target population, benefits, postpartum weight management goals, postpartum weight monitoring, dietary recommendations, exercise recommendations, and postpartum precautions. CONCLUSIONS Healthcare providers can develop comprehensive pregnancy and postpartum weight management programs for women with GDM based on the sixty-nine pieces of evidence. However, because of the paucity of evidence on postpartum weight management in women with GDM, future guidance documents should focus more on postpartum weight management in women with GDM.
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Affiliation(s)
- Jing Huang
- School of Nursing, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China; (J.H.)
| | - Yi Wu
- School of Nursing, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China; (J.H.)
| | - Hua Li
- School of Nursing, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China; (J.H.)
| | - Hangyu Cui
- School of Nursing, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China; (J.H.)
| | - Qi Zhang
- School of Nursing, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China; (J.H.)
| | - Tianxue Long
- School of Nursing, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China; (J.H.)
| | - Yiyun Zhang
- School of Nursing, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China; (J.H.)
| | - Mingzi Li
- School of Nursing, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China; (J.H.)
- School of Nursing, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing 100191, China
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Schulz JM, Marmura H, Hewitt CM, Parkinson LJ, Thornton JS. Navigating the 'new normal': what guidelines exist for postpartum return to physical activity and sport? A scoping review. Br J Sports Med 2023; 57:1573-1578. [PMID: 37898507 DOI: 10.1136/bjsports-2023-107166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVE Women are often advised to return to activity (RTA) as early as 6 weeks postpartum, despite undergoing significant physical, physiological and psychological changes. Our objective was to examine existing evidence and clinical practice guidelines to navigate a safe and successful RTA or return to sport (RTS) postpartum. METHODS We searched CINAHL, Embase, Medline, PsycINFO and SPORTDiscus and included any secondary studies with recommendations or guidelines for RTA or RTS postpartum. Grey literature and primary sources were excluded. Four reviewers independently screened titles and abstracts, followed by full-text review for eligibility, with conflicts resolved by a third-party reviewer. One reviewer extracted data, which was cross-referenced by another reviewer. RESULTS 5851 studies were screened, and 33 were included in this scoping review. Most studies stated that RTS postpartum can begin once 'medically safe', around 6 weeks postpartum, but this term was generally left undefined. In addition, most studies recommended engaging in 150 min of moderate-vigorous physical activity per week after 6 weeks postpartum, but the type of exercise recommended was often non-specific. CONCLUSION A lack of consistent, evidence-based guidelines exist for RTA or RTS postpartum. Multiple evidence gaps require additional research to inform patient and activity specific guidelines for a safe and successful RTA or RTS postpartum.
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Affiliation(s)
- Jenna M Schulz
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Fowler-Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
- Bone & Joint Institute, Western University, London, Ontario, Canada
| | - Hana Marmura
- Fowler-Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
- Bone & Joint Institute, Western University, London, Ontario, Canada
- Department of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Chloe M Hewitt
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Laura J Parkinson
- Department of Kinesiology, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Jane S Thornton
- Fowler-Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
- Bone & Joint Institute, Western University, London, Ontario, Canada
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Kumari A, Ranjan P, Anwar W, Kaur D, Upadhyay AD, Malhotra A, Vikram NK. A Cross-Sectional Survey of 505 Postpartum Women to Assess Lifestyle-Related Behaviour, Barriers, and Myths Affecting Postpartum Weight Retention and Its Management. J Obstet Gynaecol India 2023; 73:397-405. [PMID: 37916057 PMCID: PMC10616021 DOI: 10.1007/s13224-023-01748-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 03/03/2023] [Indexed: 11/03/2023] Open
Abstract
Background/Purpose This study aims to assess lifestyle-related factors such as diet, physical activity and sleep along with common myths, beliefs, and barriers to a healthy lifestyle and resultant postpartum weight retention. It has also explored the association of the aforementioned factors with socio-demographic variables. Methods A cross-sectional survey was conducted using a comprehensive pre-validated questionnaire on a convenience sample of postpartum women using a telephonic interview schedule. Results A total of 505 postpartum women were recruited with median postpartum weight retention of 5 kg. More than half of the participants had incorrect dietary practices with less than one-tenth of women indulging in low/moderate-intensity physical activity. Postpartum women had poorer diet (p < 0.05) and sleep (p < 0.01) in the initial phase postpartum as compared to late postpartum. These women were also less physically active in the initial months and as the postpartum period progressed their physical activity also improved significantly (p < 0.001). Socio-demographic variables such as socio-economic status, education, and employment status were significantly associated with unhealthy lifestyle practices. Common barriers were lack of knowledge, time constraints, lack of childcare support and cultural myths and beliefs. Conclusion The findings of the study will help in developing a comprehensive women-centric weight management module focusing on practical guidelines for lifestyle, breastfeeding and other confounding factors associated with postpartum weight management.
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Affiliation(s)
- Archana Kumari
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Piyush Ranjan
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, , New Delhi, 110029 India
| | - Wareesha Anwar
- Scholar, Department of Home Science, University of Delhi, New Delhi, India
| | - Divjyot Kaur
- Scholar, Department of Home Science, University of Delhi, New Delhi, India
| | | | - Anita Malhotra
- Department of Home Science, Laxmi Bai College, University of Delhi, New Delhi, India
| | - Naval Kishore Vikram
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, , New Delhi, 110029 India
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Kaloiya GS, Kaur T, Ranjan P, Chopra S, Sarkar S, Kumari A, Bhatia H. Counselling and Behaviour Modification Techniques for the Management of Obesity in Postpartum and Midlife Women: A Practical Guide for Clinicians. J Obstet Gynaecol India 2022; 72:134-140. [PMID: 35492859 PMCID: PMC9008080 DOI: 10.1007/s13224-022-01652-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/14/2022] [Indexed: 10/18/2022] Open
Abstract
Behaviour change is the basic foundation in the management of obesity. Such behaviour change is difficult to achieve due to several psychosocial and behavioural barriers that often remain unidentified and unaddressed in a weight management programme. This is even more challenging in postpartum and midlife women because of several biopsychosocial factors. The non-availability of psychologists or trained healthcare counsellors further complicates the attainment of behavioural changes. Therefore, clinicians, who are often the first point of contact for treating these population groups, are hamstrung by the lack of a multidisciplinary approach for weight reduction. Some of the common psychological, social and behavioural barriers have been identified in this article, and evidence-based techniques such as goal setting, stimulus control and cognitive restructuring are presented in a step-wise approach, to help clinicians cater to these population groups in a holistic manner.
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