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Summary Introduction Gestational weight gain (GWG) and postpartum weight retention (PPWR) are significant, potentially modifiable, contributors to women's future weight and health trajectories. There is a need for feasible and patient‐centered (i.e., convenient, remotely‐delivered, technology‐enhanced, and accessible through the prenatal care setting) behavioural interventions that limit GWG and PPWR. This study tests the feasibility and acceptability of a remotely‐delivered behavioural health coaching intervention to limit gestational weight gain and postpartum weight retention. Methods Pregnant women (11–16 weeks gestation) were recruited from two prenatal clinics and randomized to the active intervention or health education comparison group. Completion of the program was monitored and perceived helpfulness was rated (0–100). Results Twenty‐six women were randomized (n = 13 per arm; mean age = 31.6 years, SD = 3.6; mean BMI = 26.7 kg/m2, SD = 7.4). Participants completed a median of 18 coaching calls and 16/19 learning activities during pregnancy, and a median of 6 calls and 5/6 learning activities postpartum. They logged weights at least once/week for a median of 36/38 expected weeks and tracked daily calories and exercise for a median of 154/266 days and 72/266 days, respectively. Median (Q1, Q3) helpfulness ratings of the program during pregnancy were 80 (64, 91) and 62 (50, 81) postpartum; helpfulness ratings of coaching calls were 85 (58, 98). At 37 weeks gestation, 77% of participants achieved IOM weight gain recommendations compared to 54% in the comparison group. Conclusions This study provides evidence for the feasibility and acceptability of a remotely‐delivered behavioural weight control intervention in pregnancy and postpartum.

Background Preeclampsia increases women's risks for maternal morbidity and future cardiovascular disease. The aim of this study was to identify opportunities for prevention by examining the association between cardiometabolic risk factors and preeclampsia across 2 pregnancies among women in a high‐risk US birth cohort. Methods and Results Our sample included 618 women in the Boston Birth Cohort with index and subsequent pregnancy data collected using standard protocols. We conducted log‐binomial univariate regression models to examine the association between preeclampsia in the subsequent pregnancy (defined as incident or recurrent preeclampsia) and cardiometabolic risk factors (ie, obesity, hypertension, diabetes mellitus, preterm birth, low birth weight, and gestational diabetes mellitus) diagnosed before and during the index pregnancy, and between index and subsequent pregnancies. At the subsequent pregnancy, 7% (36/540) had incident preeclampsia and 42% (33/78) had recurrent preeclampsia. Compared with women without obesity, women with obesity had greater risk of incident preeclampsia (unadjusted risk ratio [RR], 2.2 [95% CI, 1.1–4.5]) and recurrent preeclampsia (unadjusted RR, 3.1 [95% CI, 1.5–6.7]). Preindex pregnancy chronic hypertension and diabetes mellitus were associated with incident, but not recurrent, preeclampsia (hypertension unadjusted RR, 7.9 [95% CI, 4.1–15.3]; diabetes mellitus unadjusted RR, 5.2 [95% CI, 2.5–11.1]. Women with new interpregnancy hypertension versus those without had a higher risk of incident and recurrent preeclampsia (incident preeclampsia unadjusted RR, 6.1 [95% CI, 2.9–13]); recurrent preeclampsia unadjusted RR, 2.4 [95% CI, 1.5–3.9]). Conclusions In this diverse sample of high‐risk US women, we identified modifiable and treatable risk factors, including obesity and hypertension for the prevention of preeclampsia.

Daily self-weighing is a weight management behaviour that requires a scale; however, scale ownership may be cost-prohibitive for some patients. Our objective was to understand the proportion of primary care patients with a scale at home, and factors associated with home scale access, to potentially inform future interventions that facilitate scale access. Cross sectional survey of 216 adult patients from three primary care clinics: mixed-income urban/suburban (n = 68); mixed-income urban (n = 70); low-income urban (n = 74). The dependent variable was presence of a home scale; bivariate associations were conducted with variables including demographics, insurance type, clinic setting and self-reported height/weight. Mean age was 53 years; 71% women; 71% racial minority; mean body mass index 32 kg/m(2). Overall, 56% had a home scale. Most (79%) white patients owned a scale, compared to 46% of racial minority patients (P < .01); 33% of low-income patients owned scale, compared to over 66% of patients at the clinics serving mixed-income populations (P < .01). Most low-income urban clinic patients do not own a home scale. Because self-weighing is an effective weight-management behaviour, clinicians could consider assessing scale access, and future research should assess the health impact of providing scales to patients with overweight/obesity who desire weight loss or maintenance.

Objective (1) To determine the nonphysician health profession perceived as best qualified to provide weight management. (2) To examine nutrition professionals' current practice characteristics and perceived challenges and solutions for obesity care. (3) To examine the association between nutrition professionals' quality of training and self-efficacy in weight management. Methods A 2014 national cross-sectional online survey of 500 U.S. nonphysician health professionals (100 from each: nutrition, nursing, behavioral/mental health, exercise, pharmacy) was analyzed. Results Nutrition professionals most commonly self-identified as the most qualified group to help patients lose weight (92%), sentiments supported by other health professionals (57%). The most often cited challenge was lack of patient adherence (87%). Among nutrition professionals, 77% reported receiving high-quality training in weight loss counseling. Nutrition professionals who reported high-quality training were significantly more likely to report confidence (95% vs. 48%) and success (74 vs. 50%) in helping obese patients lose weight (P

Objective To determine the prevalence of doctor shopping resulting from differential treatment and to examine associations between this shopping and current primary care relationships. Methods In 2012, a national internet-based survey of 600 adults receiving primary care in the past year with a BMI ≥ 25 kg/m2 was conducted. Our independent variable was “switching doctors because I felt treated differently because of my weight.” Logistic regression models to examine the association of prior doctor shopping with characteristics of current primary care relationships: duration, trust in primary care provider (PCP), and perceived PCP weight-related judgment, adjusted for patient factors were used. Results Overall, 13% of adults with overweight/obesity reported previously doctor shopping resulting from differential treatment. Prior shoppers were more likely to report shorter durations of their current relationships [73% vs. 52%; p = 0.01] or perceive that their current PCP judged them because of their weight [74% vs. 11%; p

Overweight and obesity are highly prevalent with a large public health impact.(1) Increasingly, evidence suggests that patterns of weight and body mass index (BMI) are formed early in life,(2) and that these patterns may begin influencing disease risk, particularly vascular disease, as early as adolescence or even childhood.(3, 4, 5) Several studies have suggested that overweight and obesity are risk factors for premature death, (6, 7, 8)particularly among younger people compared with older adults.(6, 9, 10, 11) The increased mortality risk may be attributable to higher total weight gain with age among those who are overweight early in life compared with those whose weight gain begins later in life. Additionally, early life overweight may inflict a larger cumulative exposure to adiposity and its associated disease risks. (4) However, evidence for the impact of obesity on mortality in younger adults is limited because few studies have investigated the relationship between BMI in adults younger than middle age and cause-specific mortality.(11, 12, 13) Most studies of younger adults have had relatively short follow up periods, ending before the period of peak risk for cardiovascular events and mortality, especially for women who have events even later in life than men.(9, 11, 13, 14, 15) While women generally experience cardiovascular disease later in life than men, there is some evidence that morbidity and mortality from coronary heart disease (CHD) is increasing in younger women, (16, 17) possibly due to the increasing prevalence of obesity among women.(18) Even fewer studies have observed the relationship between obesity among women of reproductive age and mortality,(13) which may be of particular importance given the potential impact of pregnancy on weight and cardiovascular health.(19) Pregnancy complications, often associated with obesity,(20) are important indicators of vascular and metabolic health and later life risk.(21, 22) Furthermore, pregnancy is a period of relatively high health care utilization and contact with medical professionals, making this an opportune time for educational messaging and/or interventions, whereby obese women or those with a history of these pregnancy complications could be targeted for cardiovascular disease prevention before middle age.(23) Our objective was to examine the association between pre-pregnancy BMI and cause-specific mortality in parous women of reproductive age over almost 40 years of follow up in the Child Health and Development Studies cohort. We hypothesized that pre-pregnancy overweight and obesity would be strongly associated with increased cardiovascular and all-cause mortality.

Gestational diabetes mellitus (GDM) complicates about seven percent of pregnancies in the U.S., depending on the population studied (1). Women with a history of GDM are at high risk for type 2 diabetes (2, 3), with 3.7% diagnosed by nine months after delivery and 19% by nine years after delivery, within a large Canadian health care system (4). Because of this increased risk, experts and national organizations are calling for increased screening, monitoring and promotion of lifestyle changes for diabetes prevention (5, 6). In addition to triggering increased provider surveillance, a diagnosis of GDM could heighten women’s awareness of diabetes risk and motivate healthy behavioral change. However, support for making these lifestyle changes is crucial. Lifestyle interventions, such as The Diabetes Prevention Program, may reduce diabetes incidence in women with GDM histories (7). Cross-sectional studies show that providers may not adequately inform patients of their diabetes risk (8, 9), women may fail to perceive themselves at risk for diabetes (10) and overall, at-risk women are not engaging in healthier lifestyles (11, 12). A recent prospective cohort followed 238 Canadian women with and without GDM for one year postpartum (13). They reported no differences at one year in work or sports-related physical activity between groups, but women with GDM reported increased leisure-time physical activity at one year compared to women without GDM (13). However, few studies have measured weight and health behaviors from before to after pregnancy in women with GDM to assess post-pregnancy changes, although one previous study reported less than a two kg difference in mean weight gain from before to after pregnancies among women with and without GDM pregnancies (3). The Coronary Artery Risk Development in Young Adults (CARDIA) Study is a prospective cohort study of young men and women with more than 20 years of follow up. Our objective was to compare changes in health behaviors (dietary intake and physical activity), and anthropometric measures (weight, body mass index [BMI] and waist circumference) from before to several years after pregnancy in women with and without GDM. We hypothesized that a diagnosis of GDM, despite its potential role as a “prognostic sign” for diabetes would not be associated with improved post-pregnancy anthropometric measures or health behaviors (e.g. less weight gain, improved diet). Understanding post-pregnancy changes in women with GDM could inform interventions aimed at promoting healthy post-pregnancy behavior changes.

Objective Examine the impact of non-physician health professional body mass index (BMI) on obesity care, self-efficacy, and perceptions of patient trust in weight loss advice.