title: Effectiveness of a weight loss intervention in postpartum women: results from a randomized controlled trial in primary health care.
abstract: BACKGROUND
  Reproduction has been identified as an important factor for long-term weight gain among women. A previous efficacy trial has successfully produced postpartum weight loss; however, the effectiveness of this intervention needs to be established.
  
  
  OBJECTIVE
  This study was designed to evaluate the short- and long-term effectiveness of a diet behavior modification treatment to produce weight loss in postpartum women within the primary health care setting in Sweden.
  
  
  METHODS
  During 2011-2014, 110 women with a self-reported body mass index (BMI; in kg/m(2)) of ≥27 at 6-15 wk postpartum were randomly assigned to the diet behavior modification group (D group) or the control group (C group). Women randomly assigned to the D group (n = 54) received a structured 12-wk diet behavior modification treatment by a dietitian and were instructed to gradually implement a diet plan based on the Nordic Nutrition Recommendations and to self-weigh ≥3 times/wk. Women randomly assigned to the C group (n = 56) were given a brochure on healthy eating. The primary outcome was change in body weight after 12 wk and 1 y. The retention rate was 91% and 85% at 12 wk and 1 y, respectively.
  
  
  RESULTS
  At baseline, women had a median (1st, 3rd quartile) BMI of 31.0 (28.8, 33.6), and 84% were breastfeeding. After 12 wk, median weight change in the D group was -6.1 kg (-8.4, -3.2 kg) compared with -1.6 kg (-3.5, -0.4 kg) in the C group (P < 0.001). The difference was maintained at the 1-y follow-up for the D group, -10.0 kg (-11.7, -5.9 kg) compared with -4.3 kg (-10.2, -1.0 kg) in the C group (P = 0.004). In addition, the D group reduced BMI, waist circumference, hip circumference, and body fat percentage more than did the C group at both 12 wk and 1 y (all P < 0.05).
  
  
  CONCLUSIONS
  A low-intensity diet treatment delivered by a dietitian within the primary health care setting can produce clinically relevant and sustainable weight loss in postpartum women with overweight and obesity. This trial was registered at clinicaltrials.gov as NCT01949558.
authors.affiliation: Department of Internal Medicine and Clinical Nutrition and ena.huseinovic@gu.se.
authors.forename: Ena
authors.initials: E
authors.lastname: Huseinovic
authors.affiliation: Department of Internal Medicine and Clinical Nutrition and.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Bertz
authors.affiliation: Section for Epidemiology and Social Medicine, Department of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;
authors.forename: Monica
authors.initials: M
authors.lastname: Leu Agelii
authors.affiliation: Närhälsan, Research and Development Primary Health Care, Region Västra Götaland, Borås, Sweden; and.
authors.forename: Else
authors.initials: E
authors.lastname: Hellebö Johansson
authors.affiliation: Department of Internal Medicine and Clinical Nutrition and.
authors.forename: Anna
authors.initials: A
authors.lastname: Winkvist
authors.affiliation: Department of Internal Medicine and Clinical Nutrition and Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
authors.forename: Hilde Kristin
authors.identifier: http://orcid.org/0000-0002-9478-9115
authors.initials: HK
authors.lastname: Brekke
mesh_terms: D000328:Adult; D001521:Behavior Therapy; D001823:Body Composition; D015992:Body Mass Index; D000068959:Body Weight Maintenance; D001942:Breast Feeding; D004038:Diet, Reducing; D005260:Female; D006801:Humans; D009765:Obesity / Q000178:diet therapy*; D050177:Overweight; D010352:Patient Dropouts; D049590:Postpartum Period; D011247:Pregnancy; D013548:Sweden; D015430:Weight Gain; D015431:Weight Loss
keywords: diet intervention; obesity; postpartum; randomized controlled trial; weight loss