title: Lifestyle intervention to prevent obesity during pregnancy: Implications and recommendations for research and implementation.
abstract: Maternal obesity and excessive gestational weight gain (GWG) are significant contributors to the global obesity epidemic. However, isolated lifestyle interventions to address this in pregnancy appear to have only modest benefit and responses can be variable. This paper aims to address the question of why the success of lifestyle interventions to prevent excessive GWG is suboptimal and variable. We suggest that there are inherent barriers to lifestyle change within pregnancy as a life stage, including the short window available for habit formation; the choice for women not to prioritise their weight; competing demands including physiological, financial, relationship, and social situations; and lack of self-efficacy among healthcare professionals on this topic. In order to address this problem, we propose that just like all successful public health approaches seeking to change behaviour, individual lifestyle interventions must be provided in the context of a supportive environment that enables, incentivises and rewards healthy changes. Future research should focus on a systems approach that integrates the needs of individuals with the context within which they exist. Borrowing from the social marketing principle of 'audience segmentation', we also need to truly understand the needs of individuals to design appropriately tailored interventions. This approach should also be applied to the preconception period for comprehensive prevention approaches. Additionally, relevant policy needs to reflect the changing evidence-based climate. Interventions in the clinical setting need to be integrally linked to multipronged obesity prevention efforts in the community, so that healthy weight goals are reinforced throughout the system.
authors.affiliation: Deakin University, GEELONG, Australia, School of Psychology, Locked Bag 20000, Geelong, VIC 3220, Australia. Electronic address: briony.hill@deakin.edu.au.
authors.forename: Briony
authors.initials: B
authors.lastname: Hill
authors.affiliation: Deakin University, GEELONG, Australia, School of Psychology, Locked Bag 20000, Geelong, VIC 3220, Australia. Electronic address: skye.mcphie@deakin.edu.au.
authors.forename: Skye
authors.initials: S
authors.lastname: McPhie
authors.affiliation: Monash Centre for Health Research and Implementation, Locked bag 29, Clayton 3168, Australia. Electronic address: lisa.moran@monash.edu.
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Moran
authors.affiliation: Deakin University, GEELONG, Australia, Deakin Business School, Locked Bag 20000, Geelong, VIC 3220, Australia. Electronic address: paul.harrison.deakin@me.com.
authors.forename: Paul
authors.initials: P
authors.lastname: Harrison
authors.affiliation: Graduate School of Public Health and Health Policy, City University of New York, 55W. 125th Street, New York, NY 10027, United States. Electronic address: terry.huang@sph.cuny.edu.
authors.forename: Terry T-K
authors.initials: TT
authors.lastname: Huang
authors.affiliation: Monash Centre for Health Research and Implementation, Locked bag 29, Clayton 3168, Australia. Electronic address: helena.teede@monash.edu.
authors.forename: Helena
authors.initials: H
authors.lastname: Teede
authors.affiliation: Deakin University, GEELONG, Australia, School of Psychology, Locked Bag 20000, Geelong, VIC 3220, Australia. Electronic address: helens@deakin.edu.au.
authors.forename: Helen
authors.initials: H
authors.lastname: Skouteris
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D006801:Humans; D000068097:Maternal Health / Q000639:trends; D009765:Obesity / Q000517:prevention & control*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control*; D012106:Research / Q000639:trends*; D012307:Risk Factors; D040242:Risk Reduction Behavior; D015430:Weight Gain
keywords: Gestational weight gain; Maternal obesity; Preconception; Prevention; Systems approach