Weight management is a crucial aspect of overall health, especially for women during postpartum and midlife phases. The Indian Council of Medical Research (ICMR) provides dietary guidelines tailored for women with sedentary lifestyles. This article delves into these guidelines, offering a structured approach to dietary advice for healthcare professionals and women alike.
The Rising Concern of Obesity in Women
The prevalence of obesity is increasing globally, with women being particularly vulnerable due to physiological, biological, hormonal, psychological, and nutritional changes during postpartum and midlife. Sociocultural myths, such as excessive calorie consumption and increased intake of ghee, further contribute to weight gain. Excessive weight gain can lead to cardiometabolic complications like type 2 diabetes, dyslipidemia, hypertension, stroke, and certain cancers.
The Importance of Dietary Intervention
Dietary intervention is a pivotal component of sustainable weight management. In resource-restricted settings, healthcare professionals like physicians, obstetricians, and pediatricians should provide timely weight management advice. This article provides dietary advice, including setting realistic weight loss goals, identifying calorie needs, distributing macronutrients, and considering important micronutrients.
Setting Realistic Weight Loss Goals
Women with a BMI in the overweight and obese categories should be advised on weight loss. Even women in the normal BMI range but with a higher waist circumference (more than 80 cm) or a higher total body fat percentage (more than 30-38%) or retaining ≥4.5kg weight as compared to the pre-pregnancy weight should be considered for weight loss. Weight loss goals should be realistic, patient-centric, and improve lean body mass and reduce fat mass without compromising nutritional status.
A weight loss of 5-10% of total body weight is considered clinically significant, fostering the loss of abdominal and intra-hepatic fat and improving blood parameters. This goal can be achieved by providing an adequate calorie diet to attain a weight loss of 0.5-1 kilogram per week over six months. The higher the degree of obesity, the longer it may take to reach the target body weight.
Read also: The Hoxsey Diet
Calorie Estimation for Postpartum and Midlife Women
Weight loss goals can be accomplished by adjusting calorie intake based on basal metabolic rate (BMR), BMI, and physical activity level (PAL). Adjustments must be made specifically for postpartum and midlife women.
Calculating Basal Metabolic Rate (BMR)
BMR is the amount of energy required to perform essential metabolic functions like cellular activity, respiration, and circulation.
Estimating Energy Requirement
Energy intake should balance energy expenditure.
Energy Needs for Postpartum Women
The energy requirements increase for postpartum women breastfeeding their infants by 600 kcal during the first six months and by 520 kcal during the seven to 12 months post-delivery.
Energy Needs for Midlife Women
To reduce weight, energy intake should be less than energy expenditure.
Read also: Walnut Keto Guide
Sustainable Dietary Prescription
A dietary prescription is based on several principles which determine sustainability in the long run. Personalised, realistic, and patient-friendly dietary prescriptions are easy to follow and ensure better adherence with successful outcomes. Postpartum women should attain either their pre-pregnancy body weight or the Ideal Body Weight (IBW).
Macronutrient Distribution
Sustainable dietary prescriptions for weight management should provide adequate levels of macronutrients and micronutrients. A balanced composition diet constituting 50-60% energy from carbohydrates, 15-25% energy from proteins, and less than 30% energy from fats has been found successful for sustainable weight loss. Emphasis should be laid on high fiber diet.
Micronutrient Considerations
Healthcare providers should provide a dietary prescription according to the personal preferences and eating habits of an individual for better adherence. For example, a vegetarian woman should be prescribed high-protein sources such as milk and its products, cereal-pulse combination, and soy, rather than egg white, chicken, and fish.
Meal Frequency and Calorie Intake
Small, frequent meals comprising three major and two-three minor meals/snacks in a day help spread total energy requirements throughout the day. A hypocaloric diet, cutting down around 500-750 kcal of usual intake, is often prescribed. A hypocaloric diet of 1200-1500 kcal is usually prescribed for midlife women aiming for weight loss. Obese postpartum women should have a calorie deficit diet of 500 kcal ranging between 1200 and 1800 kcal/day; however, if the woman is breastfeeding, additional 300 kcal need to be included.
Food Quality and Portion Control
Covering half a plate with fiber-rich vegetables and quarter of a plate with a good quality protein source in every major meal should be encouraged. Techniques such as using smaller dishes, avoiding watching television, or using phones while eating help in identifying satiety cues.
Read also: Weight Loss with Low-FODMAP
Managing Cravings and Emotional Eating
Psychological distress and mood swings are common among postpartum and midlife women, leading to cravings and emotional eating. Strategies such as ensuring consumption of five to six small, frequent meals may help in managing cravings.
Healthy Eating During Festivities
Women should be educated about healthy eating practices during outings and festivities. Strategies such as reducing the portion size or sharing the food can be helpful when eating out. Healthier food products such as multigrain bread instead of refined ones, and hung curd/vegetable sauce instead of mayonnaise or cream-based dressings should be emphasized.
Reading Food Labels and Cooking Methods
For healthy and conscious eating, comparing products in terms of nutritional values and ingredients is important. Cooking methods using air, water, or steam as a medium should be preferred over methods that use fat as a medium.
Addressing Cultural Beliefs and Perceptions
Weight loss is often associated with cultural beliefs and perceptions that may act as barriers. Healthcare providers should address these barriers to improve adherence to appropriate dietary advice.
Myths and Facts
- Myth: Postpartum women need to eat for two and consume empty calories.
- Fact: The energy requirements of lactating mothers are high but should be met by a nutrient-dense diet rather than empty calories from fat and sugar sources.
- Myth: Weight gain is natural post-delivery and with aging.
- Fact: It is crucial to increase awareness about potential weight loss opportunities.
- Myth: Skipping meals leads to weight loss.
- Fact: Skipping meals results in overeating during subsequent meals and lowers the body’s metabolism.
- Myth: Carbohydrates should be completely cut down for weight loss.
- Fact: Focus on the quality of carbohydrates, replacing refined sources with complex carbohydrates.
- Myth: Dairy products are fattening.
- Fact: Dairy products are crucial for lactating mothers and are rich sources of proteins, calcium, riboflavin, and vitamin A.
Dietary Modifications for Comorbidities
Healthcare professionals should consider comorbidities while prescribing dietary modifications. Special attention is needed for postpartum women who had gestational diabetes and hypertension during pregnancy to avoid further complications.
Diabetes Management
Achieving a weight loss goal of ≥2% initiates the improvement in glycemic and HbA1c levels. This can be achieved by prescribing a hypocaloric balanced diet consisting of complex carbohydrates proportionally distributed throughout the meals. Intake of refined cereals and added sugars should be restricted/avoided. Good quality lean protein sources that are low in cholesterol and saturated fats should be consumed. Substituting full-fat milk and milk products with low-fat milk is advisable. Certain spices like fenugreek seeds and cinnamon may be beneficial in managing blood glucose levels, but should be prescribed under professional guidance. Fasting and feasting should be discouraged, instead, small, frequent meals should be prescribed throughout the day.
Hypertension Management
A 5-10% of weight loss leads to improved triglyceride and cholesterol levels. Various diets such as the Dietary Approaches to Stop Hypertension (DASH) diet, the Mediterranean diet, or vegetarian diets can be adopted.
ICMR Dietary Guidelines for Sedentary Women
The ICMR has released specific dietary guidelines for working women who may not have time to exercise regularly. These guidelines emphasize portion control, adequate hydration, and minimizing the intake of sugary foods and unhealthy fats.
Key Highlights from ICMR Guidelines
- Plan balanced meals: Include sufficient vegetables, whole grains, and legumes.
- Practice portion control: Be mindful of portion sizes to prevent overeating.
- Snack smart: Choose nutrient-dense options like nuts, yogurt, or cut vegetables.
- Take more helpings of vegetables: Incorporate a variety of vegetables into meals.
- Opt for lean meat: Choose skinless poultry, lean cuts of meat, and fish.
- Use healthy cooking methods: Opt for grilling, baking, or steaming instead of frying.
- Limit sugary beverages: Choose water, herbal tea, or unsweetened beverages.
- Read food labels: Check for information on calories, saturated fats, added sugars, and sodium.
ICMR Sample Diet Chart for Sedentary Women (BMI 18.5-23, Body Weight 55 kg)
The ICMR has provided a sample diet chart for normally nourished sedentary women with a BMI between 18.5 and 23 and a body weight of 55 kg. This diet provides approximately 1670 kcal per day.
- Breakfast (470 Kcal):
- Soaked and boiled whole grains: 60g
- Boiled red/black beans, lobia/chickpea: 30g
- Green leafy vegetables: 50g
- Nuts: 20g
- Lunch (740 Kcal):
- Cereals: 80g
- Pulses: 20g
- Vegetables: 150g
- Green leafy vegetables: 50g
- Nuts/oil seeds (in curries with cooking oil (15g)): 10g
- Curd: 150ml/paneer
- Fruits: 50g
- Dinner (415 Kcal):
- Cereals: 60g
- Pulses: 15g
- Vegetables: 50g
- Oil: 5g
- Curd: 100ml
- Fruits: 50g
- Evening Snack (35 Kcal):
- Milk: 50 ml
Sensible Food Swapping
It is important to swap high-calorie foods with healthier foods. Foods with high calories and containing highly refined ingredients are to be replaced with low-calorie salads and sprouts.