Weight management is a lifelong journey, and for many women, significant life events like pregnancy can present unique challenges. Gestational weight gain (GWG) and postpartum weight retention (PPWR) are significant contributors to women's future weight and health trajectories. This article explores the weight loss journey of Janel Lamb, alongside insights from a study on remotely-delivered behavioral interventions for managing weight during and after pregnancy.
Janel's Story: From Dancer to Weight Loss Surgery
Janel Lamb's experience showcases the complexities of weight management across different life stages. "I had been relatively fit and thin as a child," she recounts, "I was a dancer all through my youth and teen years." After getting married young and having five children, she initially managed to keep her weight under control. However, about 15 years ago, a move to a new area, coupled with depression and a busy lifestyle, led to a gradual increase in weight.
Like many, Janel tried various weight loss strategies. “I would lose a little here and there, and it would come right back. I ruined my metabolism with diet pills, and as my muscle decreased, my metabolism and hormones really got out of whack.” She found that her usual tactics were no longer effective. Adding to her challenges, a sciatic nerve issue caused by acute piriformis syndrome left her bedridden and unable to exercise. "I tried intermittent fasting, keto, low carb, eating small meals every 2 hours, you name it, but the pounds kept packing on."
After unsuccessful weight loss attempts, Janel considered weight loss surgery. She spent about 2 months watching YouTube, talking to friends, listening to podcasts, and reading everything she could. "It all was starting to line up for me in my heart, and I knew it was time, so I called." She scheduled her surgery for September 1, 2021. Her husband, initially skeptical, was supportive.
Janel's commitment to the pre-op diet paid off. "I went into surgery at about 187 lbs, and today, 4 months later, I’m 139 pounds. I went from size 14 and XL clothes to size 4 and SM clothes." She describes the experience as "truly miraculous."
Read also: In-Depth Guide: Lamb and Rice Diet
Remote Behavioral Interventions for Weight Management During and After Pregnancy
Janel's story aligns with the broader need for effective weight management strategies, particularly for women during and after pregnancy. A pilot study, "Healthy for Two/Healthy for You” (H42/H4U), evaluated the feasibility, acceptability, and preliminary effectiveness of a remotely-delivered behavioral health coaching program to limit GWG and PPWR in pregnant and postpartum women engaged in prenatal care.
Study Design and Participants
The study was a two-arm, randomized controlled trial conducted in Baltimore, MD, from 2016-2017. Participants were recruited from hospital-based obstetric practices. The study included women, ≥ 18 years, 11-16 gestational weeks of a singleton pregnancy, and BMI ≥ 18.5 kg/m2. Participants also needed to be fluent in English and have regular access to the Internet and a smartphone they were willing to use for the study.
Participants were randomized into either the H42/H4U intervention arm or a health education comparison group. Those in the H42/H4U intervention arm were trained to use a mobile phone application (Lose It!) to track their weight, dietary intake, and exercise minutes. The health education comparison group received a single, 45-minute health education session focused on basic nutrition, low-cost healthy shopping, and food and general prenatal safety.
The H42/H4U Intervention
H42/H4U is a remotely-delivered health coaching program designed to limit GWG (H42) and reduce PPWR (H4U). Participants were encouraged to meet Institute of Medicine (IOM) pregnancy weight gain guidelines based on pre-pregnancy BMI (normal weight: 25-35 lb; overweight: 15-25 lb; obese: 11-20 lb) and to return to their pre-pregnancy weight postpartum. The postpartum program lasted 12 weeks, with additional goals for overweight or obese women to lose an additional 5% within the first postpartum year.
The program promoted weight, dietary, and physical activity objectives through:
Read also: Delicious Lamb Guide
- Patient-centered coaching phone calls
- Learning materials based on the COACH model (Commit, Omit, Add, Communicate, Honour your wellness)
- Self-monitoring of weight, calories, and exercise minutes
Health coaching calls were approximately 20-30 minutes and occurred weekly during the first 12 weeks of the program and biweekly thereafter, until 3 months postpartum. Coaches held Master's degrees and had strong backgrounds in behavioral health coaching, nutrition, and/or maternal health.
Learning materials covered a range of dietary/eating, physical activity, interpersonal, wellness, and pregnancy topics using the COACH framework. Participants were asked to weigh themselves at least weekly and to enter their weight on a readily available, free smartphone application (Lose It!), where they were also asked to enter their daily dietary intake and moderate (or higher) exercise minutes.
Measurement and Outcomes
Intervention feasibility was measured using web-generated, participant- and Coach-reported data. Indicators of feasibility included call completion, learning activity completion, and frequency of tracking of weight, calories, and exercise. Intervention acceptability was measured using visual analogue scales assessing perceived helpfulness of program components.
The study also evaluated the effectiveness of the H42/H4U program on reducing GWG and 3-month PPWR compared to the health education comparison group. Gestational weight gain was defined as the difference between 37-week and pre-pregnancy weight. Postpartum weight retention was defined as the difference between weight at 3-months postpartum and pre-pregnancy weight.
Study Results
The study showed promising results regarding the feasibility and acceptability of the remotely-delivered intervention. 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 helpfulness ratings of the program during pregnancy were 80 (on a scale of 0-100) and 62 postpartum.
Read also: Nutrition for Puppy Health
While the study was not powered to detect significant differences in weight gain between the groups, there was a tendency toward reduced GWG and PPWR in the H42/H4U group. The median change in weight from baseline to 37 weeks gestation was 9.4 kg in the H42/H4U group and 13.0 kg in the health education comparison group. At 12 weeks postpartum, the median change in weight from baseline was 0.2 kg in the H42/H4U group and 1.4 kg in the comparison group.
Participants in the H42/H4U group were highly engaged in the intervention, with most women completing at least 80% of their recommended pregnancy calls. The patient-centered nature of the program, assignment to one continuous health coach, and ease of scheduling calls may have contributed to engagement success.