ABSTRACT
Background: Evidence shows that breastfeeding has a major role to play in public health, promoting health and preventing disease in the short and long-term for both mother and infant (NICE [1]). In addition to the established benefits, exclusive breastfeeding is suggested as an effective method of weight loss during the postpartum period due to the increased energy costs of lactation (Hatsu et al. [2]).However this potential benefit is very dependent on the duration of exclusive breast-feeding. Breastfeeding may also be related to improved maternal mental well-being (Mezzacappa [3]). This aim of the study is to assess the role of breastfeeding in postpartum women on weight loss through self-reported weight measurements pre-pregnancy and current weights and to compare levels of mental well-being with those women who were not breastfeeding. Methods: Postpartum women, who had given birth in the last year, were invited to complete an online SurveyMonkey questionnaire, live from 12/10/12 to 09/11/12, posted on pregnancy forums – selected because there was no charge attached to the posting. The questionnaire, including 84 questions, was developed from previous questionnaires written by the University of Nottingham MAGIC study team to explore the predictors of weight management in post-partum women. For this research responses to seven questions were analysed. An independent t-test was conducted to investigate the relationship of breastfeeding with weight change postpartum. A Mann-Whitney U Test used to analyse the relationship between breastfeeding and maternal body satisfaction, well-being and confidence returning to pre-pregnancy weight. This data was nonparametric and was scored on a scale with a mean score used to calculate statistical significance. Ethical approval was obtained on the 18/5/2012 from the University of Nottingham School of Sociology and Social Policy. Results: The sample of 1405 postpartum women ranged in age from under 20 years to 49 years with 50.9% breastfeeding and 49.1% non-breastfeeding. No statistical significance was found between breastfeeding and postpartum weight loss. Breastfeeding women were significantly more satisfied with their body (p<0.01) compared to those not breast-feeding. The study also found a positive correlation between breastfeeding and well-being. Breastfeeding women reported feeling more calm and peaceful (p<0.005). Breastfeeding women were significantly less likely to feel downhearted and low (p<0.002). But there was no statistical difference in energy levels. Breastfeeding women were significantly more confident about losing their gestational weight (p<0.01). Discussion: Breastfeeding was not associated with improved postpartum weight loss but those women who were breast-feeding felt more confident about being able to lose weight and return to their pre-pregnancy weight compared to those women not breast-feeding. The study did find a positive correlation between breastfeeding and increased body satisfaction and maternal mental well-being. Study limitations are that the respondents were at different stages postpartum and the responses were not definite as to the duration of breastfeeding or its exclusivity. Also the pregnancy forums selected may have introduced some bias into the study sample and thus the findings may not be truly representative. Conclusion: This research may help introduce new strategies to help promote breastfeeding as a positive experience improving mother’s self-confidence and reducing depressive feelings. More research is required to further explore the links between breastfeeding and maternal self-esteem and self-worth. Being more confident about losing weight may be beneficial in postpartum weight management but this requires further study.
ABSTRACT
Background: Obesity is recognised as being at the forefront of current ‘lifestyle diseases and without appropriate interventions the prevalence levels are projected to increase, Government Office for Science, [1]. A major challenge in the treatment of obesity is maintenance of weight loss. Wing et al. [2]. The aim of this systematic review is to investigate the effectiveness of internet-based social support as a cost effective method for aiding long-term weight loss maintenance in comparison to traditional methods. Methods: Three health related databases, Medline, Web of Science and Embase, were searched for studies, reported in the English language, published between 2002 and 2012. Inclusion criteria for the study population was adults >18years who had completed a weight loss programme and then provided with internet based social support for at least a 6 month duration. BMI and weight change data needed to be available. The type of internet support could vary eg e-mails, on-line discussion forums. The quality of each paper meeting the inclusion criteria was assessed using an adapted Newcastle- Ottawa scale Wells et al. [3]; the highest score being 15. A second researcher independently assessed the selection and quality processes. Results: Seven studies met the inclusion criteria (quality scores of 7-13); one showed a statistically significant effect of web-based social support in weight loss maintenance versus a traditional face-to-face approach (p=0.05). Three studies suggested a possible effect and three no effect. Attrition rates indicate that participant engagement in webbased programmes can be poor and that participant compatibility varied. The majority of subjects were women (1504/1959). Mean duration of follow up period for weight loss maintenance =55.1 weeks. The interventions included private and group e-mails, chat room and bulletin boards. It was suggested that web-based social support programmes could enhance traditional face-to-face communication methods, as opposed to replacing them. Discussion: Given limited healthcare resources and obesity prevalence the internet could be a scalable vehicle for providing social support for weight loss maintenance. This review found mixed outcomes of the effectiveness of internet-based support. Different components of internet support may be more effective for different people. The studies were mainly comparing internet based support against traditional face-to-face support which is likely to be more costly. Conclusion: Further research in this area is required. Areas to explore include; for whom this type of weight loss maintenance support would be most appropriate and what methods of delivery/components of internet based support are more effective. Also how can this support be used alongside traditional face-to-face methods to achieve the best long-term weight loss outcomes most cost effectively.
ABSTRACT
Background: The Leicestershire dietetic service developed a website (www.lnds.nhs.uk) in 2004 with three levels of access; for the public, health care professionals (HCPs) and dietitians. Over 450 resources are available on the site. The website has never been evaluated, though is perceived as being used frequently by dietitians. Access to nutrition websites has increased over recent years. Marquis et al. and Buttriss [1,2] have discussed how nutrition websites are used by dietitians and the public and how and why their popularity has increased. The study aimed to explore the value attached to the department website, the costs of running it and make recommendations for future development of the website. Methods: The researcher developed a Survey Monkey (www.surveymonkey.com) questionnaire, containing 12 questions to assess how visitors used the website and what they viewed. This was attached to the website for 6 weeks in spring 2013. Local Health Information Services (HIS) and Google Analytics information was available to look at retrospective website activity. Information on departmental printing costs was available to see if this had reduced over the time the website had been live. Results: Fifty four website users responded to the online questionnaire and indicated that this sample of users visited the website regularly and could find the information they were looking for. On a scale of 1-5, with 5 being a very positive response, the average rating for useful information was 4.19 and the average rating from users for the quality of the information was 4.27. The retrospective information showed that users, repeat users and pages viewed had increased steadily over the last 3 years. Unique visitors had increased from 7986 in 2011 to 10641(predicted in 2013) and return visitors had increased from 50.9% in 2011 to 57.6% (predicted) in 2013. The website users were a range of patients/public, HCPs and dietitians and although most users were from the UK there was an increasing worldwide audience. The printing budget had reduced over recent years while the number of dietetic staff employed and patients seen had increased between 2010 and 2012. Discussion: The results of the online questionnaire and Google Analytics data provided information that indicated the range of visitors valued the website and could mostly find what they were looking for. Improvements were identified e.g. a better search facility and consideration given to setting up Facebook/Twitter accounts to allow user experience to be captured on an on-going basis. The website was a very cost effective way of providing, accessible, evidence based, patient centred resources when compared with other ways of providing dietary information to patients and HCPs in Leicestershire. Conclusions: The website was valued and should be maintained with consideration given to the improvements recommended.
ABSTRACT
Background: Obesity is a growing problem in the developed world affecting 23% of the UK population [1]. Current treatment relies on 1:1 counselling, group support, pharmacological management and surgery [2]. Group weight loss has been shown to be effective and may offer a scalable cost effective obesity therapy solution. A range of group therapies are in existence ranging from commercial organisations to sessions run by healthcare professionals within the NHS; the success of the groups may differ due to variability in how groups are managed and delivered. Specific factors attributed to successful weight loss outcomes are therefore of interest in the development of future programmes. Aim: To identify features of group weight loss interventions associated with increased weight loss outcomes to inform the development of group interventions. Methods: Medline, Embase, Scopus and PsychI NFO were used to select research papers investigating the effects of a group weight loss intervention on long term weight loss (>6 months) most commonly measured by group leader or research staff. Internet or telephone based interventions were excluded along with paediatric studies and those losing weight following bariatric surgery. Papers published in English within the past 15 years were included. These papers were quality assessed using an adapted Newcastle Ottawa scale. Results:15 papers were included in this review having fulfilled the inclusion criteria. 9 of the 15 authors investigated modest energy reductions whilst 5 implemented a more prescriptive energy restriction; 1 other studied the use of orlistat. 14 of the studies stated the use of behaviour modification strategies of which stages of change, goal setting and self-monitoring were most common. Weight loss ranged from 0.1-14.1kg with 10 studies reporting a clinically significant weight loss of >5%. Discussion: Group weight management is shown to result in significant weight loss. A range of contributing factors has been identified alongside social support. A worksite based intervention showed the greatest weight loss at 12 months suggesting that easy access and environment may be key influences [3]. Whilst behaviour change strategies were frequently included, groups led by those with a background in psychology showed greater weight loss. Prescriptive dietary regimes did not appear to be more effective than modest energy restriction and there was no apparent correlation between lengths of intervention or group size on weight loss. Conclusion: Group therapy can be an effective obesity treatment; however, variation exists between groups. Accessible interventions delivered in a supportive environment with the use of behaviour modification strategies are associated with improved weight loss outcomes.