| 1. |
- Bertz, Fredrik, et al.
(författare)
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Diet and exercise weight-loss trial in lactating overweight and obese women
- 2012
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Ingår i: American Journal of Clinical Nutrition. - : Elsevier BV. - 0002-9165. ; 96:4, s. 698-705
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Tidskriftsartikel (refereegranskat)abstract
- Background: Current evidence suggests a combined treatment of postpartum weight loss of diet and exercise. However, to our knowledge, neither their separate and interactive effects nor long-term outcomes have been evaluated. Objective: We evaluated whether a 12-wk dietary behavior modification (D) treatment to decrease energy intake, physical exercise behavior modification (E) treatment to implement moderate aerobic exercise, or combined dietary and physical exercise behavior modification (DE) treatment compared with control (usual care) (C) reduces body weight in lactating women measured at the end of treatment and at a 1-y follow-up 9 mo after treatment termination. Design: At 10-14 wk postpartum, 68 lactating Swedish women with a prepregnancy BMI (in kg/m(2)) of 25-35 were randomly assigned to D, E, DE, or C groups. Measurements were made at baseline, after the intervention, and again at a 1-y follow-up 9 mo later. A 2 x 2 factorial approach was used to analyze main and interaction effects of treatments. Results: Weight changes after the intervention and 1-y follow-up were -8.3 +/- 4.2 and -10.2 +/- 5.7 kg, respectively, in the D group; -2.4 +/- 3.2 and -2.7 +/- 5.9 kg, respectively, in the E group; -6.9 +/- 3.0 and -7.3 +/- 6.3 kg, respectively, in the DE group; and -0.8 +/- 3.0 and -0.9 +/- 6.6 kg, respectively, in the C group. The main effects of D treatment, but not of E treatment, on weight were significant at both times (P < 0.001). Conclusions: Dietary treatment provided clinically relevant weight loss in lactating postpartum women, which was sustained at 9 mo after treatment. The combined treatment did not yield significant weight or body-composition changes beyond those of dietary treatment alone. This trial was registered at clinicaltrials.gov as NCT01343238. Am J Clin Nutr 2012;96:698-705.
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| 2. |
- Bertz, Fredrik
(författare)
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Diet and/or exercise treatment for weight loss in overweight and obese women after childbirth
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- AIM: The aim of the research presented in this thesis was to evaluate whether, dietary behavior modification treatment (D), or physical exercise behavior modification treatment (E), or the combination of both (DE), provide short and long-term weight loss compared to control (C) among overweight and obese lactating women, and if so how. METHODS: At 10-14 weeks postpartum, 68 lactating Swedish women with a pre-pregnancy body mass index of 25-35 were randomized to 12 weeks of treatment or control. The study variables were measured at baseline, after the intervention, and again at a 1-year follow-up, 9 months after treatment termination. A total of 29 interviews were also made. RESULTS: Weight changes (kg) after the intervention and 1-year follow-up, respectively, were -8.3 ± 4.2 and -10.2 ± 5.7 in D, -2.4 ± 3.2 and -2.7 ± 5.9 in E, -6.9 ± 3.0 and -7.3 ± 6.3 in DE, and -0.8 ± 3.0 and -0.9 ± 6.6 in C. The main effects of D, but not of E, on weight were significant at both times (p<0.001). Weight loss was mainly adipose tissue in all groups. At baseline the women reported a typical Swedish diet. The D treatment led to reduced intake of energy, fat and carbohydrate. The proportion of sugar was reduced, whereas complex carbohydrates and fiber were increased. The women did not reach recommended levels of vitamins A and D, folate, and iron, with no difference between treatments. Based on the interviews a substantive theory of achieving sustainable weight loss in the specific context was developed. The women needed a ‘Catalytic Interaction’ from the health care provider, to mobilize and support their own resources. ‘Transformative Lifestyle Change’ was the key to sustainable weight loss. It comprised a journey towards gaining lifestyle control, consisting of seven stages leading to initiation, implementation, identification with, and maintenance of change. CONCLUSIONS: Dietary treatment, with or without exercise treatment, provided significant and clinically relevant weight loss among overweight and obese lactating women, and it was sustained at 9 months after treatment. Further research will be needed to evaluate the effectiveness in the health care setting. Weight loss was achieved with a diet in line with current official recommendations, indicating its usefulness for this purpose. A supplement may be useful to reach recommended intake of certain micronutrients. A successful weight loss depended on a Catalytic Interaction with the health care provider, and on the Transformative Lifestyle Change-process. This theory may be useful in the design and evaluation of weight loss treatments.
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| 3. |
- Bertz, Fredrik, et al.
(författare)
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Sustainable Weight Loss among Overweight and Obese Lactating Women Is Achieved with an Energy-Reduced Diet in Line with Dietary Recommendations: Results from the LEVA Randomized Controlled Trial.
- 2015
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Ingår i: Journal of the Academy of Nutrition and Dietetics. - : Elsevier BV. - 2212-2672. ; 115:1, s. 78-86
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to evaluate dietary changes during and after a dietary treatment shown to result in significant and sustained weight loss among lactating overweight and obese women. This is crucial before clinical implementation. Data were collected from the LEVA (in Swedish: Livsstil för Effektiv Viktminskning under Amning [Lifestyle for Effective Weight Loss During Lactation]) randomized controlled factorial trial with a 12-week intervention and a 1-year follow up. At 10 to 14 weeks postpartum, 68 lactating Swedish women with a prepregnancy body mass index (calculated as kg/m(2)) of 25 to 35 were randomized to structured dietary treatment, physical exercise treatment, combined treatment, or usual care (controls) for a 12-week intervention, with a 1-year follow-up. Dietary intake was assessed with 4-day weighed dietary records. Recruitment took place between 2007 and 2010. The main outcome measures were changes in macro- and micronutrient intake from baseline to 12 weeks and 1 year. Main and interaction effects of the treatments were analyzed by a 2×2 factorial approach using a General Linear Model adjusted for relevant covariates (baseline intake and estimated underreporting). It was found that at baseline, the women had an intake of fat and sucrose above, and an intake of total carbohydrates and fiber below, recommended levels. At 12 weeks and 1 year, the dietary treatment led to reduced intake of energy (P<0.001 and P=0.005, respectively), fat (both P values <0.001), and sucrose (P<0.001 and P=0.050). At 12 weeks, total carbohydrates were reduced (P<0.001). Amajority of women in all groups reported low intakes of vitamin D, folate, and/or iron. In conclusion, a novel dietary treatment led to reduced intake of fat and carbohydrates. Diet composition changed to decreased proportions of fat and sucrose, and increased proportions of complex carbohydrates, protein and fiber. Weight loss through dietary treatment was achieved with a diet in line with macronutrient recommendations.
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| 4. |
- Bertz, Fredrik, et al.
(författare)
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Transformative Lifestyle Change: key to sustainable weight loss among women in a post-partum diet and exercise intervention
- 2015
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Ingår i: Maternal and Child Nutrition. - : Wiley. - 1740-8695 .- 1740-8709. ; 11:4, s. 631-645
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Tidskriftsartikel (refereegranskat)abstract
- The increase in overweight and obesity among women is a growing concern, and reproduction is associated with persistent weight gain. We have shown that dietary behavioural modification treatment, with or without exercise, results in weight loss and maintenance of weight loss. The aim of this study was to provide an explanatory model of how overweight and obese women achieve weight loss during, and after, participating in a post-partum diet and/or exercise intervention. Using Grounded Theory, we performed and analysed 29 interviews with 21 women in a 12-week Swedish post-partum lifestyle intervention with a 9-month follow-up. Interviews were made after the intervention and at the 9-month follow-up. To overcome initial barriers to weight loss, the women needed a ‘Catalytic Interaction’ (CI) from the care provider. It depended on individualised, concrete, specific and useful information, and an emotional bond through joint commitment, trust and accountability. Weight loss was underpinned by gradual introduction of conventional health behaviours. However, the implementation depended on the experience of the core category process ‘Transformative Lifestyle Change’ (TLC). This developed through a transformative process of reciprocal changes in cognitions, emotions, body, environment, behaviours and perceived self. Women accomplishing the stages of the TLC process were successful in weight loss, in contrast to those who did not. The TLC process, dependent on initiation through CI, led to implementation and integration of recognised health behaviours, resulting in sustainable weight loss. The TLC model, including the CI construct and definition of barriers, facilitators and strategies provides an explanatory model of this process.
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| 5. |
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| 6. |
- Ellegård, Lars, 1958, et al.
(författare)
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Body composition in overweight and obese women postpartum: bioimpedance methods validated by dual energy X-ray absorptiometry and doubly labeled water
- 2016
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Ingår i: European Journal of Clinical Nutrition. - : Springer Science and Business Media LLC. - 0954-3007 .- 1476-5640. ; 70, s. 1181-1188
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Tidskriftsartikel (refereegranskat)abstract
- © 2016 Macmillan Publishers LimitedBackground/Objectives:Obesity, pregnancy and lactation all affect body composition. Simple methods to estimate body composition are useful in clinical practice and to evaluate interventions. In overweight and obese lactating women, such methods are not fully validated. The objective of this study was to validate the accuracy and precision of bioimpedance spectroscopy (BIS) by Xitron 4200 and 8-electrode multifrequency impedance (multifrequency bioimpedance analysis, MFBIA) by Tanita MC180MA with the reference methods dual energy X-ray absorptiometry (DXA) and doubly labeled water (DLW) for the assessment of body composition in 70 overweight and obese women postpartum.Subjects/Methods:The LEVA-study (Lifestyle for Effective Weight loss during lactation) consisted of an intervention and follow-up with three assessments at 3, 6 and 15 months postpartum, which made possible the validation of both accuracy and precision. Mean differences between methods were tested by a paired t-test and Bland–Altman plots for systematic bias.Results:At baseline, BIS and MFBIA underestimated fat mass (FM) by 2.6±2.8 and 8.0±4.2kg compared with DXA (P<0.001) but without systematic bias. BIS and MFBIA overestimated total body water (TBW) by 2.4±2.2 and 4.4±3.2kg (P<0.001) compared with DLW, with slight systematic bias by BIS. BIS correctly estimated muscle mass without systematic bias (P>0.05). BIS overestimated changes in TBW (P=0.01) without systematic bias, whereas MFBIA varied greatly and with systematic bias.Conclusions:BIS underestimates mean FM compared with DXA but can detect mean changes in body composition, although with large limits of agreement. BIS both accurately and precisely estimates muscle mass in overweight and obese women postpartum. MFBIA underestimates FM and overestimates TBW by proprietary equations compared with DXA and DLW.European Journal of Clinical Nutrition advance online publication, 30 March 2016; doi:10.1038/ejcn.2016.50.
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| 7. |
- Hagberg, Lars A., 1956-, et al.
(författare)
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Cost-utility analysis of a randomized controlled weight loss trial among lactating overweight/obese women
- 2014
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Ingår i: BMC Public Health. - : BioMed Central. - 1471-2458. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- Background: Overweight and obesity among young, adult women are increasing problems in Sweden as in many other countries. The postpartum period may be a good opportunity to improve eating habits and lose weight in a sustainable manner. The aim was to make a cost-utility analysis of a dietary behavior modification treatment alongside usual care, compared to usual care alone, among lactating overweight and obese women.Methods: This study was a cost-utility analysis based on a randomized controlled and longitudinal clinical diet intervention. Between 2007-2010, 68 women living in Sweden were, after baseline measurement at 8-12 weeks postpartum, randomly assigned to a 12-week dietary behavior modification treatment or control group.Inclusion criteria were: self-reported pre-pregnancy body mass index (BMI) 25-35 kg/m(2), non-smoker, singleton term delivery, birth weight > 2500 g, intention to breastfeed for 6 mo and no diseases (mother and child). The women in the intervention group received 1.5 hour of individual counseling at study start and 1 hour at follow-up home visits after 6 weeks of intervention, with support through cell phone text messages every two wk. Dietary intervention aimed to reduce dietary intake by 500 kcal/day. The control group received usual care. Weight results have previously been reported. Here we report on analyses carried out during 2012-2013 of cost per quality adjusted life years (QALY), based on the changes in quality of life measured by EQ-5D-3 L and SF-6D. Likelihood of cost-effectiveness was calculated using Net Monetary Benefit method.Results: Based on conservative assumptions of no remaining effect after 1 year follow-up, the diet intervention was cost-effective. Costs per gained QALY were 8 643 - 9 758 USD. The likelihood for cost-effectiveness, considering a willingness to pay 50 000 USD for a QALY, was 87-93%.Conclusions: The diet intervention is cost-effective.
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| 8. |
- Hagberg, Lars, 1956-, et al.
(författare)
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Cost-effectiveness and quality of life of a diet intervention postpartum: 2-year results from a randomized controlled trial
- 2019
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 19
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPregnancy has been identified as a contributor to obesity. We have shown that a diet intervention postpartum produced a 2-y weight loss of 8%. Here, we present the impact of the diet intervention on cost-effectiveness and explore changes in quality of life (QOL).MethodsA total of 110 postpartum women with overweight/obesity were randomly assigned to diet (D-group) or control (C-group). D-group received a 12-wk diet intervention within primary health care followed by monthly emails up to the 1-y follow-up. C-group received a brochure. Changes in QOL were measured using the 36-item Short Form Health Survey and EQ-5D. The analysis of cost-effectiveness was a cost-utility analysis with a health care perspective and included costs of intervention for stakeholder, quality-adjusted life-years (QALYs) gained and savings in health care. The likelihood of cost-effectiveness was examined using the net monetary benefit method.ResultsThe D-group increased their QOL more than the C-group at 12 wk. and 1 y, with pronounced differences for the dimensions general health and mental health, and the mental component summary score (all p<0.05). Cost per gained QALY was 1704-7889 USD. The likelihood for cost-effectiveness, based on a willingness to pay 50,000 USD per QALY, was 0.77-1.00.ConclusionsA diet intervention that produced clinically relevant postpartum weight loss also resulted in increased QOL and was cost-effective.Trial registrationClinical trials, NCT01949558, 2013-09-24
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| 9. |
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| 10. |
- Huseinovic, Ena, et al.
(författare)
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Dietary assessment among women with overweight and obesity in early postpartum
- 2016
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Ingår i: Journal of Human Nutrition and Dietetics. - : Wiley. - 0952-3871 .- 1365-277X. ; 29:4, s. 411-417
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThe present study aimed to assess dietary intake and evaluate the degree of agreement of group-level dietary intake as measured by 24-h recall against a 4-day diet record among postpartum women with overweight and obesity. MethodsA cross-sectional study was conducted of 110 Swedish women with a body mass index of 27 kg m(-2) at 6-15 weeks postpartum who were recruited to a weight loss trial and randomised to diet intervention or control. One 24-h recall was conducted among all women prior to randomisation. In addition, women subsequently randomised to diet intervention also conducted a 4-day diet record before receiving dietary treatment (n = 54). Paired tests were used to evaluate agreement of group-level dietary intake as measured by 24-h recall against 4-day diet record among women randomised to diet intervention. ResultsWomen reported a median (25th and 75th percentiles) energy intake of 9.1 (6.9, 11.7) MJ day(-1) and an intake of fibre, vitamin D, folate and iron below the recommended intake as assessed by 24-h recall prior to randomisation (n = 110). Group-level median intakes of energy (9.9 versus 10.0 MJ day(-1)), fibre (21.9 versus 21.3 g day(-1)), vitamin D (4.8 versus 6.5 g day(-1)), folate (296 versus 287 g day(-1)), iron (11.0 versus 11.3 mg day(-1)) and calcium (915 versus 968 mg day(-1)) did not differ significantly between the methods; however, the record captured a higher energy-adjusted intake of fat, saturated fat and alcohol, as well as a lower intake of carbohydrates, compared to the recall (n = 54). ConclusionsWe found no difference in group-level estimates of energy or micronutrients between the recall and the record; however, there were some differences for macronutrients.
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