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Average BMI with 95% confidence intervals by area of residence for the Mid-aged cohort, at Surveys 1, 2, 3 and 4, from 1996 to 2004.  

Average BMI with 95% confidence intervals by area of residence for the Mid-aged cohort, at Surveys 1, 2, 3 and 4, from 1996 to 2004.  

Citations

... According to a government report published in 2019, about 41% of women and 11% of men aged 15 years and above were obese [12]. Because women of childbearing age between 15 to 49 years old (WCBA) accumulate weight faster than other women [13][14][15][16], the adverse consequences of obesity among this group could be pronounced. Obesity during a woman's childbearing years is associated with an increased risk of infertility, miscarriage, stillbirths and births with congenital disabilities, shoulder dystocia and other adverse obstetric outcomes [17][18][19][20][21][22]. ...
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Background Overweight and obesity in adults are increasing globally and in South Africa (SA), contributing substantially to deaths and disability from non-communicable diseases. Compared to men, women suffer a disproportionate burden of obesity, which adversely affects their health and that of their offspring. This study assessed the changing patterns in prevalence and determinants of overweight and obesity among non-pregnant women in SA aged 15 to 49 years (women of childbearing age (WCBA)) between 1998 and 2017. Methods This paper conducts secondary data analysis of seven consecutive nationally representative household surveys—the 1998 and 2016 SA Demographic and Health Surveys, 2008, 2010–2011, 2012, 2014–2015 and 2017 waves of the National Income Dynamics Survey, containing anthropometric and sociodemographic data. The changing patterns of the overweight and obesity prevalence were assessed across key variables. The inferential assessment was based on a standard t-test for the prevalence. Adjusted odds ratios from logistic regression analysis were used to examine the factors associated with overweight and obesity at each time point. Results Overweight and obesity prevalence among WCBA in SA increased from 51.3 to 60.0% and 24.7 to 35.2%, respectively, between 1998 and 2017. The urban-rural disparities in overweight and obesity decreased steadily between 1998 and 2017. The prevalence of overweight and obesity among WCBA varied by age, population group, location, current smoking status and socioeconomic status of women. For most women, the prevalence of overweight and/or obesity in 2017 was significantly higher than in 1998. Significant factors associated with being overweight and obese included increased age, self-identifying with the Black African population group, higher educational attainment, urban area residence, and wealthier socioeconomic quintiles. Smoking was inversely related to being overweight and obese. Conclusions The increasing trend in overweight and obesity in WCBA in SA demands urgent public health attention. Increased public awareness is needed about obesity and its health consequences for this vulnerable population. Efforts are needed across different sectors to prevent excessive weight gain in WCBA, focusing on older women, self-identified Black African population group, women with higher educational attainment, women residing in urban areas, and wealthy women.
... Women, in particular, appear more susceptible to obesity, with the prevalence of female obesity having more than doubled in the past 30 years and the prevalence of morbid obesity in women more than twice that recorded in men [3]. Evidence suggests that among adults, young women of childbearing age (18-44 years) are the most at risk of developing obesity [4,5], with this cohort demonstrating the highest rate of weight gain [6][7][8][9][10]. Furthermore, the adverse effects associated with obesity appear to be greater in women, with the risks of developing cancer and cardiovascular and metabolic disorders significantly higher than observed in men [11][12][13][14][15]. Mounting evidence highlights the strong association between excessive weight gained during early childbearing years and longer-term adverse health outcomes [4,[16][17][18]. ...
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Introduction Obesity in women has more than doubled in the past thirty years. Increasing research suggests that increased cardiorespiratory fitness (CRF) can largely attenuate the negative health risks associated with obesity. Though previous literature suggests that combined training may be the most effective for improving CRF in adults with obesity, there is minimal research investigating the efficacy of combined and resistance programmes in women with obesity. This article outlines a protocol for a parallel pilot study which aims to evaluate the feasibility and efficacy of three exercise modalities in women with obesity for increasing CRF and strength and improving body composition and other health outcomes (i.e. quality of life). Methods and analysis Sixty women (aged 18–50) with obesity (body mass index [BMI] ≥ 30 and/or waist circumference ≥ 88 cm) who are physically inactive, have no unstable health conditions and are safe to exercise will be recruited from September 2021 to December 2022. The main outcome will be feasibility and acceptability of the intervention and procedures. Trial feasibility outcomes will be evaluated to determine if a definitive trial should be undertaken. Trial acceptability will be explored through follow-up qualitative interviews with participants. Secondary outcomes will include CRF (predicted VO 2 max), anthropometrics (i.e. BMI), strength (5RM bench press, leg dynamometry, grip strength) and other health outcomes (i.e., pain). Participants will be block randomised into one of four trial arms (aerobic exercise, resistance training and combined training groups, non-active control group) and measurements will be completed pre- and post-intervention. The exercise groups will receive an individualised supervised exercise programme for 3× sessions/week for 12 weeks. The change in mean values before and after intervention will be calculated for primary and secondary outcomes. ANOVA and t -tests will be applied to evaluate within-group and between-group differences. If sufficient participants are recruited, the data will be analysed using ANCOVA with the age and BMI as covariates. Discussion This pilot will provide data on the feasibility and acceptability of trial procedures and of the programmes’ three progressive time-matched exercise interventions (aerobic, resistance and combined) for women living with obesity, which will help inform future research and the potential development of a full-scale randomised clinical trial. Trial registration ISRCTN, ISRCTN13517067 . Registered 16 November 2021—retrospectively registered.
... Furthermore, women of reproductive age are at a particularly higher risk of weight gain and obesity exacerbated by excess gestational weight gain and postpartum weight retention. For example, reproductive age women in Australia had an average weight gain of 6.3 kg over 10 years [6] with this rate of weight gain greater in women 18-50 years (0.4-0.7 kg/year) compared to women above 50 years (0.2-0.5 kg/year) [7]. In addition to increasing the risk of obesity, weight gain in adults is associated with increased risk of various chronic diseases including type 2 diabetes, hypertension, cardiovascular diseases and cancer [8,9] and an overall increased risk of mortality [10]. ...
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Weight gain prevention interventions are likely to be more effective with the inclusion of behaviour change techniques. However, evidence on which behaviour change techniques (BCT) are most effective for preventing weight gain and improving lifestyle (diet and physical activity) is limited, especially in reproductive-aged adults. This meta-analysis and meta-regression aimed to identify BCT associated with changes in weight, energy intake and physical activity in reproductive-aged adults. BCT were identified using the BCT Taxonomy (v1) from each intervention. Meta-regression analyses were used to identify BCT associated with change in weight, energy intake and physical activity. Thirty-four articles were included with twenty-nine articles for the meta-analysis. Forty-three of the ninety-three possible BCT listed in the taxonomy were identified in the included studies. Feedback on behaviour and Graded tasks were significantly associated with less weight gain, and Review behaviour goals was significantly associated with lower energy intake. No individual BCT were significantly associated with physical activity. Our analysis provides further evidence for which BCT are most effective in weight gain prevention interventions. The findings support that the use of key BCT within interventions can contribute to successful weight gain prevention in adults of reproductive age.
... This excess weight gain is associated with reproductive, metabolic, and psychosocial complications, development of major chronic disease and lower likelihood of healthy aging. 1,2 Vulnerability to accelerated weight gain in women is complex with preconception, pregnancy, and postpartum (within 12 months of childbirth) recognized as critical contributory life stages. 3 Preconception, women do not identify themselves as a distinct highrisk group or at a specific life stage. ...
Article
This systematic review and quality appraisal evaluated clinical practice guidelines (CPGs) for weight management and weight‐related behaviors across preconception, pregnancy, and postpartum. CPGs published in English were identified from research and guideline‐specific databases between 2010 and 2019. Recommendations were categorized into weight (body mass index screening, weight loss, weight gain prevention, and gestational weight gain), diet, food safety, physical activity, and behavioral strategies. Three independent appraisers assessed CPG quality using the Appraisal of Guidelines Research and Evaluation II instrument. Twenty‐two CPGs were included across preconception (n = 2), pregnancy (n = 8), postpartum (n = 2), or a combination (n = 10). Overall, 45% of CPGs were appraised as poor quality, 32% as moderate, and 23% as high. Evaluation of body mass index and supplementation recommendations were most common across CPGs, alongside secondary weight management recommendations for women with obesity in fewer CPGs. Accompanying recommendations for diet, physical activity, and behavior were highly variable between guidelines. We report significant ambiguity in existing guidance and an absence of important considerations, including targeting weight gain prevention and limiting excess gestational weight gain. Results emphasize the need for development of robust, comprehensive, and high quality guidelines on healthy lifestyle and weight management across these formative reproductive life stages.
... Prevalence of women affected by obesity is increasing globally, with prevalence rates increasing from 6.4% in 1975 to 14.9% in 2014 [1]. Women of childbearing age (15 to 44 years) are particularly vulnerable to weight gain, with many large cohort studies demonstrating this life stage is the time of greatest weight gain [2][3][4][5]. For example, the Australian Longitudinal Study of Women's Health has found women in their younger cohort (aged 18-23 years at survey 1) experience an average weight gain of 6.3 kg over 10 years [3]. ...
... Women of childbearing age (15 to 44 years) are particularly vulnerable to weight gain, with many large cohort studies demonstrating this life stage is the time of greatest weight gain [2][3][4][5]. For example, the Australian Longitudinal Study of Women's Health has found women in their younger cohort (aged 18-23 years at survey 1) experience an average weight gain of 6.3 kg over 10 years [3]. Notably, in women of childbearing age, pregnancy has been investigated as a potential trigger for excessive weight gain and the development of overweight and obesity. ...
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Background: Women of childbearing age are vulnerable to weight gain. This scoping review examines the extent and range of research undertaken to evaluate behavioral interventions to support women of childbearing age to prevent and treat overweight and obesity. Methods: Eight electronic databases were searched for randomized controlled trials (RCT) or systematic reviews of RCTs until 31st January 2018. Eligible studies included women of childbearing age (aged 15-44 years), evaluated interventions promoting behavior change related to diet or physical activity to achieve weight gain prevention, weight loss or maintenance and reported weight-related outcomes. Results: Ninety studies met the inclusion criteria (87 RCTs, 3 systematic reviews). Included studies were published from 1998 to 2018. The studies primarily focused on preventing excessive gestational weight gain (n = 46 RCTs, n = 2 systematic reviews), preventing postpartum weight retention (n = 18 RCTs) or a combination of the two (n = 14 RCTs, n = 1 systematic review). The RCTs predominantly evaluated interventions that aimed to change both diet and physical activity behaviors (n = 84) and were delivered in-person (n = 85). Conclusions: This scoping review identified an increasing volume of research over time undertaken to support women of childbearing age to prevent and treat overweight and obesity. It highlights, however, that little research is being undertaken to support the young adult female population unrelated to pregnancy or preconception.
... Considering the overall modest energy reduction (600 kJ/day) seen in the current review, significant weight loss is an unlikely outcome. However, improved diet quality independent of weight changes could improve total and cause-specific mortality [53], and considering the high risk of weight gain in this population [54], a modest energy restriction to prevent further weight gain could support chronic diseases prevention [55]. Thus, behavioural strategies effective in reducing energy intake with or without significant weight loss could also be implemented in interventions for postpartum women with the aim of improving overall health. ...
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Successful implementation of postpartum lifestyle interventions first requires the identification of effective core components, such as strategies for behavioural change. This systematic review and meta-analysis aimed to describe the associations between behavioural strategies and changes in weight, diet, and physical activity in postpartum women. Databases MEDLINE, CINAHL, EMBASE, and PsycINFO were searched for randomised controlled trials of lifestyle interventions in postpartum women (within 2 years post-delivery). Strategies were categorised according to the Behaviour Change Technique Taxonomy (v1). Forty-six articles were included (n = 3905 women, age 23–36 years). Meta-analysis showed that postpartum lifestyle interventions significantly improved weight (mean difference −2.46 kg, 95%CI −3.65 to −1.27) and physical activity (standardised mean difference 0.61, 95%CI 0.20 to 1.02) but not in energy intake. No individual strategy was significantly associated with weight or physical activity outcomes. On meta-regression, strategies such as problem solving (β = −1.74, P = 0.045), goal setting of outcome (β = −1.91, P = 0.046), reviewing outcome goal (β = −3.94, P = 0.007), feedback on behaviour (β = −2.81, P = 0.002), self-monitoring of behaviour (β = −3.20, P = 0.003), behavioural substitution (β = −3.20, P = 0.003), and credible source (β = −1.72, P = 0.033) were associated with greater reduction in energy intake. Behavioural strategies relating to self-regulation are associated with greater reduction in energy intake.
... In any given 5-year period, 20% of women of reproductive age have sufficient weight gain to progress them into a higher body mass index (BMI) category [2,3]. Furthermore, the rate of weight gain is highest (approximately 700 g per year) among women of normal BMI [4,5]. Pregnancy often represents a significant turning point in a woman's cardiovascular and metabolic health trajectory secondary to pregnancy-related changes, including relative insulin resistance, which promotes weight gain [6], and risk of developing obesity subsequently [7,8]. ...
... 2 Termination of pregnancy (TOP) 3 Three hundred and twelve infants with non-missing data included in raw data analysis, one infant with missing data had outcomes imputed and was therefore included in the imputed analysis. 4 Stillbirths excluded from infant outcomes analysis but included for analysis of maternal antenatal outcomes only. ...
... 2 Termination of pregnancy (TOP) 3 Three hundred and twelve infants with non-missing data included in raw data analysis, one infant with missing data had outcomes imputed and was therefore included in the imputed analysis. 4 Stillbirths excluded from infant outcomes analysis but included for analysis of maternal antenatal outcomes only. * = mean and standard deviation. ...
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There are well-recognised associations between excessive gestational weight gain (GWG) and adverse pregnancy outcomes, including an increased risk of pre-eclampsia, gestational diabetes and caesarean birth. The aim of the OPTIMISE randomised trial was to evaluate the effect of dietary and exercise advice among pregnant women of normal body mass index (BMI), on pregnancy and birth outcomes. The trial was conducted in Adelaide, South Australia. Pregnant women with a body mass index in the healthy weight range (18.5–24.9 kg/m2) were enrolled in a randomised controlled trial of a dietary and lifestyle intervention versus standard antenatal care. The dietitian-led dietary and lifestyle intervention over the course of pregnancy was based on the Australian Guide to Healthy Eating. Baseline characteristics of women in the two treatment groups were similar. There was no statistically significant difference in the proportion of infants with birth weight above 4.0 kg between the Lifestyle Advice and Standard Care groups (24/316 (7.59%) Lifestyle Advice versus 26/313 (8.31%) Standard Care; adjusted risk ratio (aRR) 0.91; 95% confidence interval (CI) 0.54 to 1.55; p = 0.732). Despite improvements in maternal diet quality, no significant differences between the treatment groups were observed for total GWG, or other pregnancy and birth outcomes.
... This suggests that participant fidelity is important in achieving intervention outcomes. This modest improvement aligns with the primary outcome findings showing women in the intervention group maintaining their weight over the 12month study period while the control group continued to gain weight at the Australian national average rate for this age group, which is 700 g per annum [38]. ...
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Background: Women with gestational diabetes have low diet quality. We evaluated the effectiveness of a group-based lifestyle modification program for improvement of dietary quality in women with previous gestational diabetes predominantly within their first postnatal year. Methods: Women were randomised to intervention (n = 284) or usual care (n = 289). Dietary data was collected at baseline and twelve months using a food frequency questionnaire and recoded into the Australian Recommended Food Score (ARFS). Mixed model analyses investigated the intervention effect on ARFS (per-protocol-set (PPS) excluded women without the minimum intervention exposure). Results: Baseline mean total ARFS was low (31.8 ± 8.9, maximum score = 74) and no significant changes were seen in total ARFS (Cohen's D = - 0.06). 2% reduction in alcohol for intervention (0.05, 0.26) compared with - 1% for usual care (Odds ratio: 0.68; 95%CI 0.46, 0.99). Dairy ARFS sub-category significantly improved (low fat/saturated fat foods) in the intervention group over time compared with usual care for the PPS analysis (dairy + 0.28 in intervention (95%CI 0.08, 0.48) compared with + 0.02 in usual care (95%CI -0.14, 0.18) (group-by-treatment interaction p = 0.05, Cohen's D = 0.14)). Conclusions: Engaging with the intervention improved aspects of diet quality that aligned with minimum intervention exposure, but the total diet quality remains low. Further research is needed to improve diabetes prevention program engagement. Trial registration: Australian New Zealand Clinical Trials Registry ANZCTRN12610000338066 , April 2010.
... Advice may only be provided to women who appear overweight meaning health professionals are missing opportunities to prevent weight gain [82]. This is of particular importance given women with PCOS gain more than their reproductive aged peers, a population group already predisposed to significant longitudinal gains [29,84]. ...
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Polycystic ovary syndrome (PCOS) is a complex condition that involves metabolic, psychological and reproductive complications. Insulin resistance underlies much of the pathophysiology and symptomatology of the condition and contributes to long term complications including cardiovascular disease and diabetes. Women with PCOS are at increased risk of obesity which further compounds metabolic, reproductive and psychological risks. Lifestyle interventions including diet, exercise and behavioural management have been shown to improve PCOS presentations across the reproductive, metabolic and psychological spectrum and are recommended as first line treatment for any presentation of PCOS in women with excess weight by the International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2018. However, there is a paucity of research on the implementation lifestyle management in women with PCOS by healthcare providers. Limited existing evidence indicates lifestyle management is not consistently provided and not meeting the needs of the patients. In this review, barriers and facilitators to the implementation of evidence-based lifestyle management in reference to PCOS are discussed in the context of a federally-funded health system. This review highlights the need for targeted research on the knowledge and practice of PCOS healthcare providers to best inform implementation strategies for the translation of the PCOS guidelines on lifestyle management in PCOS.
... Obesity is one of the strongest modifiable risk factors for T2DM development [5,42], and postnatal weight gain is a key risk factor for women [16,43], especially women with previous GDM [12,44]. Australian women typically gain 650 g annually [45], and the women in the MAGDA-DPP usual care group were no different (720 g average). The US Agency for Healthcare Research and Quality recently identified a 0.5-kg between-group weight gain difference as significant [46], and similarly the US Community Preventive Services Task Force found that even low levels of weight loss are effective in reducing T2DM risk [47]. ...