R E S E A R C H A R T I C L E Open Access
Supporting women of childbearing age in
the prevention and treatment of
overweight and obesity: a scoping review
of randomized control trials of behavioral
Melinda J. Hutchesson
, Mette de Jonge Mulock Houwer
, Hannah M. Brown
, Siew Lim
, Lisa J. Moran
, Megan E. Rollo
and Jenna L. Hollis
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.
Keywords: Childbearing, Women, Obesity treatment, Obesity prevention, Scoping review
Prevalence of women affected by obesity is increasing glo-
bally, with prevalence rates increasing from 6.4% in 1975
to 14.9% in 2014 . 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 [2–5]. For example, the
Australian Longitudinal Study of Women’sHealthhas
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 . 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. The results however are inconsistent, with
some studies in women of childbearing age demonstrating
an association between parity and weight gain and/or the
development of overweight and obesity, while others have
shown no association [6,7].
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* Correspondence: Melinda.firstname.lastname@example.org
School of Health Sciences, Faculty of Health and Medicine, and Priority
Research Centre for Physical Activity and Nutrition, University of Newcastle,
University Drive, Callaghan, New South Wales, Australia
Full list of author information is available at the end of the article
Hutchesson et al. BMC Women's Health (2020) 20:14
Weight gained during the childbearing years is
strongly associated with adverse health outcomes later
in life. For example, the Nurses’Health Study (n= 92,
837) identified that for every additional 5 kg of weight
gained from 21 years of age there were 142.6 additional
cases of Type 2 diabetes (per 100,000 person-years
from age 55 onwards), 458.8 for hypertension, 36.9 for
cardiovascular disease, 36.9 for cancer, and 76.7 for
overall mortality . Furthermore, obesity during the
childbearing years has been associated with adverse
pregnancy outcomes for the mother (e.g. gestational
diabetes, pre-eclampsia, gestational hypertension, ante-
natal anxiety and postpartum depression), as well as for
the babies (e.g. pre-term birth, and large for gestational
age babies) [9,10].
Behavioral interventions to support women to prevent
weight gain during the childbearing years, or treat over-
weight or obesity, have the potential to have an impact
on the health and well-being of women, as well as their
offspring. Behavioral interventions are those designed to
influence individuals’actions, more specifically for
weight management, interventions include those which
influence physical activity and sedentary and/or dietary
behaviors. A large number of systematic reviews have
been undertaken to determine the most effective inter-
ventions to support women during this life stage to pre-
vent and treat overweight and obesity [11–23]. However,
reviews published to date have typically been limited to
one type of intervention (e.g. treatment or prevention of
obesity, preventing excessive gestational weight gain
(GWG)), population group (e.g. pregnant/postpartum
women) or mode of delivery (e.g. web-based), or com-
bined a variety of intervention approaches (e.g. behav-
ioral, surgical, pharmacological) in the one review.
Therefore, previous systematic reviews are unable to de-
termine the most appropriate time for intervention dur-
ing this life stage (e.g. pre-conception, postpartum), the
most efficacious behavioral intervention approach (e.g.
treatment, prevention) nor the optimal mode of delivery
To our knowledge, no single review has identified all
behavioral interventions aiming to support women of
childbearing age to prevent weight gain, or achieve
weight loss or weight loss maintenance. Therefore, the
aim of this scoping review is to examine the extent and
range of research undertaken to evaluate behavioral in-
terventions that support women of childbearing age to
prevent or treat overweight and obesity. The scoping
review methodology allows mapping of the range of re-
search that has been undertaken over time. The scoping
review is the first step in determining the most effica-
cious intervention approach. It will help identify gaps
in research undertaken to date, and determine whether
a full systematic review can be undertaken.
A scoping review was undertaken using a predefined
protocol following the methodological framework of
Arksey and O’Malley,  including identifying the re-
search question, searching for relevant studies, selecting
studies, charting the data and collating, summarizing,
and reporting the results. The conduct and reporting of
the scoping review is consistent with the Preferred
Reporting Items for Systematic reviews and Meta-
Analyses extension for Scoping Reviews (PRISMA-ScR)
Checklist. Preliminary findings of the scoping review
were previously presented .
Identifying the research question
The research question was operationalized using the
design (PICOS) format. Inclusion criteria for the scoping
review were therefore as follows:
Women of childbearing age (i.e. aged 15 to 44 years as
per US Centre for Disease Control Definition).
Interventions promoting behavior change (e.g. dietary
behavior, physical activity and/or sedentary behavior) to
prevent weight gain or overweight and obesity, or
achieve weight loss or weight loss maintenance were in-
cluded. Non-behavioral interventions, including very low
energy diets (including meal replacements), weight loss
medications and surgery alone or in combination with
behavioral interventions will be excluded.
No intervention control group, wait-list control group,
standard/usual care or another active behavioral
To be included in the review studies must have mea-
sured and reported weight-related outcomes (e.g. weight,
BMI, percentage body fat, waist circumference).
Systematic reviews of randomized control trials (RCTs)
and RCTs as the two highest levels of evidence for evalu-
ating interventions .
Selection of studies relevant to the research question
The search strategy, including database selection and
search teams, was developed in consultation with an ex-
pert medical librarian. The search aimed to find peer
reviewed journal articles published in English. All
Hutchesson et al. BMC Women's Health (2020) 20:14 Page 2 of 15
sources were searched from the date of inception up
until the 31st January 2018 (Additional file 1: Table S1).
The databases searched were MEDLINE (Ovid), MED-
LINE in process (Ovid), EMBASE (Ovid), PsycINFO
(Ovid), Scopus, CINAHL (EbscoHost) and Cochrane Li-
brary (Wiley). The reference lists of all included articles
and reports were also searched for additional studies.
Screening was managed using Covidence (www.covi-
dence.org). Title, abstract and keywords of all identified
papers were each assessed by two independent reviewers
(Reviewer 1: MMH; Reviewer 2: MH, JG, SL, LM, LV).
Full text screening was conducted by two independent
reviewers, and reasons for exclusions recorded (MMH,
MH). A third reviewer was consulted for all conflicts for
both abstract and full text screening (MR).
Charting of information and data within the included
Data were extracted by one reviewer (MMH) and
checked by a second reviewer (LV, LM, SL, JH, MR).
Any differences between the first and second extractor
were resolved by a third reviewer (HB). Data extracted
included: study characteristics (i.e. year study con-
ducted/published, country of origin, study design, num-
ber of study arms and comparators, intervention
duration); participants (i.e. study inclusion criteria relat-
ing to age, BMI, ethnicity, socio-economic status, parity,
clinical conditions or pregnancy); interventions (i.e. goal
[weight loss, weight loss maintenance, weight gain pre-
vention, excessive gestational weight gain prevention],
behavior change promoted [dietary behavior, physical
activity and/or sedentary behavior], setting [e.g. clinic,
community], mode of delivery [i.e. individual, group or
combination] and medium of delivery [e.g. in-person,
website] and profession of intervention deliverer) and
outcomes (i.e. what weight-related outcomes were mea-
sured and when, and other outcomes measured).
Collating, summarizing and reporting results of the
As is convention in scoping reviews, a numerical analysis
was undertaken to elucidate the number of the studies,
as well as changes overtime (based on publication date).
In addition, results are presented by intervention goal,
with studies group as general weight loss, post-partum
weight loss/preventing weight retention, general weight
gain prevention, excessive GWG, and combine excessive
GWG prevention and post-partum weight loss. ‘General’
weight loss and weigh gain prevention includes those in-
terventions unrelated to pregnancy status.
Of the 8543 articles identified, 307 full text articles were
assessed for eligibility and 115 articles met the inclusion
criteria (Fig. 1). The articles described 87 RCTs and
three systematic reviews.
Randomized control trials
Table 1describes the study characteristics of the in-
cluded RCTs overall, and by intervention goal. Individual
study characteristics are described in Additional file 1:
Table S2. Of the 87 included RCTs, 52.9% (n= 46)
focused on preventing excessive GWG, [27–71] 20.7%
(n= 18) on weight loss or preventing weight retention in
the postpartum period, [72–89] and 16.1% (n= 14) fo-
cused on both preventing excessive GWG and prevent-
ing weight retention in the postpartum period [90–103].
Few studies supported general reproductive-aged women
(i.e. not specifically related to current or recent preg-
nancy) in weight loss (4.6%, n=4) [104–107] or weight
gain prevention (5.7%, n=5) [108–112]. Most of the in-
cluded studies were conducted in the United States
(46.0%, n= 40), followed by Australia (16.1%, n= 14).
Figure 2demonstrates the year of publication of the
included RCTs, by weight focus. Studies were published
from 1998 up until 2018, but with no studies published
from 1998 to 2000, and only zero to two studies pub-
lished per year from 2000 to 2008. From 2009 to 2017
the number of studies conducted per year ranged from
three (2010) to 14 (2014). The intervention goal of
included studies varied over time. While the number of
studies focusing solely on postpartum weight loss/pre-
venting weight retention has remained consistent focus
over time, the number of weight gain prevention and
weight loss studies unrelated to pregnancy decreased
overtime, with more of a focus on prevention of exces-
sive GWG, and the prevention of excessive GWG
combined with postpartum weight loss/preventing post-
partum weight retention.
Across the included RCTs there were 26,750 partici-
pants (Mean: 307.5). Many of the RCTs (59.8%, n= 52)
recruited women of childbearing age as per our defin-
ition for inclusion (i.e. 18 to 44 years) or did not specific-
ally define the age range for participant inclusion but
implied they were ‘of childbearing’age due to other in-
clusion criteria (i.e. pregnancy) (19.5%, n= 17). A signifi-
cant number of RCTs (41.4%, n= 36) recruited only
women who were affected by overweight or obesity,
while many also did not report a BMI inclusion criteria
Only five studies required women to be of a specific
parity, with all five recruiting women during their first
pregnancy. Twelve studies recruited participants from
specific ethnicities, including African American (6.9%,
n= 6) and Latina/Hispanic (5.7%, n= 5) women, and one
Hutchesson et al. BMC Women's Health (2020) 20:14 Page 3 of 15
study (1.1%) recruited only ‘white’women. Ten RCTs
(11.5%) had participant recruitment criteria related to
the socio-economic status of the participant, with all
specifically recruiting women of lower socio-economic
status (e.g. lower income). Five studies recruited women
with specific clinical conditions, including three studies
(3.4%) that recruited women with gestational diabetes,
one (1.1%) recruited women who were infertile, and one
(1.1%) recruited women who were breastfeeding.
Table 2describes the outcomes measured across the
included RCTs. All studies measured weight related out-
comes, with 78.2% (n= 62) having a weight-related pri-
mary outcome [27,29–34,36,38,40–44,46,47,50,51,
106,108–111]. Over half of the included RCTs (62.1%,
n= 54) measured dietary and physical activity-related
outcomes, with eight RCTs (9.2%) having a diet-related
[45,49,51,67,71,73,75,80] and five (5.7%) a physical
activity related primary outcome [45,49,51,73,80]. At
a minimum, all studies measured outcomes twice (i.e.
baseline and follow-up), but the mean number of data
collection points were 3.7 ± 2.0 (Range 2–14). There was
a notable greater number of data collection points
among studies focusing on GWG and preventing weight
retention in the postpartum period (mean 5.1 ± 2.8).
intervention arms. Table 3describes the characteris-
tics of the 105 interventions overall and by weight
focus. The majority (80.0%, n= 84) of the interven-
tions focused on promoting both changes to dietary
behavior and physical activity to achieve changes to
weight-related outcomes. The interventions were most
commonly delivered by those with expertise in nutri-
tion, such as dietitians or nutritionists (42.9%, n= 45),
or clinicians involved in the women’s care, such as
midwives and/or general practitioners (GPs) (29.5%,
n= 31). The setting for the interventions were com-
monly within the hospital or clinic (30.5%, n= 32),
the participant’s home (28.6%, n= 30), or was not re-
ported (27.6%, n= 29). Two-thirds (66.7%, n= 70) of
interventions were delivered individually, 14 (13.3%)
were group-based, and 23 (21.9%) used a combination
of individual and group-based delivery.
Approximately half (49.5%, n= 52) of the interventions
were delivered using one medium, and approximately
one third (35.2%, n= 37) using two media. One study
Fig. 1 Flow diagram of included studies
Hutchesson et al. BMC Women's Health (2020) 20:14 Page 4 of 15
used five media to deliver the intervention. Most inter-
ventions (81.0%, n= 85) included components delivered
in-person. A variety of other delivery mediums however
were used across studies, including telephone (29.5%,
n= 31), paper-based (27.6%, n= 29) (e.g. brochures), text
message (10.5%, n= 11) and websites (9.5%, n= 10). Fig-
ure 3shows the number of studies using different deliv-
ery modes by year of publication, demonstrating that the
number of different delivery mediums utilized had in-
creased over time.
Table 1 Summary of study characteristics by intervention goal and in total
Combined excessive GWG
prevention & postpartum
weight loss (n= 14)
Publication year 2000–2010, n (%) 17 (19.5) 2 (50) 4 (22.2) 2 (40) 8 (17.4) 1 (7.1)
2011 - Jan 2018, n (%) 70 (80.5) 2 (50) 14 (77.8) 3 (60) 38 (82.6) 13 (92.9)
Country United States, n (%) 40 (46.0) 2 (50) 14 (77.8) 4 (80) 12 (26.1) 8 (57.1)
Australia, n (%) 14 (16.1) 1 (25) 1 (5.6) –11 (23.9) 1 (7.1)
Sweden, n (%) 5 (5.8) –2 (11.1) 1 (20) 2 (4.4) –
Canada, n (%) 4 (4.6) –– – 4 (8.7) –
Denmark, n (%) 3 (3.5) –– – 3 (6.5) –
Other, n (%) 21 (24.1) 1 (25) 1 (5.6) –14 (30.4) 5 (35.7)
Total 26, 750 976 3878 586 15,929 5381
Mean ± SD 307.5 ±
215.4 ± 313.7 117.2 ± 65.9 346.3 ±
384.4 ± 555.1
Median 150 166 82.5 102 197.5 237.5
Range 16–2500 67–577 18–1325 40–194 16–2500 36–2280
Broad range- all
childbearing women, n (%)
54 (62.1) –12 (66.7) 1 (20) 29 (63.0) 12 (85.7)
Younger age groups
(< 30 years), n (%)
5 (5.8) 1 (25) 1 (5.6) 1 (20) 1 (2.2) 1 (7.1)
Specific/limited range, n (%) 12 (13.8) 3 (75) 2 (11.1) 3 (60) 2 (4.4) –
Age range not reported, n (%) 18 (20.7) –3 (16.7) –14 (30.4) 1 (7.1)
Underweight, healthy weight,
overweight and obese, n (%)
2 (2.3) –– – 2 (4.4) –
Underweight, healthy weight
and overweight, n (%)
1 (1.2) –– – 1 (2.2) –
Healthy weight and
overweight, n (%)
1 (1.2) –– 1 (20) ––
Healthy weight, overweight
and obese, n (%)
16 (18.4) –3 (16.7) 1 (20) 10 (21.7) 2 (14.3)
Overweight only, n (%) 1 (1.2) –1 (5.6) –––
Overweight and obese, n (%) 36 (41.4) 4 (100) 12 (66.7) 3 (60) 13 (28.3) 4 (28.6)
Obese only, n (%) 9 (10.3) –– – 7 (15.2) 2 (14.3)
Not reported, n (%) 21 (24.1) 2 (11.1) 13 (28.3) 6 (42.9)
Antenatal, n (%) 59 (67.8) –– – 45 (97.8) 14 (100)
Postpartum, n (%) 18 (20.7) –18 (100) –––
Planning pregnancy, n (%) 1 (1.15) –– – 1 (2.2) –
Not pregnancy related, n (%) 9 (10.3) 4 (100) –5 (100) ––
Parity, n (%) 5 (5.8) –– – 3 (6.5) 2 (14.3)
Ethnicity, n (%) 12 (13.8) 1 (25) 2 (11.1) 3 (60) 3 (6.5) 3 (21.4)
Socio-economic status, n (%) 10 (11.5) 1 (25) 4 (22.2) 1 (20) 3 (6.5) 1 (7.1)
Clinical condition, n (%) 5 (5.8) 1 (25) 2 (11.1) ––2 (14.3)
BMI classifications as per the World Health Organization International Classification of adult underweight, overweight and obesity according to BMI
Hutchesson et al. BMC Women's Health (2020) 20:14 Page 5 of 15
Three systematic reviews of RCTs were included in the
scoping review, [15,18,113] which are described in de-
tail in Additional file 1: Table S3. They included a total
of 12 RCTs published from 1998 to 2011. Two of the re-
views simply included studies with women of childbear-
ing age, [18,113] while the third included women of
childbearing age ≥18 years of age . Only one of the
reviews specified that it only included participants af-
fected by overweight or obesity . None of the reviews
had inclusion criteria related to participant’s ethnicity,
clinical conditions or socio-economic status.
In terms of the reviews’inclusion criteria for interven-
tions, all reviews included studies with interventions that
focused on modifying dietary intake, and two on modify-
ing physical activity levels [15,113]. Two of the reviews
focused on prevention of excessive GWG, [15,18] and
one on prevention of excessive GWG and preventing
weight retention in the postpartum period . The re-
views had no other specific inclusion criteria related to
intervention types (e.g. mode of delivery, setting etc).
All three reviews required weight be reported as an
outcome in the included studies, with one requiring it to
be the primary outcome of the study . There was no
requirement in the three systematic reviews for diet or
physical activity outcomes to be measured for the stud-
ies to be included in the review.
This is the first scoping review, to our knowledge, to
comprehensively examine the extent and range of re-
search undertaken to evaluate behavioral interventions
that support women of childbearing age to prevent and
treat overweight and obesity. The review identified 87
RCTs and three systematic reviews published in the last
two decades. All of the systematic reviews addressed
gestational weight gain, [15,18,113]andonealsofo-
cused on postpartum weight retention . There has
been an increasing volume of research on supporting
this age group of women through weight-related behav-
ioral interventions over time, particularly in the last
decade. The majority of studies were conducted in the
United States and Australia although there was repre-
sentation of studies from middle income (although not
lower income) countries, supporting evidence from glo-
bal data on the rising prevalence of women affected by
overweight and obesity, that supporting women of
childbearing age in weight management is an inter-
national issue .
Fig. 2 Number of included RCTs per year by weight focus
Hutchesson et al. BMC Women's Health (2020) 20:14 Page 6 of 15
Almost 90% of the RCTs aimed to support women to
gain an appropriate amount of weight during pregnancy,
and/or support weight loss or prevent weight retention
following pregnancy. The surge in studies addressing ex-
cess gestational weight gain aligns with the 2009 publica-
tion of the revised United States Institute of Medicine
(IOM) Weight Gain during Pregnancy: Re-examining the
Guidelines . National pregnancy guidelines of many
countries, including Canada  and Australia, 
follow the pregnancy weight gain recommended ranges
established by the IOM (i.e. total weight gain during
pregnancy of 12.5–18.0 kg for pre-pregnancy BMI < 18.5
[Underweight], 11.5–16.0 kg for pre-pregancy
BMI of 18.5–24.9 kg/m
[Normal weight], 7.0–11.5 kg
for pre-pregnancy BMI of 25.0–29. 9 kg/m
weight], and 5.0–9.0 kg for pre-pregnancy BMI ≥30.0 kg/
[Obese]). There are many strengths to the approach
of engaging women in weight management interventions
during or following pregnancy. Pregnancy has been pro-
posed as a time when effective behavioral interventions
can impact the health of two generations, 
potentially increasing the return for investment. There
may be a heightened level of interest and motivation by
women to address weight, healthy eating and physical
activity behaviors to improve pregnancy and health out-
comes for themselves and their child [118,119]. It may
also be easier to reach women through existing routine
antenatal and postnatal health care services when they
come in to regular contact with a range of health care
providers including doctors, midwives, nurses, dietitians,
pharmacists, and reproductive health specialists .
However, there are limitations to heavily relying on
pregnancy and postpartum interventions. Pregnant
women are typically recruited to participate in gesta-
tional weight gain behavioral interventions midway
through their second trimester . This limits the po-
tential impact of the intervention to support weight
management since women who conceive with an obese,
overweight or healthy weight BMI on average surpass
their recommended weight gain by 18, 20 and 30 weeks
of pregnancy, respectively . First trimester weight
gain in excess of 0.5–2 kg is also predictive of excess
Table 2 Summary of study outcomes by intervention goal and in total
retention (n= 18)
Combined excessive GWG
prevention and postpartum
weight loss (n= 14)
of data collection points
Mean, time points 3.7 ± 2.0 3.0 ±
2.6 ± 0.5 3.2 ± 0.8 3.8 ± 2.0 5.1 ± 2.8
Median, time points 3 3 3 3 3 4
Range, time points 2–14 2–42–32–42–10 2–14
reported, n (%)
–– – 10 (21.7) –
Weight Primary outcome,n
2 (50) 15 (83.3) 4 (80) 33 (71.7) 14 (100)
Not reported if primary
outcome, n (%)
3 (3.5) –3 (16.7) –––
outcome, n (%)
2 (50) –1 (20) 13 (28.3) –
Dietary behavior An outcome, n (%) 54
2 (50) 16 (88.9) 2 (40) 26 (56.5) 8 (57.1)
Primary outcome, n
8 (9.2) –3 (16.7) –5 (10.9) –
Not reported if primary
outcome, n (%)
5 (5.8) 1 (25) 2 (11.1) –2 (4.4) –
outcome, n (%)
1 (25) 11 (61.1) 2 (40) 19 (41.3) 8 (57.1)
Physical activity An outcome, n (%) 54
2 (50) 14 (77.8) 3 (60) 26 (56.5) 9 (64.3)
Primary outcome, n
5 (5.8) –2 (11.1) –3 (6.5) –
Not reported if primary
outcome, n (%)
5 (5.8) 1 (25) 2 (11.1) –2 (4.4) –
outcome, n (%)
1 (25) 10 (55.6) 3 (60) 21 (45.7) 9 (64.3)
Hutchesson et al. BMC Women's Health (2020) 20:14 Page 7 of 15
Table 3 Summary of intervention characteristics by intervention goal and in total
(n= 21 intervention
Combined excessive GWG
prevention and postpartum
weight loss (n=19
only, n (%)
13 (12.4) –4 (19.1) 1 (16.7) 5 (9.4) 3 (15.8)
only, n (%)
5 (4.8) –2 (9.5) –2 (3.8) 1 (5.3)
Combination, n (%) 85 (81) 6 (100) 15 (71.4) 5 (83.3) 44 (83.0) 16 (84.2)
Individual, n (%) 70 (66.7) 3 (50) 12 (57.1) 3 (50) 38 (71.7) 14 (73.7)
Group, n (%) 14 (13.3) 2 (33.3) 2 (9.5) 2 (33.3) 6 (11.3) 2 (10.5)
Combination, n (%) 23 (21.9) 1 (16.7) 7 (33.3) 1 (16.7) 10 (18.9) 4 (21.1)
In-person, n (%) 85 (81.0) 5 (83.3) 17 (81.0) 3 (50) 43 (81.1) 17 (89.5)
Telephone, n (%) 31 (29.5) 2 (33.3) 7 (33.3) 3 (50) 10 (18.9) 9 (47.4)
Email, n (%) 7 (6.7) 2 (33.3) 1 (4.8) 2 (33.3) 1 (1.9) 1 (5.3)
Web-based, n (%) 10 (9.5) 2 (33.3) 4 (19.1) –4 (7.6) –
Paper-based, n (%) 29 (27.6) –4 (19.1) 2 (33.3) 17 (32.1) 6 (31.6)
Text message, n (%) 11 (10.5) –6 (28.6) –4 (7.6) 1 (5.3)
Social media, n (%) 3 (2.9) –1 (4.8) –1 (1.9) 1 (5.3)
Video, n (%) 7 (6.7) 1 (16.7) 1 (4.8) –5 (9.4) –
App, n (%) 1 (1.0) –1 (4.8) –––
One medium, n (%) 52 (49.5) 2 (33.3) 5 (23.8) 4 (66.7) 32 (60.4) 9 (47.4)
Two media, n (%) 37 (35.2) 2 (33.3) 10 (47.6) 1 (16.7) 16 (30.2) 8 (42.1)
Three media, n (%) 14 (13.3) 2 (33.3) 6 (28.6) –4 (7.6) 2 (10.5)
Four media, n (%) 3 (2.9) –– 1 (16.7) 1 (1.9) 1 (5.3)
Five media, n (%) 1 (1.0) –– – 1 (1.9) –
45 (42.9) 1 (16.7) 12 (57.1) 3 (50) 22 (41.5) 7 (36.8)
Exercise professional (EP,
trainers), n (%)
10 (9.5) –3 (14.3) –6 (11.3) 1 (5.3)
obstetrician’s), n (%)
31 (29.5) 1 (16.7) 1 (4.8) –24 (45.3) 5 (26.3)
16 (15.2) 1 (16.7) 5 (23.8) 1 (16.7) 6 (11.3) 3 (15.8)
(counsellors), n (%)
6 (5.7) 2 (33.3) 2 (9.5) –2 (3.8) –
Research staff (research
interventionists), n (%)
11 (10.5) –1 (4.8) –8 (15.1) 2 (10.5)
Other, n (%) 2 (1.9) ––1 (1.9) 1 (5.3)
Not reported, n (%) 18 (17.1) 2 (33.3) 2 (9.5) 2 (33.3) 7 (13.2) 5 (26.3)
Setting Home, n (%) 30 (28.6) 2 (33.3) 10 (47.6) 3 (50) 8 (15.1) 7 (36.8)
Clinic/hospital, n (%) 32 (30.5) 1 (16.7) 1 (4.8) –24 (45.3) 6 (31.6)
Community center, n (%) 10 (9.5) –3 (14.3) 2 (33.3) 4 (7.6) 1 (5.3)
Research facility, n (%) 6 (5.7) –5 (23.8) ––1 (5.3)
Other, n (%) 8 (7.6) –3 (14.3) 1 (16.7) 2 (3.8) 2 (10.5)
Not reported, n (%) 29 (27.6) 3 (50) 4 (19.1) 1 (16.7) 17 (32.1) 4 (21.1)
Hutchesson et al. BMC Women's Health (2020) 20:14 Page 8 of 15
gestational weight gain during pregnancy . Behav-
ioral interventions that engage and support women to
gain an appropriate amount of weight from earlier in
pregnancy are needed . However, this brings further
clinical practice implementation challenges when up to
30–40% of woman do not begin receiving antenatal care
until their second trimester [125,126]. Given that preg-
nancy behavioral interventions have resulted in only
modest reductions in gestational weight gain (of about
0.7 kg), and few have improved maternal and child
health outcomes, there are compelling calls for future
intervention research to also focus on the preconception
There is growing evidence on the role of obesity in
preconception as a major determinant of offspring
health in childhood and later adult life through the de-
velopmental origins of health and disease hypothesis
. In pregnant women, a higher pre-pregnancy BMI
has been consistently identified as a strong predictor of
pregnancy complications  and adverse offspring
non-communicable health trajectories [130–132]. For
example, when compared to a healthy pre-pregnancy
BMI (18.5–24.9 kg/m
) a pre-pregnancy BMI of ≥40 kg/
has been shown to be associated with increased risk
of gestational diabetes (Odds Ratio: 11.01 95% confi-
dence interval 10.25–11.82), preeclampsia (OR: 4.44,
95%CI:4.17–4.72) and pre-term birth (OR: 2.91 95% CI:
2.21–3.81) . The scoping review identified only one
behavioral intervention directly supporting women in
the preconception period who were planning a preg-
nancy. While the opportunity to support women at the
individual level who are actively planning a pregnancy is
important, it is also limited by low preconception care
engagement (60–80% of women don’t receive precon-
ception care [133–135]) and unplanned pregnancies,
with global estimates that 44% of all pregnancies are un-
By only addressing weight management associated
with a pregnancy event, an opportunity is missed to sup-
port weight management in the young female popula-
tion, regardless of their intention or ability to have
children. Only nine intervention studies that were unre-
lated to pregnancy were identified through the scoping
review demonstrating a substantial research gap.
Women tend to gain 0.5–1 kg each year from early
adulthood until middle-age, [137,138] with all young
women, not only those who bear children, at risk of un-
healthy weight gain . An 18 year follow-up of 92,837
women from early to mid-adulthood in the Nurses’
Health Study found that women who gained between
2.5–10 kg had an increased incidence of type II diabetes,
cardiovascular disease, obesity-related cancer, and mor-
tality . Effective behavioral interventions to support
the entire young adult female population to improve
health behaviors and weight management will improve
chronic disease health trajectories more broadly, with
added reproductive and intergenerational health benefits
for women whose future pregnancies are both planned
Few weight management behavioral studies, with
weight as the primary focus, have been conducted with
women with clinical conditions. Engaging young women
with existing or previous clinical conditions, such as type
II diabetes, polycystic ovary syndrome, pre-eclampsia,
and women who are experiencing obesity-related infer-
tility, may help to reach and support young women at
higher risk of obesity. More than half of the studies in
this scoping review only recruited women who were
affected by overweight and/or obesity. Weight gain pre-
vention research to support young women to maintain
their weight is needed if the rising obesity epidemic is to
be halted. More research is also needed with populations
under-represented in this review, such as women from
lower socioeconomic groups and culturally diverse pop-
ulations who may experience other barriers to weight
management and have different patterns of health ser-
vice engagement. Researchers should draw on existing
behavioral modification research with lower socioeco-
nomic groups and culturally diverse population groups
to inform intervention design. Developing a better
understanding of effective socially and culturally appro-
priate behavioral support, and clinician barriers to pro-
viding best practice care (e.g. clinician BMI and personal
weight satisfaction may influence their confidence in
providing best practice care ), could inform the de-
livery of population and primary health care initiatives
for weight management.
The interventions included a variety of delivery modes
and mediums, with individual and in-person delivery
most commonly used. While the number of different de-
livery mediums used has increased over-time, no con-
sistent or proven delivery medium has emerged .
Half of the interventions used more than one type of
medium, such as in-person, telephone and text mes-
sages. Interventions delivered in the postpartum period
tended to use more than one medium, and a greater var-
iety of mediums. The use of multiple communication av-
enues may highlight efforts to overcome the difficulty of
reaching new mothers who face complex barriers to par-
ticipation, including a lack of time and need for child-
care [141,142]. Identifying whether one or more of the
delivery modes and mediums are more effective in help-
ing young women to manage their weight could help to
inform the delivery of future interventions. Assessment
of the intervention feasibility and acceptability by those
delivering, and women receiving, weight management
care should also be undertaken. Interventions were com-
monly provided by dietitians or nutritionists, or health
Hutchesson et al. BMC Women's Health (2020) 20:14 Page 9 of 15
care providers such as midwives and GPs. However, half
of the studies did not deliver care through a dietetic or
exercise professional, despite the professions’expertise
in nutrition [143,144] and physical activity  for
weight management. Systematic review evidence has
shown that weight management interventions delivered
by health care providers,  including dietitians, 
are more effective than those delivered by non-health
This review has several strengths. It is the first scop-
ing review to comprehensively examine the extent and
range of research undertaken to evaluate behavioral in-
terventions that support women of childbearing age to
prevent and treat overweight and obesity. The review
employed a comprehensive search strategy across nu-
merous databases, and summarized the evidence from
systematic reviews and RCTs, the two highest levels of
evidence . However, by limiting to systematic re-
views and RCTs, evaluations of relevant interventions
using other experimental study designs (e.g. pre-post
studies, non-randomized control trials) were excluded
from the review. In addition, the review only consid-
ered the extent and range of studies, and did not
explore the efficacy of the interventions. Another main
limitation of the scoping review was the challenge of
combining data of studies that spanned different life
periods (e.g. preconception, pregnancy, postpartum,
non-pregnancy related) to accurately describe inter-
vention duration and the timing of measurement out-
comes, as they were variable within studies (e.g. due to
timing of intervention delivery approximately based on
weeks’gestation in pregnancy) and across studies (e.g.
due to differences in health service delivery, and the
timing of when women are seen during and after preg-
nancy). Further, while 92 and 85% of studies reported
interventions that targeted diet and/or physical activity
behaviour change, respectively, only 62% of studies
measured diet and 62% measured physical activity as
outcomes. There is a need for studies to include valid
and reliable diet and physical activity outcomes, par-
ticularly to investigate changes in diet and physical ac-
tivity as a mediator of weight change. Finally, the
scoping review included studies published up until
31st January 2018, therefore it is possible that add-
itional studies meeting the inclusion criteria have been
published since that time.
Fig. 3 Medium of intervention delivery across included RCTs per year
Hutchesson et al. BMC Women's Health (2020) 20:14 Page 10 of 15
There is a substantial body of research from the two
highest levels of evidence on behavioral interventions
that support women of childbearing age to prevent and
treat overweight and obesity, particularly from research
published within the last decade. The majority has fo-
cused on weight management during or after a preg-
nancy event, demonstrating a research gap to support
weight management in the young adult female popula-
tion in preconception and unrelated to pregnancy to im-
prove their own chronic disease health trajectories, with
reproductive and intergenerational health benefits for fu-
ture planned and unplanned pregnancies. Future re-
search to examine delivery modes and mediums, optimal
intervention duration and intensity, involvement of
health care providers, and involvement of under-
represented populations should be considered, both to
understand effective behavioral interventions, and to en-
sure that interventions are scalable and can be imple-
mented within policy and practice, such as through
population and primary health care.
Supplementary information accompanies this paper at https://doi.org/10.
Additional file 1: Table S1. Full electronic search for one database
(MEDLINE). Table S2. Summary of included Randomised Control Trials.
Table S3. Summary of Included Systematic Reviews.
BMI: Body mass index; GWG: Gestational weight gain; IOM: Institute of
Medicine; RCT: Randomized controlled trial
MJH, MMH, HB, SL, LM, LV, MR, JH contributed to the design/methodology
of the scoping review, as well as screening and data extraction. MJH, MMH
and HB collated the results, MH and JH drafted the manuscript, and MJH,
MMH, HB, SL, LM, LV, MR, JH read and approved the final manuscript.
The scoping review was supported by a School of Health Sciences small
grant. Dr. Melinda Hutchesson is supported by a Gladys M Brawn Career
Development Fellowship (Teaching Assistance).Dr. Siew Lim is supported by
a National Health and Medical Research Council Early Career Fellowship. A/
Prof Lisa Moran is supported by a National Heart Foundation Future Leader
Fellowship. The funding bodies played no role in the study.
Availability of data and materials
All data generated or analyzed during this study are included in this
published article [and its supplementary information files]. The databases
utilized in the search strategy were accessed via institutional licenses of the
University of Newcastle, and therefore public access to the databases is
Ethics approval and consent to participate
Consent for publication
The authors declare that they have no competing interests.
School of Health Sciences, Faculty of Health and Medicine, and Priority
Research Centre for Physical Activity and Nutrition, University of Newcastle,
University Drive, Callaghan, New South Wales, Australia.
Division of Human
Nutrition and Health, Wageningen University, Wageningen, The Netherlands.
Monash Centre for Health Research and Implementation, Monash University,
Clayton, Victoria, Australia.
School of Allied Health Science, Griffith University,
Gold Coast, Queensland, Australia.
Hunter New England Population Health,
Longworth Avenue, Wallsend, Australia.
School of Medicine and Public
Health, The University of Newcastle, Callaghan, Australia.
Centre for Health Behaviour, University of Newcastle, Callaghan, New South
Hunter Medical Research Institute, New Lambton Heights,
Received: 21 May 2019 Accepted: 10 January 2020
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