Discussion
obesity, overweight or obese women gain, weight retention, weight gain, overweight, metabolic dysfunction
OBESITY, CHILDHOOD OBESITY, OBESE, RECRUITMENT
Postpartum weight retention increases women’s future cardiometabolic risks and obesity in subsequent pregnancies. In addition, the offspring of overweight or obese women have an increased risk of obstetric morbidity and mortality, as well as a long-term risk of childhood obesity and metabolic dysfunction. Nonetheless, half of overweight or obese women gain more weight than that recommended by the Institute of Medicine gestational weight guidelines [The SLIM intervention was developed in collaboration with overweight women and PHNs working in maternity clinics with the aim of increasing self-efficacy in weight management. Developing feasible implementation strategies to support the provision of effective weight-management interventions is crucial and implementing complex interventions in different contexts usually requires tailoring. The process evaluation focuses on the implementation process and attempts to determine how successfully the project followed the strategy laid out in the logic model. In addition, the process evaluation focuses on the acceptability of the intervention and its evaluation and it also enables the researchers to distinguish adaptations that can be made in different contexts [The strengths of this study can be found in the theory-based development of the trial and also in including the end users in the intervention and trial development. A potential limitation of this study is the selection bias in participant recruitment and retention; as weight is a sensitive subject and participation is voluntary, it is expected that those overweight women willing to participate are already motivated to make behavioral change, and this will probably result in more positive findings. There will most likely be a number of overweight women that would benefit from this intervention, but did not want to participate, e.g., women with mental problems that are often related to being overweight; these women would also be more challenging to motivate into behavioral change. Another limitation is our relatively long follow-up time, which might result in high drop-out rates. However, possible drop-outs were considered in the power calculations so that the results reached the necessary sample size.The SLIM intervention has a strong potential to increase overweight pregnant women’s self-efficacy, limit excessive gestational weight gain and also prevent postpartum weight retention. This may impact the lifestyle and long-term health of these women as well as their families. Our long-term aim is to involve communal care maternal clinics in promoting women’s healthy lifestyle, improved self-efficacy, and healthy weight management.