Discussion
obesity, atherosclerosis, weight loss
OBESITY, ATHEROSCLEROSIS
In the present randomised controlled trial, we aimed to test the effects of a diet intervention using the LEVA method on weight loss and cardiometabolic risk factors in postpartum women with higher BMIs than in previous studies testing the same intervention. The women had an average BMI at baseline of 40.0 kg/mThe goal of the programme is to lose 6 kg in 12 weeks, which only one participant in the diet group achieved. However, the mean GWG in the present study was half the size as in the effectiveness study (8 kg versus 17 kg) [Two meta-analyses reviewing trials with lifestyle interventions for weight loss postpartum reported a pooled between-group difference of only around 2.5 kg [The reduction in weight, waist circumference, PPWR and fasting glucose caused by the diet intervention may be clinically relevant despite the lack of statistically significant effects on the other markers of lipid and glucose metabolism. Waist circumference and abdominal obesity are associated with early atherosclerosis in young adults [Our study has limitations. We aimed to include 40 subjects but terminated before we reached this number because of stagnation in the number of eligible women at the clinic. In addition, the 12-month lost-to-follow-up rate was higher (45%) than expected (25%). With more study subjects, we would consider to adjust for breastfeeding status at each visit, as breastfeeding may influence body weight [The strengths of our study are the randomised, controlled design, the use of an evidence-based dietary intervention and the inclusion of subjects that are less studied. Our findings are applicable to postpartum women with obesity and a personal motivation to lose weight who have the benefit of a comparatively long maternity leave and who have a higher education level than average Norwegian women [The LEVA method has been shown not only to produce clinically relevant postpartum weight loss at 2 years but also to increase quality of life and be a cost-effective treatment [