Diet Quality and Weight Change among Overweight and Obese Postpartum Women Enrolled in a Behavioral Intervention Program

Background Postpartum weight retention is a risk factor for long-term weight gain. Encouraging new mothers to consume a healthy diet may result in weight loss. Objective To assess predictors of diet quality during the early postpartum period; to determine whether diet quality, energy intake, and lactation status predicted weight change from 5 to 15 months postpartum; and to determine whether an intervention improved diet quality, reduced energy intake, and achieved greater weight loss compared with usual care. Design Randomized clinical trial (KAN-DO: Kids and Adults Now Defeat Obesity), a family- and home-based, 10-month, behavioral intervention to prevent childhood obesity, with secondary aims to improve diet and physical activity habits of mothers to promote postpartum weight loss. Participants Overweight/obese, postpartum women (n=400), recruited from 14 counties in the Piedmont region of North Carolina. Intervention Eight education kits, each mailed monthly; motivational counseling; and one group class. Methods Anthropometric measurements and 24-hour dietary recalls collected at baseline (approximately 5 months postpartum) and follow-up (approximately 10 months later). Diet quality was determined using the Healthy Eating Index-2005 (HEI-2005). Statistical analyses Descriptive statistics, chi(2), analysis of variance, bi- and multivariate analyses were used. Results At baseline, mothers consumed a low-quality diet (HEI-2005 score=64.4 +/- 11.4). Breastfeeding and income were positive, significant predictors of diet quality, whereas body mass index was a negative predictor. Diet quality did not predict weight change. However, total energy intake, not working outside of the home, and breastfeeding duration/intensity were negative predictors of weight loss. There were no significant differences in changes in diet quality, decreases in energy intake, or weight loss between the intervention (2.3 +/- 5.4 kg) and control (1.5 +/- 4.7 kg) arms. Conclusions The family-based intervention did not promote postpartum weight loss. Reducing energy intake, rather than improving diet quality, should be the focus of weight-loss interventions for overweight/obese postpartum women. J Acad Nutr Diet. 2013;113:54-62.