Weight management

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Weight management before, during and after
pregnancy
Implementing NICE guidance
2010
NICE public health guidance 27
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What this presentation covers

• Background
• Scope
• Recommendations
• Common myths
• Costs and savings
• Discussion
• Find out more

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Background

• Women who are obese when they become pregnant
  face an increased risk of - miscarriage, -
  pre-eclampsia, - induced or prolonged labour,
  instrumental delivery or caesarean section
• Babies of women who are obese are more likely to
  be stillborn or have congenital abnormalities

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Scope

• This guidance aims to help women achieve and
  maintain a healthy weight before, during and
  after pregnancy by
• eating healthily
• being physically active
• losing weight gradually

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Recommendations

• There are 6 recommendations
• Preparing women with a BMI of 30 or more for
  pregnancy (R1)
• Helping women to eat healthily and stay active
  during their pregnancy (R2)
• Supporting all women after childbirth (R3 4)
• Community-based services (R5)
• Professional skills (R6)
• Community-based services
• Professional skills

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  Preparing for pregnancywomen with a BMI of
30 or more 

• Provide information about the health benefits of
  losing weight prior to pregnancy and on the
  risks of obesity in pregnancy
• Advise, encourage and support women to lose
  weight by eating a balanced healthy diet and
  being physically active
• Ensure weight-loss programmes are tailored to
  individual needs and include evidence-based
  behaviour change techniques

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Pregnant women

• Measure weight and height at the first contact
• Do not rely on self reported measures of weight
  and height
• Do not routinely weigh women repeatedly during
  pregnancy unless important to the clinical
  management of their care
• Discuss eating habits and physical activity

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Pregnant women with a BMI of 30 or more

• Explain how their weight poses a risk to their
  health and that of their unborn child
• Explain that they should not try to diet while
  pregnant as this may harm the unborn child
• Offer a referral for specialist advice on healthy
  eating and physical activity

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Supporting all women after childbirth

• Use the 68 week postnatal check as an
  opportunity to discuss weight issues.
• Then or during the follow-up appointment, provide
  advice on how to lose weight gradually and safely
  
• Discuss how the family could help women have a
  healthy diet and be physically active

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Women with a BMI of 30 or more after childbirth

• Explain the increased risks that being obese
  poses and encourage women to lose weight
• Offer a structured weight-loss programme or
  referral for specialist help
• Use evidence-based behaviour change techniques to
  motivate and support them
• Encourage them to breastfeed

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Community-based services

• Local authority leisure and community services
  should offer affordable, accessible activities
  for women with children and babies, including
  provision for women who wish to breastfeed
• Health and fitness advisers should encourage
  those with weight concerns to get help
• The NHS and local authorities should work
  together to offer weight management groups or
  slimming clubs

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Professional skills

• Health workers should be able to
• broach weight management sensitively and advise
  on the health benefits
• advise on the risks of being obese or overweight,
  including when pregnant
• advise on womens nutritional needs
• use behaviour change techniques
• dispel common myths

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Addressing common myths

• Moderate physical activity will not harm women or
  their unborn child
• There is no need to eat for two or drink full
  fat milk
• Gradual weight loss and moderate intensity
  physical activity will not affect breastfeeding
  or the quality of breast milk

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Costs and savings

• Recommendations on the following may result in
  additional costs or savings
• weighing all women at the ante-natal booking
• appointment
• provision of effective weight management services
• helping women and babies to avoid health
• problems

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Discussion

• How are the risks of being overweight or obese
  explained to women before, during or after
  pregnancy?
• What weight management services are available for
  women before, during or after pregnancy?
• How can we ensure the 68 week appointment is
  used effectively to discuss health and weight?

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Find out more

• Visit www.nice.org.uk/guidance/PH27 for the
• guidance
• quick reference guide
• costing report
• self-assessment tool for local planning
• commissioning guide