Maternal overweight and obesity: a survey of clinicians’ characteristics and attitudes, and their responses to their pregnant clients

BMC Pregnancy and Childbirth

Helen Stapleton²  Di Poad¹  Shelley A Wilkinson¹ 

[1]Mater Mothers’ Hospital, Raymond Terrace, South Brisbane, Queensland 4101, Australia

[2]Australian Catholic University, 1100 Nudgee Road, Banyo, QLD 4014, Australia

关键词: Fetal programming;    Weight perception;    Staff characteristics;    Obstetrics;    Obesity;    Midwifery;    Guidelines;    Maternity;   

Others  :  1138023
DOI  :  10.1186/1471-2393-13-117

 received in 2012-10-16, accepted in 2013-05-15,  发布年份 2013

【 摘 要 】

Background

Statewide (Queensland) Clinical Guidelines reflecting current best practice have recently become available for the management of pregnancy-related obesity. Our aim was to assess staff knowledge about, adherence to, and characteristics that influence delivery of care according to these Guidelines.

Methods

An online survey, available over a three week period (May-June 2011), was disseminated to obstetric, midwifery and allied health staff working in a tertiary maternity hospital. Outcomes included knowledge of guideline content, advice given, knowledge of obesity pregnancy-related complications, previous training, referral patterns, and staff characteristics, including lifestyle habits, body satisfaction, and Body Mass Index (BMI).

Results

Seventy-three staff completed surveys (59.6% response rate). Mean self-reported BMI was 24.2 ± 4.1 kg/m² (17.9-36.4); 28.5% of staff were overweight (19%) or obese (9.5%), and 27.4% were underweight. However, 28.6%, 2.4%, and 1.2% ‘self-classified’ themselves as overweight, obese, and underweight, respectively. Almost 40% were dissatisfied/extremely dissatisfied with their weight. While the majority reported overweight/obesity (ow/ob) as an important/very important general obstetric issue and most correctly identified associated perinatal complications, only 32.1% were aware of existing guidelines, with only half correctly identifying BMI categories for ow/ob. A quarter indicated they did not provide women with gestational weight gain (GWG) advice relative to BMI category. Staff identified they would like more training in the area of supporting women to achieve and understand the need for healthy GWG. Staff role was significantly associated with guideline adherence (p=0.03) and association with BMI category approached significance (p=0.07). An association was observed between staff’s BMI and their belief in the influence of their advice on women’s GWG (p=0.013) and weight satisfaction and belief in women having the resources to make the changes they recommend (p=0.003).

Conclusions

Whilst lack of guideline knowledge provides a barrier to best-practice care, our findings suggest an interplay between staff confidence and personal characteristics in delivering such care which deserves recognition in staff education and training, and service development programs and future research.

【 授权许可】

   
2013 Wilkinson et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Prentice AM: The emerging epidemic of obesity in developing countries. Int JEpidemiol 2006, 35(1):93-99.
• [2]International Association for the Study of Obesity (IASO): International Obesity Taskforce. Global prevalence of adult obesity. http://www.iaso.org/site_media/uploads/Prevalence_of_Adult_Obesity_19th_January_2012.pdf webcite
• [3]Queensland Health: Overweight and Obesity. http://www.health.qld.gov.au/epidemiology/documents/overweight-2011-fs.pdf webcite
• [4]World Health Organisation: Preventing Chronic Disease: A Vital Investment. Preventing Chronic Disease: A Vital Investment. http://www.who.int/chp/chronic_disease_report/contents/en/index.html webcite
• [5]Access Economics Pty Ltd: The growing cost of obesity in 2008: three years on. http://www.diabetesaustralia.com.au/PageFiles/7830/FULLREPORTGrowingCostOfObesity2008.pdf webcite
• [6]National Institute for Health and Clinical Excellence: Obesity: guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children. NICE clinical guideline 43. London: National Collaborating Centre for Primary Care and the Centre for Public Health Excellence; 2006.
• [7]Health Committee (2004) House of Commons: Third Report of Session 2003/04. http://www.publications.parliament.uk/pa/cm200304/cmselect/cmhealth/23/2302.htm webcite
• [8]American Dietetic Association: Position of the American Dietetic Association and American Society for Nutrition: Obesity, Reproduction, and Pregnancy Outcomes. J Am Diet Assoc 2009, 109:918-927.
• [9]Queensland Health: Obesity (Statewide Maternity and Neonatal Clinical Guideline). http://www.health.qld.gov.au/qcg/documents/g_obesity.pdf webcite
• [10]Laraia BA, Bodnar LM, Siega-Riz AM: Pregravid body mass index is negatively associated with diet quality during pregnancy. Public Health Nutr 2007, 10(9):920-926.
• [11]Kirkham M, Stapleton H: Informed choice in maternity care: an evaluation of evidence based leaflets. In In Informed choice in maternity care: an evaluation of evidence based leaflets. 4th edition. Edited by Kirkham M, Stapleton H. University of York: NHS Centre for Reviews and Dissemination; 2001.
• [12]Herring S, Platek D, Elliott P, Riley L, Stuebe A, Oken E: Addressing obesity in pregnancy: what do obstetric providers recommend? Women Health Iss 2010, 19(1):65-70.
• [13]Herring SJ, Nelson DB, Davey A, Klotz AA, Dibble LV, Oken E, Foster GD: Determinants of excessive gestational weight gain in urban, Low-Income Women. Women Health Iss 2012, 22(5):e439-e446.
• [14]Wilkinson S, Stapleton H: Overweight and obesity in pregnancy: the evidence-practice gap in staff knowledge, attitudes and practices. Aust N Z J Obstet Gynaecol 52:588-592.
• [15]Olander E, Atkinson L, Edmunds J, French D: The views of pre- and post-natal women and health professionals regarding gestational weight gain: An exploratory study. Sex Reprod Health 2010, 2:43-48.
• [16]Stotland N, Gilbert P, Bogetz A, Harper C, Abrams B, Gerbert B: Preventing excessive weight gain in pregnancy: How do prenatal care providers approach counseling? J Women’s Health 2010, 19(4):807-814.
• [17]Willcox J, Campbell K, van der Plight P, Hoban E, Pidd D, Wilkinson S: Excess gestational weight gain: An exploration of Midwives’ views, attitudes and practice. BMC Pregnancy Childbirth 2012, 12:102. BioMed Central Full Text
• [18]Chisholm A, Hart J, Lam V, Peters S: Current challenges of behavior change talk for medical professionals and trainees. Patient Educ Couns 2012, 87(3):389-394.
• [19]Heslehurst N, Russell S, McCormack S, Sedgewick G, Rankin J: Midwives perspectives of their training and education requirements in maternal obesity: A qualitative study. Midwifery 2012. http://dx.doi.org/10.1016/j.midw.2012.07.007 webcite
• [20]Stewart ZA, Wallace E, Allan C: Weight gain in pregnancy: a survey of current practices in a teaching hospital. Aust N Z J Obstet Gynaecol 2012, 52(2):208-210.
• [21]Wilkinson S, Tolcher D: Nutrition and maternal health: What women want and can we provide it? Nutr Diet 2010, 67(1):18-25.
• [22]Commonwealth Department of Health and Aged Care: National physical activity guidelines for Australians. Canberra: Department of Health and Aged Care; 1999.
• [23]Gunderson EP: Childbearing and obesity in women: Weight before, during and after pregnancy. Obstet Gyn Clin N Am 2009, 36:317-332.
• [24]Guelinckx I, Devlieger R, Beckers K, Vansant G: Maternal obesity: pregnancy complications, gestational weight gain and nutrition. Obes Rev 2008, 9:140-150.
• [25]Grol R, Wensing M: What drives change? Barriers to and incentives for achieving evidence-based practice. Brit Med 2004, 180:s57-60.
• [26]Wilkinson S, Stapleton H: Overweight and obesity in pregnancy: the evidence-practice gap in staff knowledge, attitudes and practices. Aust N Z J Obstet Gynaecol 2012, 52:588-592.
• [27]French SD, Green SE, O’Connor DA, McKenzie JE, Francis JJ, Michie S, Buchbinder R, Schattner P, Spike N, Grimshaw J: Developing theory-informed behaviour change interventions to implement evidence into practice: a systematic approach using the Theoretical Domains Framework. Implement Sci 2012., 7(38) 24 April
• [28]Michie S, van Stralen MM, West R: The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implement Sci 2011., 6(42) 23 April
• [29]Institute of Medicine: Weight gain during pregnancy: Reexamining the guidelines. Washington, D.C.: The National Academies Press; 2009.
• [30]Stotland NE, Haas JS, Brawarsky P, Jackson RA, Fuentes-Afflick E, Escobar GJ: Body mass index, provider advice, and target gestational weight gain. Obstet Gynecol 2005, 105(3):633-638.
• [31]Schmied V, Duff M, Dahlen H, Mills A, Kolt G: ‘Not waving but drowning’: a study of the experiences and concerns of midwives and other health professionals caring for obese childbearing women. Midwifery 2011, 27(4):424-430.
• [32]Murray S: (Un/Be)Coming Out? Rethinking Fat Politics. Soc Semiot 2005, 15(2):153-163.
• [33]Butland B, Jebb S, Kopelman P, McPherson K, Thomas S, Mardell J, Parry V: In Foresight, Tackling Obesities: Future Choices, Project Report. Edited by Science UGOf. 2007.
• [34]Mauro M, Taylor V, Wharton S, Sharma A: Barriers to obesity treatment. Eur J Inter Med 2008, 19(3):173-180.
• [35]Gray C, Hunt K, Lorimer K, Anderson A, Benzeval M, Wyke S: Words matter: a qualitative investigation of which weight status terms are acceptable and motivate weight loss when used by health professionals. BMC Public Health 2011, 11:513. BioMed Central Full Text
• [36]Thomas S, Hyde J, Karunaratne A, Herbert D, Komesaroff P: Being ‘fat’ in today’s world: a qualitative study of the lived experiences of people with obesity in Australia. Health Expect 2008, 11:321-330.
• [37]Wadden T, Didie E: What’s in a name? Patients’ preferred terms for describing obesity. Obes Res 2003, 11(9):1140-1145.
• [38]Schmied V, Homer C, Kemp L, Thomas C, Fowler C, Kruske S: The role and nature of universal health services for pregnant women, children and families in Australia: Literature review. http://www.aracy.org.au/publications-resources/command/download_file/id/151/filename/The_role_and_nature_of_universal_health_services_for_pregnant_women,_children_and_families_in_Australia_-_Literature_review.pdf webcite
• [39]Stamatakis E, Primatesta P, Chinn S, Rona R, Falascheti E: Overweight and obesity trends from 1974 to 2003 in English children: what is the role of socioeconomic factors. Arch Dis Child 2005, 90:999-1004.
• [40]Gordon-Larsen P, Adair L, Popkin B: The relationship of ethnicity, socioeconomic factors, and overweight in US adolescents. Obes Res 2003, 11:121-129.
• [41]Wang Y, Beydoun M, Liang L, Caballero B, Kumanyika S: Will all Americans become overweight or obese? Obesity 2008, 16(10):2323-2330.
• [42]Australian Institute of Health and Welfare: Australia’s health 2012. In vol. Australia’s health no. 13. Cat. no. AUS 156. Canberra: Australian Institute of Health and Welfare; 2012.