A Cochrane review [Abstract] 1 included 12 studies with a total of 910 women. Women who took part in a diet (WMD -1.70 kg, 95% CI -2.08 to -1.32; 1 study, n = 45) or diet plus exercise programme (WMDWMD -1.93 kg; 95% CI -2.96 to -0.89; 7 studies, n = 573, I² = 71%) lost significantly more weight than women in the usual care. The nutritional interventions included dietary advice, individualised dietary counselling, or prescription of a calorie-restricted diet. Exercise interventions were exercise counselling or structured exercise programmes. There was no difference in the magnitude of weight loss between diet and diet plus exercise group (WMD 0.30 kg, 95% CI -0.60 to 0.66; 1 study, n = 43). However, it seems preferable to lose weight through a combination of dieting and exercise to dieting alone because exercise compared to usual care improves cardiorespiratory fitness level (WMD in VO2max 6.73 ml/kg/minute, 95% CI 4.28 to 9.17; 4 studies, n = 90) and preserves fat-free mass (WMD -0.20 kg, 95% CI -0.67 to 0.27; 2 studies, n = 84), while diet alone compared to usual care reduces fat-free mass (WMD -0.90 kg, 95% CI -1.38 to -0.42; 1 study, n = 45;). Exercise alone did not increase weight loss compared to the usual care (WMD 0.00 kg, 95% CI -8.63 to 8.63; 1 study, n = 33). The interventions seemed not to affect breastfeeding performance adversely.
In primary health care 110 women with a self-reported BMI≥27 at 6-15 weeks postpartum were randomly assigned 2 to the diet behavior modification group or the control group. Diet group (n = 54) received a structured 12-week diet behavior modification treatment by a dietitian and were instructed to gradually implement a diet plan based on the Nordic Nutrition Recommendations and to self-weigh ≥3 times/week. Control group (n = 56) were given a brochure on healthy eating. At baseline, women had a median BMI of 31 (28 to 33), and 84% were breastfeeding. After 12 weeks, median weight change in the diet group was -6.1 kg (-8.4 to -3.2 kg) compared with -1.6 kg (-3.5 to -0.4 kg) in the control group (P < 0.001). The difference was maintained at the 1-year follow-up for the diet group, -10.0 kg (-11.7 to -5.9 kg) compared with -4.3 kg (-10.2 to -1.0 kg) in the control group (P = 0.004). In addition, the diet group reduced BMI, waist circumference, hip circumference, and body fat percentage more than did the control group at both 12 weeks and 1 year (all P < 0.05).
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment and lack of blinding in half of the studies.
Primary/Secondary Keywords