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Revised draft Clinical Practice Guidelines for the Management of Overweight and Obesity in Adults, Children and Adolescents

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Specific questions
Question 2: What would help you implement these recommendations into practice?: 

There is reference to the existence of the IOM gestational weight gain guidelines but disappointingly the NHMRC draft falls short of actually recommending the use of the IOM guidelines in Australia or the development of an alternative national gestational weight gain guideline.  Maternity care professionals (and women) are desperately in need of consistent guidance regarding weight gain in pregnancy and effective models of care that promote, achieve and sustain positive weight change, especially in women who are overweight and obese.

Pregnancy is a window of opprotunity to influence not only the mother's health, but alo that of her baby and her family. It is noted that the DoHA has funded the NHMRC to update the Guidelines as part of a "suite" of documents on weight management, amongst which those for pregnancy should be considered.

Specific comments
8 Practice guide

Section 8: Practice Guide

The case study using a pregnant woman at 12 weeks gestation (BMI 29.3. p49).  A rather "directive" and negative approach - there is no consultation with the woman, or a recommendation of continuity of care model, which could encourage a more senstive and personal approach. The IOM guidelines are used to advise the woman, which is a useful focussed starting point. However, there is a strong emphasis on telling the woman about the risks of obesity in pregnancy but no suggestion of engaging her in a conversation about her progress and her plans based on her individual circumstance (ie using motivational techniques).  The plan to "review weight at next antenatal visit" is not sufficiently detailed -  it is not clear whether this means standing the woman on the scales and recording her weight change, or furthering the conversation based on her needs.


General comments

In regard to interventions there is a clear emphasis throughout the document on tailoring advice to individual need and using various motivational techniques, but very little detail for pregnancy.  There is frequent mention of assessing the individual's "readiness for change". Motivational interviewing techniques were used as a strategy in many of the selected studies in the document to engage participants and families in the decision making process for lifestyle change, but there is no mention of using this approach specifically with pregnant women.

Overall, there is a good foundation here for in-depth guidance on weight management in pregnancy.  

Page reviewed: 6 September, 2012