“People from racial and ethnic minority groups are disproportionately affected by postpartum weight retention (PPWR).” According to a report published in Women’s Health, examining a narrative mapping literature to the National Institute on Minority Health and Health Disparities Research Framework. “80% of Black and 69.5% of Hispanic/Latina/o/x birthing people begin pregnancy overweight or obese compared to 55% of white, non-Hispanic birthing people.”
The report indicates that up to 50% of birthing people retain 10 pounds or more, and up to 25% retain more than 20 pounds.
Being proactive about your patient’s PPWR now could avoid the associated comorbidity medical risks such as cardiovascular disease and type 2 diabetes in the future.
Recognizing the Roadblocks
There is room to improve the postpartum wellness journey and obesity outcomes for your patients who give birth—currently, care often centers around the most visible challenges associated with the post-delivery period. However, that period is extensive, and patients need instruction on caring for their mind and body during that time.
A review published in Heylion found that “When communicating with patients from different cultural backgrounds, physicians were found to be authoritarian, biomedical-focused, and not involved with patients in decision-making.” Perceptions like these create roadblocks to effective obesity treatment.
Why Cultural Sensitivity Matters
Leah Hairston, a birth and postpartum doula who earned the recognition of John Hopkins Social Innovation Lab and as a semifinalist for Pharell Williams’ Black Ambition Prize last year, Sweet Bee Services, spoke to the need for professionals who understand the cultural sensitivity challenges faced in postpartum.
“There’s a dearth of access to Black dietitians and nutritionists,” she told Black Health Matters.
The American Journal of Clinical Nutrition states, “Reproduction has been identified as an important factor for long-term weight gain among women.”
Hairston and her team offer solutions to the people they serve. “People feel a lot more at ease because there’s somebody who looks like them who also understands,” she explained.
Hairston gave an example of the need for cultural sensitivity in postpartum nutrition: “My family’s Caribbean. So, I’m gonna eat plantains and rice and beans. I don’t want to feel like rice and beans are a punitive meal,” she explained. But I might not need to eat six helpings of rice and beans.”
She values practitioners who are “able to honor the things that are important to me and my family while also honoring our budgetary restrictions and any other needs that we might have.” She brings that awareness to her work.
Rethinking Postpartum Evaluations
Birthing persons require support far beyond the first few months of the postpartum era, but an article from Nutrition Research Reviews reported that “much less attention is being given to the postpartum period beyond 18 months.”
Postpartum patients need thorough evaluations to determine if they have obesity. These evaluations need to go beyond the sparse required check-ins for birthing persons.
“There is a great need for postpartum women to identify the implications of postpartum obesity. There is also a need for healthcare professionals to treat postpartum women with greater competency, having a structured postpartum follow-up with counseling and motivation for weight loss and investigations like hemoglobin, TSH, and blood sugars at follow-up,” according to a 2022 article published by the Journal of Obstetrics and Gynecology of India.
The Annals of Hematology noted that “postpartum anemia has been linked to several important postpartum morbidities, including depression, reduced cognition, and fatigue.” Still, it is critical to learn how it plays into postpartum obesity.
Dr. Danielle Wright-Terre, founder of the Honey, a postpartum community and app, commented on gaps in the postpartum care process that begin earlier than that. “Regarding check-ins for the mom, there are gaps,” she said. “There needs to be more guidance on the physical recovery aspect.”
Many doctors focus on ruling out issues for new mothers instead of being evaluated for ways they can thrive.
“The postpartum phase is just to make sure mom is doing well from a mental health standpoint. After that visit, if nothing is identified, her next visit is at 12 months, and that’s the annual visit. So, there’s not a lot of check-ins,” Dr. Wright-Terrell continued.
Key Factors Impacting PPWR
According to the Journal of Clinical Medicine, “Irregular sleep and mealtimes during the postpartum period could also interfere with body weight. Emerging evidence suggests that the misalignment of eating and fasting patterns with the body’s circadian rhythm could impact metabolic function and consequently body weight.”
Irregular sleep can also contribute to an individual becoming obese.
“Individuals who regularly slept less than seven hours per night were more likely to have higher average body mass indexes and develop obesity than those who slept more,” in a study published by BMJ Open Sport & Exercise Medicine.
Current Obesity Reports states, “Epigenetic programming that occurs at conception and throughout pregnancy predisposes children born to mothers with obesity to a range of chronic metabolic conditions including type 2 diabetes and heart disease.”
Taking an Individualized Approach
Healthcare practitioners must individualize their engagement with birthing people. Not all people who give birth are the same, and they do not all come from the same culture.
An informed perspective can help a practitioner be more effective.
Dr. Wright-Terrell pointed out that people who deliver without complications might not need to wait the widely recommended six weeks before engaging in movement that might help their mind and body. She said sometimes they “can start moving and gentle exercise as soon as 72 hours after delivery.”
Talking to your patients to determine what is best for them can help you make recommendations that suit their goals best.
“I try not to restrict my patients in terms of movement because movement is really powerful and healthy overall, and it can help you feel more like yourself.”
Referrals are crucial in helping people with uteruses re-engage with their fitness plans. Hairston uses referrals to help her clients understand the resources available to them.
“A nutritionist is covered under your insurance when you’re pregnant and usually in the first couple weeks of postpartum, and so it should be pretty easy to find somebody in-network,” she said.
Dr. Wright-Terrell explained the importance of educating patients on how their fitness goals can be achieved through seeking specific care to prevent sustained weight gain. For example, physical therapy can help build core strength, which is essential to pursuing weight loss through physical exercise. “Another great resource that I feel is underutilized is physical therapists, specifically pelvic floor physical therapists,” she said.
Dr. Wright-Terrell states, “Every OB should have a low threshold to send out the referral” for a specialist to accommodate them.
When HCPs approach patients holistically, we may have a better chance of reducing PPWR in our community.
Supported by an educational grant from Novo Nordisk Inc.
