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REVIEW ARTICLE

VOL. 72 ● NUMBER 2 ● March-April  2022
REVIEW ARTICLE

A stepwise approach to prescribe dietary advice for weight management in postpartum and midlife women

Anita Malhotra1 · Aditi Verma2 · Divjyot Kaur2 · Piyush Ranjan3 · Archana Kumari4 · Jagmeet Madan5

Anita Malhotra, Associate Professor, Department of Home Science, Lakshmibai College, University of Delhi, New Delhi, India; Aditi Verma, PhD Scholar, Department of Home Science, University of Delhi, New Delhi, India; Divjyot Kaur, PhD Scholar, Department of Home Science, University of Delhi, New Delhi, India; Piyush Ranjan, Additional Professor, Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India; Archana Kumari, Assistant Professor, Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India; Jagmeet Madan, Professor, Department of Food Nutrition and Dietetics, Sir Vithaldas Thackersey College of Home Science, SNDT Women's University, Mumbai, India.


Piyush Ranjan drpiyushdost@gmail.com

1 Department of Home Science, Lakshmibai College, University of Delhi, New Delhi, India

2 Department of Home Science, University of Delhi, New Delhi, India

3 Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India

4 Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India

5 Department of Food Nutrition and Dietetics, Sir Vithaldas Thackersey College of Home Science, SNDT Women’s University, Mumbai, India

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Weight retention and weight gain during the postpartum and midlife periods subsequently increase the risk of chronic health conditions, thereby deteriorating the overall health. Dietary intervention is the pivotal component of sustainable weight management. However, in resource restricted settings, where dietitians may not be present, other healthcare professionals such as physicians, obstetricians and paediatricians should play a vital role in providing timely weight management advice to these women. Therefore, this article provides dietary advice including the setting of realistic weight loss goals, identifying an individual's calorie needs, distribution of macronutrients and consideration of important micronutrients. Healthcare professionals can follow the stepwise approach to prescribe dietary advice to postpartum and midlife women for their weight management. Various dietary principles such as cultural and regional preferences of an individual, portion size, hypocaloric diets, and nutrient-dense meals, eating habits, cultural beliefs and myths along with co-morbid conditions should be taken into consideration by healthcare professionals while providing the dietary prescription.

Keywords : Women · Postpartum · Midlife · Weight management · Dietary advice · India

The prevalence of obesity is rising in women in both developed and developing countries [1]. Among women, various physiological, biological, hormonal, psychological and nutritional changes especially during postpartum and midlife phases are associated with excessive weight retention and weight gain [2, 3]. Various sociocultural myths such as excessive calorie consumption, increased intake of ghee, intake of high fat and sugar-based galactagogues especially in the postpartum period are also associated with increased weight [4]. Excessive weight gain may lead to the development of cardiometabolic complications such as type 2 diabetes, dyslipidaemia, hypertension, stroke, and certain types of cancers such as breast and ovarian cancers [5, 6]. This underscores the need to prioritise weight management among women.

Weight management involves the shedding of excessive body weight and prevention of regaining the lost weight [7]. One of the most effective components of achieving appropriate body weight is dietary management [8]. The dietary advice depends on numerous factors such as body mass index (BMI) of the patient, physical activity status, and breastfeeding status (for postpartum women) [9]. These factors should be taken into account by a registered dietitian while prescribing the individualised diet to the patient. However, registered dietitians might not be available in every healthcare setting particularly when resources are limited. Women during the postpartum period commonly visit gynaecologists and paediatricians while midlife women visit physicians for health-related issues other than their own weight management. Such healthcare providers may lack appropriate knowledge about dietary advice. This highlights the importance of developing stepwise dietary guidance that can easily be followed by healthcare professionals such as gynaecologists, paediatricians, and physicians to facilitate generic dietary advice to postpartum and midlife women for their weight management and encourage them to take professional advice from a qualified nutritionist, whenever feasible.

Weight Loss Goals and Calorie Estimation

Women with BMI in the overweight and obese categories should be adviced weight loss. Women lying in the normal BMI range yet having a higher waist circumference (more than 80 cm) or a higher total body fat percentage (more than 30–38%) or retaining ≥4.5kg weight as compared to the pre-pregnancy weight should also be taken into consideration for weight loss [10]. The weight loss goals should be realistic, patient-centric, and should assist in improving lean body mass and reducing fat mass without compromising the nutritional status of an individual [11, 12]. A weight loss of 5–10% of total body weight is considered to be clinically significant as it fosters the loss of abdominal and intra-hepatic fat [13] and subsequently improves various blood parameters such as blood glucose, blood pressure, and blood lipid levels in all BMI categories [14]. Such a goal can be accomplished by providing an adequate calorie diet to attain the weight loss of 0.5–1 kilogram per week usually over a period of six months [12]. However, it should be taken into consideration that the higher the degree of obesity [Obese I (BMI: 25-29.9kg/m2) or Obese II (BMI: ≥30 kg/m2)], the longer it may take to reach the target body weight. Weight loss goals can be accomplished by adjusting the calorie intake of an individual based on basal metabolic rate (BMR), BMI, and physical activity level (PAL) of an individual. Further adjustments must be made specifically for postpartum and midlife women. A method based on total energy expenditure (TEE) to calculate energy requirements [15–17] is explained in Table 1. Another method based on an individual’s activity level, BMI status, and ideal body weight (IBW) for calorie estimation is explained in Table 2.

Principles of a Dietary Prescription

A dietary prescription is based on several principles which determine sustainability in the long run. Personalised, realistic, and patient friendly dietary prescriptions are easy to follow and ensure better adherence with successful outcomes.Some important dimensions that make the diet plan sustainable for the long term are discussed below.

Conflict of interest None.

Consent for Publication We, the authors, approve that the requirement for the authorship as stated has been met and we believe that the manuscript represents honest work.

  1.  Bhurosy T, Jeewon R. Overweight and obesity epidemic in developing countries: a problem with diet, physical activity, or socioeconomic status? Sci World J. 2014;2014:964236. https:// doi. org/ 10. 1155/ 2014/ 964236. 
  2. Chopra S, Sharma KA, Ranjan P, Malhotra A, Vikram NK, Kumari A. Weight management module for perimenopausal women: a practical guide for gynecologists. J Midlife Health. 2019;10(4):165–72. https:// doi. org/ 10. 4103/ jmh. JMH_ 155_ 19. 
  3. Kaur D, Malhotra A, Ranjan P, Chopra S, Kumari A, Vikram NK. Weight management in postpartum women—an Indian perspective. Diabetes Metab Syndr. 2021;15(6):102291. https:// doi. org/ 10. 1016/j. dsx. 2021. 102291. 
  4. Kajale N, Khadilkar A, Chiponkar S, Unni J, Mansukhani N. Effect of traditional food supplements on nutritional status of lactating mothers and growth of their infants. Nutrition. 2014;30(11–12):1360–5. https:// doi. org/ 10. 1016/j. nut. 2014. 04. 005.
  5. Hruby A, Hu FB. The epidemiology of obesity: a big picture. Pharmacoeconomics. 2015;33(7):673–89. https:// doi. org/ 10. 1007/ s40273- 014- 0243-x. 
  6. Vesco KK, Leo MC, Karanja N, Gillman MW, McEvoy CT, King JC, Eckhardt CL, Smith KS, Perrin N, Stevens VJ. One-year postpartum outcomes following a weight management intervention in pregnant women with obesity. Obesity. 2016;24(10):2042–9. https:// doi. org/ 10. 1002/ oby. 21597.
  7. Brończyk-Puzoń A, Piecha D, Nowak J, Koszowska A, Kulik- Kupka K, Dittfeld A, Zubelewicz-Szkodzińska B. Guidelines for dietary management of menopausal women with simple obesity. Prz Menopauzalny. 2015;14(1):48–52. https:// doi. org/ 10. 5114/ pm. 2015. 48678.
  8. Smethers AD, Rolls BJ. Dietary management of obesity: cornerstones of healthy eating patterns. Med Clin North Am. 2018;102(1):107–24. https:// doi. org/ 10. 1016/j. mcna. 2017. 08. 009.
  9. Kominiarek MA, Rajan P. Nutrition recommendations in pregnancy and lactation. Med Clin North Am. 2016;100(6):1199–215. https:// doi. org/ 10. 1016/j. mcna. 2016. 06. 004.
  10. Bennion KA, Tate D, Muñoz-Christian K, Phelan S. Impact of an internet-based lifestyle intervention on behavioral and psychosocial factors during postpartum weight loss. Obesity. 2020;28(10):1860–7. https:// doi. org/ 10. 1002/ oby. 22921. 
  11. Willoughby D, Hewlings S, Kalman D. Body composition changes in weight loss: strategies and supplementation for maintaining lean body mass, a brief review. Nutrients. 2018;10(12):1876. https:// doi. org/ 10. 3390/ nu101 21876.
  12. Yumuk V, Tsigos C, Fried M, Schindler K, Busetto L, Micic D, Toplak H; Obesity Management Task Force of the European Association for the Study of Obesity. European Guidelines for Obesity Management in Adults. Obes Facts. 2015;8(6):402-24. doi: https:// doi. org/ 10. 1159/ 00044 2721. Epub 2015 Dec 5. Erratum in: Obes Facts. 2016;9(1):64
  13. Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, Hu FB, Hubbard VS, Jakicic JM, Kushner RF, Loria CM, Millen BE, Nonas CA, Pi-Sunyer FX, Stevens J, Stevens VJ, Wadden TA, Wolfe BM, Yanovski SZ; American College of Cardiology/American Heart Association Task Force on Practice Guidelines; Obesity Society. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol. 2014 Jul 1;63(25 Pt B):2985-3023. doi: https:// doi. org/ 10. 1016/j. jacc. 2013. 11. 004. Epub 2013 Nov 12. Erratum in: J Am Coll Cardiol. 2014 Jul 1;63(25 Pt B):3029-3030. PMID: 24239920.
  14. Ryan DH, Yockey SR. Weight loss and improvement in comorbidity: differences at 5%, 10%, 15%, and over. Curr Obes Rep. 2017;6(2):187–94. https:// doi. org/ 10. 1007/ s13679- 017- 0262-y.
  15. Human Energy Requirements. report of a joint FAO/WHO/UNU Expert Consultation. Food Nutr Bull. 2005;26(1):166. 
  16. ICMR-NIN Expert Group on Nutrient Requirement for Indians, Recommended Diary Allowances (RDA) and Estimated Average Requirements (EAR)—2020. 
  17. Magnon V, Dutheil F, Auxiette C. Sedentariness: a need for a definition. Front Public Health. 2018;21(6):372. https:// doi. org/ 10. 3389/ fpubh. 2018. 00372.
  18. Koliaki C, Spinos T, Spinou Μ, Brinia ΜE, Mitsopoulou D, Katsilambros N. Defining the optimal dietary approach for safe, effective and sustainable weight loss in overweight and obese adults. Healthcare. 2018;6(3):73. https:// doi. org/ 10. 3390/ healt hcare 60300 73.
  19. Chopra S, Malhotra A, Ranjan P, Vikram NK, Singh N. Lifestyle- related advice in the management of obesity: a step-wise approach. J Educ Health Promot. 2020;9:239. https:// doi. org/ 10. 4103/ jehp. jehp_ 216_ 20.
  20. Varady KA. Dietary strategies for weight loss in midlife women. Menopause. 2018;25(6):697–9. https:// doi. org/ 10. 1097/ GME. 00000 00000 001098.
  21. Van Horn L, Carson JA, Appel LJ, Burke LE, Economos C, Karmally W, Lancaster K, Lichtenstein AH, Johnson RK, Thomas RJ, Vos M. Recommended dietary pattern to achieve adherence to the American Heart Association/American College of Cardiology (AHA/ACC) guidelines: a scientific statement from the American Heart Association. Circulation. 2016;134(22):e505-29.
  22. Rebello CJ, O’Neil CE, Greenway FL. Dietary fiber and satiety: the effects of oats on satiety. Nutr Rev. 2016;74(2):131–47. https:// doi. org/ 10. 1093/ nutrit/ nuv063. 
  23. Schreiber DR, Dautovich ND. Depressive symptoms and weight in midlife women: the role of stress eating and menopause status. Menopause. 2017;24(10):1190–9. https:// doi. org/ 10. 1097/ GME. 00000 00000 000897.
  24. Steenhuis I, Poelman M. Portion size: latest developments and interventions. Curr Obes Rep. 2017;6(1):10–7. https:// doi. org/ 10. 1007/ s13679- 017- 0239-x. 
  25. Viola GC, Bianchi F, Croce E, Ceretti E. Are food labels effective as a means of health prevention? J Public Health Res. 2016;5(3):768. https:// doi. org/ 10. 4081/ jphr. 2016. 768.
  26. Soeliman FA, Azadbakht L. Weight loss maintenance: a review on dietary related strategies. J Res Med Sci. 2014;19(3):268–75. 
  27. Casazza K, Brown A, Astrup A, Bertz F, Baum C, Brown MB, Dawson J, Durant N, Dutton G, Fields DA, Fontaine KR, Heymsfield S, Levitsky D, Mehta T, Menachemi N, Newby PK, Pate R, Raynor H, Rolls BJ, Sen B, Smith DL Jr, Thomas D, Wansink B, Allison DB. Weighing the evidence of common beliefs in obesity research. Crit Rev Food Sci Nutr. 2015;55(14):2014–53. https:// doi. org/ 10. 1080/ 10408 398. 2014. 922044.
  28. Gray A, Threlkeld RJ. Nutritional Recommendations for Individuals with Diabetes. 2019 Oct 13. In: Feingold KR, Anawalt B, Boyce A, Chrousos G, de Herder WW, Dhatariya K, Dungan K, Hershman JM, Hofland J, Kalra S, Kaltsas G, Koch C, Kopp P, Korbonits M, Kovacs CS, Kuohung W, Laferrère B, Levy M, McGee EA, McLachlan R, Morley JE, New M, Purnell J, Sahay R, Singer F, Sperling MA, Stratakis CA, Trence DL, Wilson DP, editors. Endotext [Internet]. South Dartmouth (MA): MDText. com, Inc.; 2000–. PMID: 25905243.
  29. National Institute of Nutrition. DIETARY GUIDELINES FOR INDIANS -A Manual. NIN, Hyderabad, 2011. 
  30. Geberemeskel GA, Debebe YG, Nguse NA. Antidiabetic effect of fenugreek seed powder solution (Trigonella foenum-graecum L.) on hyperlipidemia in diabetic patients. J Diab Res. 2019;5(2019):8507453. https:// doi. org/ 10. 1155/ 2019/ 85074 53. 
  31. Salehi B, Ata A, V Anil Kumar N, Sharopov F, Ramírez-Alarcón K, Ruiz-Ortega A, Abdulmajid Ayatollahi S, Tsouh Fokou PV, Kobarfard F, Amiruddin Zakaria Z, Iriti M, Taheri Y, Martorell M, Sureda A, Setzer WN, Durazzo A, Lucarini M, Santini A, Capasso R, Ostrander EA, Atta-ur-Rahman, Choudhary MI, Cho WC, Sharifi-Rad J. Antidiabetic potential of medicinal plants and their active components. Biomolecules. 2019;9(10):551 doi:https:// doi. org/ 10. 3390/ biom9 100551
  32. Locke A, Schneiderhan J, Zick SM. Diets for health: goals and guidelines. Am Fam Physician. 2018;97(11):721–8.
  33. Skulas-Ray AC, Wilson PWF, Harris WS, Brinton EA, Kris- Etherton PM, Richter CK, Jacobson TA, Engler MB, Miller M, Robinson JG, Blum CB, Rodriguez-Leyva D, de Ferranti SD, Welty FK. American Heart Association Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; and Council on Clinical Cardiology. Omega-3 fatty acids for the management of hypertriglyceridemia: a science advisory from the american heart association. Circulation. 2019;140(12):e673–91. https:// doi. org/ 10. 1161/ CIR. 00000 00000 000709. 
  34. Bazzano LA, Green T, Harrison TN, Reynolds K. Dietary approaches to prevent hypertension. Curr Hypertens Rep. 2013;15(6):694–702. https:// doi. org/ 10. 1007/ s11906- 013- 0390-z.
  35. Teede HJ, Misso ML, Boyle JA, Garad RM, McAllister V, Downes L, Gibson M, Hart RJ, Rombauts L, Moran L, Dokras A, Laven J, Piltonen T, Rodgers RJ, Thondan M, Costello MF, Norman RJ. International PCOS Network. Translation and implementation of the Australian-led PCOS guideline: clinical summary and translation resources from the International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Med J Aust. 2018;209(S7):S3–8. https:// doi. org/ 10. 5694/ mja18. 00656. 
  36. Babiker A, Alawi A, Al Atawi M, Al Alwan A. The role of micronutrients in thyroid dysfunction. Sudan J Paediatr. 2020;20(1):13– 9. https:// doi. org/ 10. 24911/ SJP. 106- 15871 38942. 
  37. Davis JN, Shearrer GE, Tao W, Hurston SR, Gunderson EP. Dietary variables associated with substantial postpartum weight retention at 1-year among women with GDM pregnancy. BMC Obes. 2017;3(4):31. https:// doi. org/ 10. 1186/ s40608- 017- 0166-0.
  38. Rani PR, Begum J. Screening and diagnosis of gestational diabetes mellitus, where do we stand. J Clin Diagn Res. 2016;10(4):QE- 01-4. https:// doi. org/ 10. 7860/ JCDR/ 2016/ 17588. 7689.
  39. Coutinho T, Lamai O, Nerenberg K. Hypertensive disorders of pregnancy and cardiovascular diseases: current knowledge and future directions. Curr Treat Options Cardiovasc Med. 2018;20(7):56. https:// doi. org/ 10. 1007/ s11936- 018- 0653-8.
  40. Meeta M, Harinarayan CV, Marwah R, Sahay R, Kalra S, Babhulkar S. Clinical Practice Guidelines on Postmenopausal Osteoporosis: an executive summary and recommendations. J Midlife Health. 2020;11(2):96–112. https:// doi. org/ 10. 4103/ jmh. JMH_ 143_ 20.
  41. Holesh JE, Aslam S, Martin A. Physiology, Carbohydrates. 2021 Jul 26. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 29083823.
  42. Lonnie M, Hooker E, Brunstrom JM, Corfe BM, Green MA, Watson AW, Williams EA, Stevenson EJ, Penson S, Johnstone AM. Protein for life: review of optimal protein intake, sustainable dietary sources and the effect on appetite in ageing adults. Nutrients. 2018;10(3):360. https:// doi. org/ 10. 3390/ nu100 30360.
  43. Taneja DK, Rai SK, Yadav K. Evaluation of promotion of ironrich foods for the prevention of nutritional anemia in India. Indian J Public Health. 2020;64(3):236–41. https:// doi. org/ 10. 4103/ ijph. IJPH_ 65_ 20.
  44. Dror DK, Allen LH. Overview of nutrients in human milk. Adv Nutr. 2018;9(suppl_1):278S-294S. https:// doi. org/ 10. 1093/ advan ces/ nmy022. 
  45. Petroski W, Minich DM. Is there such a thing as “anti-nutrients”? A narrative review of perceived problematic plant compounds. Nutrients. 2020;12(10):2929. https:// doi. org/ 10. 3390/ nu121 02929.
  46. Misra A, Dhurandhar NV. Current formula for calculating body mass index is applicable to Asian populations. Nutr Diab. 2019. https:// doi. org/ 10. 1038/ s41387- 018- 0070-9. 
  47. Khanna K, Gupta S, Passi SJ, Seth R, Mahna R, Puri S. Textbook of Nutrition and Dietetics. 2nd ed. Ltd: Elite Publishing House Pvt; 2015. 
  48. Zeballos E, Todd JE. The effects of skipping a meal on daily energy intake and diet quality. Public Health Nutr. 2020;23(18):3346–55. https:// doi. org/ 10. 1017/ S1368 98002 00006 83. 
  49. Lee TS, Kim JS, Hwang YJ, Park YC. Habit of eating breakfast is associated with a lower risk of hypertension. J Lifestyle Med. 2016;6(2):64–7. https:// doi. org/ 10. 15280/ jlm. 2016.6. 2. 64.
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