Barriers to Weight Loss and Diet After Gestational Diabetes 

No differences in the barriers to weight loss and weight loss success were observed between the intermittent (IER) and continuous (CER) dieters, in a study of women who had previously had gestational diabetes.

Gestational diabetes causes women to have close to a tenfold risk of developing type 2 diabetes than those who do not have a history of gestational diabetes. One of the things women with overweight can do to minimize the risk of developing type 2 diabetes is to lose weight. However, barriers to achieving weight loss usually affect attempts and motivation. One of the emerging ways to lose weight is intermittent energy restriction (IER). Research suggests that IER can achieve similar results to continuous energy restriction, but further research needs to be done to support this claim entirely. Nevertheless, understanding how barriers affect weight-loss efforts can help with successful intervention.

This trial sought to explore a secondary analysis of the original 12-month clinical trial about barriers to weight loss. Dr. Gray and her colleagues submitted this research to the International Journal of Environmental Research and Public Health on October 18, 2021. The participants took part in the study from March 2018 to March 2019. One hundred twenty-one patients were randomized into the trial, while 62 participated to completion. Eligible patients were females older than 18, previous gestational diabetes, BMI greater than 25, with no other type of diabetes. Each participant was randomized in a 1:1 fashion to either the IER group or the CER group. Randomization was done with an online random number generator. The IER diet consisted of 40% protein, 35% carbohydrates, and 25% fat on two days during the nonconsecutive week. The CER diet consisted of 30% protein, 45% carbohydrate, and 25% fat for seven days a week.

Quality of dietary status was examined at baseline and also at 12 months. Participants were assessed on barriers to weight loss using 5-point Likert scales ranging from strongly agree to disagree strongly. Higher scores represented more compliance with dietary guidelines, while lower scores represented a lower quality diet. Statistical analysis was measured using SPSS statistical software with a significant p-value of < 0.05. The test used for analysis included Q-Q plots, histograms, and Shapiro-Wilk tests.

According to Dr. Gray, the most common barriers identified were “finding it hard to stay on a diet, finding it hard to deal with hunger while on a diet, and family responsibilities taking priority over weight loss.” However, there were no significant differences between the groups and the barriers to weight loss. In addition, there were no significant differences between healthy diet scores and weight loss outcomes between groups and baseline values. Lastly, about diabetes risk and health diet scores, there were no significant correlations between groups.

In conclusion, the role and impact of barriers to weight loss and its role in reducing type 2 diabetes in patients with previous gestational diabetes have not been thoroughly examined. As stated by Dr. Gray, no differences in the barriers to weight-loss and weight loss success were observed between the intermittent and continuous dieters. These findings address potential gaps of possible health implications for maternal health during and after pregnancy. This study was unique because it took a step further to determine how able women feel to accomplish goals that health care practitioners often set. Limitations of this study include it having a high withdrawal rate. This limits the generalizability that can be used from the results. Another limitation of the study is that only ten statements regarding barriers to weight loss were included in the questionnaire. Thirty-two women chose to add their barriers to weight loss to the questionnaire, implicating that other barriers were not included for analysis of all participants. Perhaps a more comprehensive questionnaire can be used for future studies to eliminate this weakness. Still, the research obtained from this study is consistent with previous gestational diabetes research that suggests interventions for diabetes prevention must be done.

Practice Pearls:

• Gestational diabetes causes women to have close to a tenfold risk of developing type 2 diabetes than those who do not have a history of gestational diabetes.
• The most common barriers identified were “finding it hard to stay on a diet, finding it hard to deal with hunger while on a diet, and family responsibilities taking priority over weight loss.”
• No differences in weight loss and success barriers were observed between the intermittent and continuous dieters.

Gray, Kristy L., et al. “Weight Loss Barriers and Dietary Quality of Intermittent and Continuous Dieters in Women with a History of Gestational Diabetes.” International Journal of Environmental Research and Public Health,

Vounzoulaki, Elpida, et al. “Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis.” BMJ.

Welton, Stephanie, et al. “Intermittent fasting and weight loss: Systematic review.” Canadian Family Physician

Kmeone Kingdom, MPH, PharmD Candidate, South College School of Pharmacy