Postpartum Weight Loss Struggles

Journal of Holistic Nursing
http://jhn.sagepub.com/
Postpartum Weight Loss : Weight Struggles, Eating, Exercise, and Breast-Feeding
Kristen S. Montgomery, Melissa Best, Tracy B. Aniello, Jennifer D. Phillips and Elizabeth Hatmaker-Flanigan
J Holist Nurs published online 21 November 2012
DOI: 10.1177/0898010112464120
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Postpartum Weight Loss
Journal of Holistic Nursing

American Holistic Nurses Association
Volume XX Number X
Month XXXX 1-10
The Author(s) 2012
10.1177/0898010112464120
http://jhn.sagepub.com
Weight Struggles, Eating, Exercise,

and Breast-Feeding
Kristen S. Montgomery, PhD, RN
Melissa Best, BSN, RN
University of North Carolina at Charlotte
Tracy B. Aniello, MSN, RN, FNP

Jennifer D. Phillips, MSN, RN
University of South Carolina
Elizabeth Hatmaker-Flanigan, MS
University of North Carolina at Charlotte
Twenty-four women with children 5 years old or younger were interviewed regarding their experiences
in losing weight during the postpartum period. Phenomenological interviews were conducted according
to Husserls perspective. Women who participated in the study revealed the issues related to postpartum
weight loss: weight struggles, exercise, breast-feeding, eating, and pregnancy contributions to weight
gain. The overall theme that resulted from these in-depth interviews was that women struggle to balance their successes and setbacks in losing weight during the postpartum period.
Keywords: maternal nutrition; perinatal weight gain; pregnancy weight gain; postpartum exercise; postpartum weight loss
Obesity is epidemic in the United States and is

associated with significant morbidity, including
heart disease, diabetes, and certain types of cancer.
Adults aged 25 to 34 years have the highest incidence of weight gain, and women are twice as likely as
men to gain weight during this life phase (Rooney &
Schauberger, 2002). Pregnancy is a time of normal
(and needed) weight gain among women, and if the
weight gained during pregnancy is not lost, it may lead
to obesity. Understanding womens weight loss experiences postpartum can help care providers develop
useful interventions to assist women in maintaining a
healthy weight following childbirth.
Pregravid weight and weight gain during pregnancy are thought to be the most important factors
in determining weight retention in the postpartum
period (Butte, Ellis, Wong, Hopkinson, & Smith,
2003). Pregnant women who gain excessive weight
during pregnancy are more likely to retain the weight

after delivery and more likely to become overweight
(Bianco et al., 1998; Crowell, 1995; Gunderson,
Abrams, & Selvin, 2001; Linne & Rossner, 2003;
Parham, Astrom, & King, 1990; Rooney & Schauberger,
2002). Also, obese and overweight women tend to gain
more weight during pregnancy (Lederman, Alfasi, &
Deckelbaum, 2002).
Authors Note: The authors would like to thank the following

individuals for their assistance with this article: Lindsay F.
Schalles, Terrie Kirkpatrick, Courtney Catledge, Kristin Braveboy,
Carol ORourke, Neema Patel, Malshundria Prophet, Anita
Cooper, Lori Mosely, Christie Parker, and Gaye M. Douglas.
Please address correspondence to Kristen S. Montgomery, 1181
Hartford Court, Rock Hill, SC 29732, USA; e-mail: krismontgomery@hotmail.com.
Journal of Holistic Nursing / Vol. XX, No. X, Month XXXX
Factors Associated With Postpartum

Weight Loss
Many factors affect a womans weight loss in the
postpartum period, including socioeconomic status,
race, marital status, body mass index, lactation,
genetics, differences in maternal age, and the time
when childbearing occurs (Crowell, 1995; Gunderson
et al., 2001). Postpartum weight loss is determined
in large part by the womans prepregnancy eating
habits, weight status (normal weight vs. overweight),
and exercise routine. Devine, Bove, and Olsen (2000)
studied 36 women (mostly White and well-educated)
from pregnancy to 1-year postpartum, using multiple in-depth qualitative interviews to learn more
about the womens experiences with pregnancy and
postpartum weight changes. The findings suggest
that prepregnancy habits have a more powerful
effect on postpartum attitudes and behaviors than
the transition to motherhood. Women who were
exercisers and weight conscious before pregnancy
tended to maintain these same behaviors in their
attempt postpartum to return to prepregnancy
weight, though modified by the addition of a new
baby (Devine et al., 2000).
Breast-Feeding
The role of breast-feeding in postpartum weight
loss and retention is controversial. Rooney and
Schauberger (2002) observed the weight of 540
women during pregnancy, at 6 months postpartum,
and at 10 years. They found that women who lost all
pregnancy weight during the first 6 months postpartum and breast-fed for at least 3 months had lower
weight gain, body mass index, and overall obesity
than other women at the 10-year weight review. In
this same study, women who breast-fed for 3 months
or more also had an overall lower body mass index
than those who did not breast-feed. Another study,
however, found no significant differences in the rate
of postpartum weight loss between Canadian women
who breast-fed or bottle-fed their infant up to the
ninth month postpartum (Haiek, Kramer, Ciampi, &
Tirado, 2001). Another study found that breastfeeding status did not modify the amount or pattern
of body fat lost postpartum (Sidebottom, Brown, &
Jacobs, 2001). However, it is possible that the
women in these studies did not see an effect from
breast-feeding because breast-feeding was of short
duration and was combined with bottle and formula
feeding. More research is needed to fully understand breast-feedings role in postpartum weight loss
and retention.
Body Image
Body image is individuals perception of their
body and their feelings associated with their body
(National Eating Disorders Association, 2005). The
changes that occur to the body from pregnancy and
weight gain during pregnancy certainly affect many
womens body image. Body image is therefore related
to womens behaviors, perceptions, and experiences
with postpartum weight loss. Carter-Edwards et al.s
(2010) Active Mothers Postpartum Study assessed a
group of overweight African American and White
womens perceived body image at 6 months postpartum. Participants selected from nine figures on the
Stunkard Figure Rating Scale the figures that represented their current image, ideal image, and ideal
mother image. Each image was assigned a body mass
index. Both groups were dissatisfied with their current
image and desired smaller images; but White women
showed greater dissatisfaction with their image than
African American women. African American women
were more accepting of a larger body image than White
women. These results were similar to what was found
by Walker, Timmerman, Kim, and Sterling (2002),
where women in all three ethnic groups studied
(Caucasian, African American, and Hispanic) reported
dissatisfaction with their bodies postpartum. Also, in
this sample of women, negative body image attitudes
predicted depressive symptoms. For some women,
unhealthy behaviors prior to pregnancy influenced
body image during pregnancy and postpartum, negatively affecting the health of both mother and baby.
For example, women who use smoking as a weight
control strategy are more likely to use other weight
loss strategies potentially detrimental to their health,
such as fasting and taking weight loss medications
(Pomerleau, Brouwer, & Jones, 2000). Body image
concerns also affect women with eating disorders.
Need for Further Research

Lifestyle and physiological changes following
pregnancy and birth are vast and significant to womens lives. These changes make weight loss programs
difficult for many women to follow, with the added
stress, fatigue, and changing roles that occur following birth. However, although much research has
Postpartum Weight Loss / Montgomery et al.
been done on postpartum weight retention and loss

and its role in obesity, little research has specifically
addressed womens experience with weight loss following birth. Thus, this study was designed to gain a
better understanding of womens experiences and
struggles in losing weight gained from pregnancy.
Method
Design
Phenomenology was the qualitative method used
to guide the study. Participant interviews were conducted according to Husserls perspective. Husserl
believed that a persons experience of an event was
best accessed through his or her own words and to
really understand the experience, an interviewer
must put aside any preconceived biases about the
subject through use of a procedure referred to as
bracketing. During bracketing, an individual consciously identifies preconceived notions about the
phenomenon being investigated and formally puts
them aside.
Procedure
Women who had delivered a child d5 years ago
were eligible to participate in the study and were
recruited through personal contacts with the
research team. Because the goal was to understand
the womens experiences in losing weight postpartum, the sample was specifically targeted to this
group. Women who were willing to share their experience were interviewed in a private location following informed consent. The interviews began with
the lead question: Please tell me about your experiences losing weight postpartum. Five years was
chosen as the cutoff period, because we determined
that it would give women long enough to have the
opportunity to lose weight and reflect on that experience; in addition, this would allow women to get
past the intensive newborn period and thus would
increase the pool of women who could participate.
Women were given ample time to share all of
their experiences. The interviewer asked for clarification or used probes as needed to continue the
flow of conversation. Silence was also used to
allow women to reflect on what they had shared.
Women were encouraged to share whatever they
felt comfortable sharing. All interviews were audio
recorded. Interviews lasted approximately 1 hour. A

second interview with each participant was held to
ensure that the information gained in the first interview was correct and to determine whether there
was any additional information the participant
wished to add. The follow-up interviews began with
the researcher sharing what he or she thought were
the most significant themes of the first interview
and then asking the participant to comment and/or
confirm the themes and add new information if
needed. These second interviews were brief, lasting
only about 15 minutes. Women were interviewed
until theme saturation occurred, that is, when no
new information resulted from the interviews.
Sample size was not predetermined ahead of time.
Interviews were analyzed simultaneously with data
collection and themes/ideas that were discovered in
interviews were shared in future interviews with different participants to determine whether participants had similar experiences. Approval for the
study was granted by the university institutional
review board.
Sample
Twenty-four women agreed to participate in the
study. They ranged in age from 25 to 35 years, with
1 to 4 children. The majority were Caucasian (n =
22; 83%) and nearly all were married (n = 22; 83%).
The youngest childrens ages ranged from 2 months
to 5 years (the cutoff age); however, there were
many different mixes of childrens ages (e.g., some
women had multiple children younger than 5 years
and some had only 1 child younger than 5 years but
had older children). The women worked in a variety
of occupations and equal numbers of women worked
full- or part-time and stayed at home. Overall, the
participants had a high level of education: some or
completed college: n = 15 (62.5%), high school: n =
3 (12.5%), and unknown: n = 6 (25%). All participants (where data were known) had at least a high
school diploma.
Analysis
Analysis of the interviews was done according to
the Giorgi (1985) method. With this method, transcribed interviews are read through to gain a sense
of the whole, a second reading allows the reader to
highlight areas of significance or common themes,
and finally, these themes are grouped together to a
higher level of analysis. Themes were identified by all

the investigators, and much discussion ensued. The
initial grouping of themes was also reviewed by an
expert in qualitative research methods to increase
the trustworthiness of the data. The themes were
compared with the raw data and discussed among
the investigators and by the outside expert.
Participants were also given the opportunity to review
the transcripts.
Results
Overall, the experience of trying to lose weight
during the postpartum period described by the
women who participated in this study was one of
achieving balance between their various life roles.
Weight loss efforts during the postpartum were balanced with other life and family demands. Weight
struggles, exercise, breast-feeding, eating, and pregnancy contributions to weight gain were common
themes that emerged from the interviews.
Weight Struggles
Many themes emerged that could be broadly categorized as weight struggles. One woman described
the fear of the unknown: I didnt know how it would
be after I had her. I was scared. Scared of not being
able to lose the weight. Over half of the women
interviewed were surprised by how difficult it was to
lose the weight. One stated, It was tough to realize
that the weight wasnt coming off; another stated,
I just assumed I would go back to my normal size.
Several women came to the realization during the
postpartum period that it was going to take time to
lose the weight. One woman specifically noted,
One has to come to the realization that weight loss
takes time and not everyone has a high metabolism.
Another said, Slow loss of weight and gaining a little then losing a little were discouraging. I just had
to make myself realize you cant see immediate
results. You just have to take it slow.
Several women had been unable to lose the
weight they gained during pregnancy. One woman
stated, I havent really lost much of anything,
except for maybe a little bit of baby weight. I gained
45 pounds with her and I lost just enough to account
for the baby. Another woman said she also did not
lose any weight after her pregnancy. Other women
were able to lose the weight but only after extended
periods of time. One woman stated, Im still struggling

to get that weight off (80 pounds) after 14 months.
Another lamented that it had taken her over a year
to lose the weight from her pregnancy.
Several of the women found that the weight was
harder to lose during subsequent pregnancies: It
took longer to lose the weight with the second one
than it did with the first, but I gained more with the
second one. And I was older. The third one is
much harder. I still have about fifteen pounds to go
and hes seven months old. One factor that seemed
to play into this was that some women did not lose
the weight from their first pregnancy before becoming pregnant again. One woman stated, I was still
overweight from my first one when I had her.
Many of the women associated age with their
difficulty losing weight. It was commonly thought
that the weight was more difficult to lose because
now that they were older. One woman stated, The
older you get, the more you gain, you know, so
because your metabolism slows down. Another
woman summed it up thus: When we get older we
think it is so hard to lose this weight. It is so hard.
Body image was a factor in the womens weight
struggles. For some of the women, it was the first
time they had ever had any excess weight. One
woman said, I was always the tiniest person in
school. Most of the women had very negative feelings about the excess weight they were carrying after
they had their babies: I felt very large, just feeling
unattractive, very unsexy. A couple of the women
described feeling like they were still pregnant after
they had the baby:
Sometimes I look in the mirror and think, gosh, I
still look like Im pregnant. And I wonder if other
people still think I look pregnant. Actually, I did have
someone ask me, when my child was 3 months old.
Another woman described being asked when she

was due and said that it made her feel very frustrated. The weight made one woman feel self-conscious: The heavier I got, the more self-conscious I
got. Another stated that the excess weight made her
feel depressed, and the depression made it difficult
for her to lose the weight. Another woman described
not wanting to take her daughter to the pool because
she worried about what people would say about her
in a bathing suit.
A predominant concept that emerged from the
discussions of weight struggles was clothing. Several
of the women said that they were able to tell that

they were becoming successful in their weight loss
quest because their clothes were fitting better. One
woman said that she started feeling good about
myself because I started getting the clothes [out] that
I had put in a box. However, the majority of the
women interviewed had negative feelings about their
clothes and weight loss. One woman said she got
tired of having to buy new clothes all the time
because of the weight she had gained. Another said,
The weight didnt bother me until I started trying to
put on clothes that I couldnt get into anymore. One
woman said the most negative experience she had
was realizing she had nothing to wear because nothing fit anymore. Women were depressed that they
could not fit into the clothes that they once had:
The most negative part was the clothes that dont fit
right and then your body type changes after you have
children and the clothes you think you want to wear,
you cant wear anymore. One woman said that she
would be happiest if she could wear her old clothes
again. Other women used clothes as an incentive for
losing the weight. One woman said, I think I would
reward myself with nicer clothing [if I could lose the
weight].
Exercise
Exercise was a recurrent theme in the weight
loss effort during the postpartum period for most of
the participants. All but one of the participants
acknowledged the importance of exercise in weight
loss. One described exercise as a big obstacle, yet
she knew she had to start doing something. Another
went so far to say, If I could go back and do it all over
again I would have just started right back in the gym
immediately. Several of the women described walking as their primary form of exercise, yet they did not
seem committed to the task. One participant described
walking as a leisurely stroll, and another noted that
she did not do it enough to see any real difference.
Another took her walking more seriously, walking 2.5
miles nightly, but quit during the Christmas season
and never resumed.
Other women described how taking care of their
children was their form of exercise. One noted that
staying busy is kind of like exercising constantly
and another was running after three kids. It kept
me busy. Another participant added, I get exercise
taking care of her [her child]. Other participants
also thought playing with their children provided
exercise. A few of the participants gave reasons why

they were not involved in an exercise program. One
described being unable to enroll in a rigorous exercise program because of health problems. Another
experienced pain from fibroids, which kept me
from exercising very much.
Not wanting to exercise was another obstacle
some of the women faced. One participant admitted,
Im not much of an exerciser. I dont like to exercise. Another went on further saying, I absolutely
hate to exercise. One participant noted that exercising is not as high a priority. The babies come first.
Another echoed the frustration of many mothers
with her comment: I would go walking and nothing
happened. Clearly, exercise was perceived as a
necessity in postpartum weight loss; however, fulfilling that need is not easily accomplished.
Breast-Feeding
One theme identified in this study was breastfeeding, but only by14 out of the 24 participants
interviewed. Breast-feeding was considered by some
to be a positive experience in that they perceived that
breast-feeding helped them lose weight postpartum.
Others reported that breast-feeding had no significant
impact on their weight loss following childbirth. Some
participants were unclear about whether or not breastfeeding was a factor in their postpartum weight loss.
One participant was an advocate for breastfeeding as a means to lose weight. As the mother of
three children, she had noticed a significant change
in her postpartum weight loss when she breast-fed.
This participant, however, did not attribute all of her
postpartum weight loss to breast-feeding. She noted
that breast-feeding was a motivator to eat healthier,
which also contributed to her weight loss. Another
participant stated, I do think nursing helped me to
lose it a little faster. Another also reported weight
loss while breast-feeding her infant.
Several participants did not report significant
weight loss with breast-feeding. One participant
stated, I thought breast-feeding would help me with
my weight loss efforts, but that just didnt work out
for me. Two other participants had also thought
that breast-feeding would assist them in weight
loss, but they too were disappointed with their
weight loss. All three had expected to lose weight
because they had chosen to breast-feed, but they
did not feel they benefited from breast-feeding in
regard to postpartum weight loss.
A few participants reported that nursing made

them eat more and changed their dietary routine.
Two participants, both mothers of two children,
reported differences with their pregnancies. The first
participant breast-fed both of her children and lost
weight easier with the first child. The second participant noted that she breast-fed both of her children but was unable to tell whether or not her
weight loss was because of breast-feeding since she
had no comparison.
Healthier Food Consumption Choices

Whether pregnancy-related weight was lost or
not, eating played a part in all of these womens
postpartum weight loss experiences. Although few
returned to their prepregnancy weight, many did
have some success in losing weight after delivery.
Seven women mentioned making healthy food
choices as the key to their success. One participant
stated, I dont buy the food I used to. I used to buy
potato chips, cookies, just junk. If I dont buy that, I
dont have anything in my refrigerator or my cabinets. Three participants credited Weight Watchers
with their weight loss success by teaching them and
encouraging healthier eating habits.
Six participants stressed watching the quantity
of food consumed. One recalled,
In my dieting, I have really watched the quantity of
food I was eating. Not cleaning off all of my plate. I
used to push away from the table when I was full
when I should have stopped eating a while ago.
Youve had way more than you need by the time you
are full.
Another participant supported this by saying,

The main obstacle I found is that . . . um . . . I got
in the habit of finishing their (childrens) meal if
they didnt. I just didnt want to throw it away. So,
thats a real obstacle. Now, I throw out any food my
children leave on their plates. I throw it away
immediately. I dont even think about it.
Convenience was another theme, with fast food

being a major culprit. One participant suggested
that she frequented fast-food restaurants because
her toddler wanted to eat out all the time, and
another participant ate fast food because she did
not have time to think about healthy food; a third
participant avoided this problem by preparing meals

ahead of time: Preparing meals ahead of time can
help you to eat more healthy. I also cook large portions and refrigerate the rest for later.
Excess weight gain during pregnancy was
brought up often during the interviews. Weight is
hard to get off because, if you think about it, you
had 9 months to eat whatever you want and crave,
said one participant, whose craving stayed with her
after giving birth:
I want to eat, eat, eat. I would lay up and eat a pack
(of cookies) by myself in one sitting. Its not like I
can go back. Im talking about just laying up eating
a whole bag of cookies and whatever. Once I had my
child, I couldnt break that habit and that was the
hardest problem about losing weight; the constant
eating and you know, the urges.
Another participant echoed this sentiment: I

gained over 50 pounds with my first pregnancy. I ate
whatever I wanted. Unfortunately, gaining additional weight during pregnancy increased the difficulty of weight loss following childbirth. One
participant realized this early on. She stated that she
was not eating for two as many people say: When
I got pregnant, I started eating normal. I didnt overeat. Um, I wasnt one of those people who thinks
that every meal should be double to eat for two. I
ate healthier and reasonable portions.
One other factor that was noted through the
interviews was the presence of stress, whether
brought about from postpartum depression (mentioned by two participants), the illness of the mother
or a close family member, or the social situation of
the home. Four participants believed that stress was
responsible for their failure to lose weight. For one
participant, eating was a way to cope with stress:
When I ate I felt full and when I felt full I would
want to go to sleep. Plus I guess I was hoping that
when I woke up things would be different. I was
overeating as a way to get back at him (husband),
because when I overate I thought I was punishing
him, but in a way, I mean if you can understand . . .
um . . . when I met him, I was a size seven and as
the years went on he would always tell me, you
know, how good I looked, but the bigger I got, he
said you know, you need to lose weight. So, I
thought, Ill fix him. Im gonna eat this, Im gonna
eat that, and I did.
Pregnancy Contributions to Weight Gain

Pregnancy contribution to weight gain was a
prominent theme in this study. The participants
made 21 total references to how pregnancy affected
their weight gain and their experience with postpartum weight loss. Both the amount of weight gained
with the pregnancy and the appearance of the postpartum body were mentioned. One participant
stated, I gained 40 pounds and everything was big.
Another participant commented, I gained over 50
pounds with my first pregnancy. I ate whatever I
wanted. Although some participants did not try to
control the amount of weight they gained, others
gained too much weight with pregnancy despite
their best efforts. For example, one participant
reported, I really tried to watch what I ate during
pregnancy. I even saw a nutritionist, who told me I
was eating exactly what I should be eating. But I still
just gained fast.
Some of the women felt that subsequent pregnancies led to even more weight gain, as evidenced
by comments such as this: I gained 55 pounds with
my second, but I started out a little higher. Then it
didnt come off naturally. Another participant
stated, I gained more weight with my second pregnancy, and another woman reflected, My body is a
whole lot different. Its a whole lot different the
second time around [second pregnancy].
One person lamented, Ive always been petite.
When I got pregnant I only weighed 105 pounds.
And She weighed about 7 pounds 4 ounces. Which
was a big baby for me because I was so little.
Another commented, I was a lot smaller before I
had her.
Participants also reported the feelings they had
as they watched their weight rise with pregnancy.
One woman stated, If there was anything negative it
was watching the scale numbers go up and up and
up. Another participant felt that the weight gain was
both upsetting and scary. One participant made
reference to feeling like she blew up like a balloon.
Pregnancy changes in the body were also part of
this theme. One participant spoke of changes in
muscle mass postpartum. Another stated,
Pregnancy does make your body change. Nothing
goes back like it was; along with stretch marks and
the sagging and everything else, it does take a toll on
you mentally because you look at magazines and
supermodels are slim and trim and then . . . they
have their own personal trainer. They make it seem

like a breeze to have a child and go back to that
normal weight.
Most participants in this study commented on

how pregnancy contributed to weight gain, and
some spoke of how easy it was to gain the pregnancy
weight but how difficult it was to lose it postpartum.
Discussion
The themes addressed in this article (weight
struggles, exercise, breast-feeding, eating, and pregnancy contributions to weight gain) represent the
nutrition, weight, and physical activity triad, which
are all related concepts that influence one another.
Behavior change or influence in one area is likely to
result in changes in the other, except perhaps for
breast-feeding.
As earlier mentioned, breast-feedings role in
postpartum weight loss is controversial. Some
research supports the idea that breast-feeding can
help postpartum women lose more weight in a
shorter amount of time (Baker et al., 2008; Hatsu,
McDougald, & Anderson, 2008). However, other
studies have found that breast-feeding does not contribute to weight loss (Haiek et al., 2001; Walker et al.,
2004; Walker, Sterling, Kim, Arheart, & Timmerman,
2006). The participants in this study had mixed
experiences with weight loss and breast-feeding.
Some of the women perceived that breast-feeding
helped them lose weight, whereas others perceived
that breast-feeding did not help them. It may be that
some other factor that remains unknown contributed to the success of some breast-feeding women
but not others.
Many of the participants felt that their second
pregnancies played a major role in weight retention
and difficulty in losing weight during the postpartum period. Some felt that the fact that they had not
lost the weight after their first pregnancy before they
got pregnant again contributed to increased weight
retention during the postpartum period. Others felt
it just was harder to lose weight after the second
pregnancy, owing to more household demands and/
or age. The overall theme that resulted from these
in-depth qualitative interviews was that women
struggle to lose weight during the postpartum period,
and this is consistent with the research published by
Carter-Edwards et al. (2009).
We evaluated the data to see if there were any patterns apparent based on the time since birth. However,
many women had more than one child and the total
number of children any woman had older than 5 or
younger than 5 years varied considerably. Some women
had multiple children in the younger than 5 range and
other women had only one child younger than 5 years
but several older children. Thus, we were unable to
provide any results that represent how the weight loss
trajectory might vary across time.
Limitations
The sample was composed of mainly Caucasian
women who had adequate resources (income) to meet
their familys needs. Although a narrow sample can
help us understand the experience of the women
included more thoroughly, a narrow sample limits our
understanding of the phenomenon of womens experience with postpartum weight loss, especially women of
different races and ethnicities. Also, our sample
included some women with young infants who had just
begun their postpartum weight loss journey; their experience was not as fully developed as that of participants
with an older child who had more time to lose weight.
In addition, multiple researchers conducted the interviews and many of the women knew the person who
interviewed them prior to this experience. Knowing
the interviewer does not necessarily pose a problem,
it but it may have influenced how participants
responded during the interview and this needs to be
recognized in the interpretation of these results.
Recommendations for Practice

The stories provided by these women provide
insight into the types of interventions that are needed
during both pregnancy and the postpartum period.
The finding that many of the women in this study
were surprised that they did not lose their pregnancy
weight immediately or early in the postpartum period
indicates a need for anticipatory guidance about the
reality of postpartum weight loss. In general populations, weight loss is recommended at rate of 0.5 to 2
pounds per week depending on the kilocalorie deficit
(Centers for Disease Control and Prevention, 2011).
However, values have not been established for postpartum women because of the intense physiological
changes that the body experiences during the postpartum transition. In addition, drastic amounts of
weight loss in the early postpartum are common and
often expected particularly in women who have

retained a lot of fluid during the later parts of pregnancy. In planning and developing practice guidelines to assist women with successful postpartum
weight loss, nurses should consider womens perceptions, attitudes, and beliefs to assist in developing a
feasible weight loss plan.
Individualized and creative weight management
strategies must consider the postpartum womans feelings, assist her in removing barriers, and encourage her
to make healthy choices in exercise and eating. In addition, successful weight management programs must be
based on a womans interest in making a change and
her readiness for change. Finally, family and other support networks must also be included.
Some women in this study felt that their weight
loss experience was positive: The weight came off
quickly, generally with little effort on their part.
These women felt optimistic. The majority of the
women, however, shared negative feelings and mixed
emotions about how slow and hard it was to lose the
postpartum weight. Many women expressed feelings
of depression, frustration, stress, and discouragement. Herring et al. (2008) found that new-onset
postpartum depression was significantly linked to
difficulty losing weight 1 year after childbirth. The
authors suggest that depression may change sleep
patterns, physical activity, television habits, and diet,
leading to weight retention.
Prepregnancy counseling provides an opportunity
for women to share feelings regarding healthy life
style choices and weight management habits and consequences throughout the stages of life. Prepregnancy
is particularly important in the area of weight gain
during pregnancy as excessive weight gain during
pregnancy can increase the risk of complications and
contribute to retained weight beyond the postpartum
period. Nurses can be proactive in assisting the client
to consider the benefits of initiating such a program.
During the pregnancy and postpartum period, supportive counseling can be provided.
The study participants desire to lose weight and
ability to achieve their goals wavered depending on
obstacles or barriers. Obstacles included preexisting
medical conditions, surgery, and infection due to
mastitis. Infant behaviors sometimes became a source
of distress. Triggers for unhealthy eating habits
included craving fast food, continuous snacking, more
often at home than at work, and a busy schedule
between home and work with no time for exercise.
Self-imposed body image expectations differed from
reality in physical changes, and conscious awareness

of others opinions led some women to feel unattractive. Anticipating the potential obstacles that postpartum women may face, nurses can engage clients
in problem-solving strategies to counter this influence. It can be recommended that clients keep a
journal of thoughts and feelings and a diary of daily
food and exercise choices to be reviewed and discussed during prenatal and postpartum visits.
The study participants suggested several exercise
and eating activities they found useful. Exercise suggestions included activities at home with the children, for example, outdoor play and active games,
exercising with their infant, walking, and aerobic
exercise or exercise videos. Outside-the-home activities included joining structured exercise and weight
management programs, for example, Curves or
Weight Watchers.
Eating habits included portion control, cutting
back on sweets, preparing meals in advance, keeping
healthy finger foods available; making food selection
easier, for example, Healthy Choice frozen food
meals; grilling; drinking water; eating more fruits
and vegetables; and practicing moderation.
The majority of the women knew what they
needed to do for successful weight loss, yet they
were not able to reach their goals. Therein lies the
dilemma: As indicated by the women in this study,
achieving healthy postpartum weight loss involves
numerous factors. Providing praise for efforts,
rewarding target goals achieved, and troubleshooting difficult areas can build the womans self-esteem,
self-confidence, and self-efficacy. Referrals to a
nutritionist or exercise coach may be needed if the
client continues to be unsuccessful in her weight
management program. Formal education classes
related to nutrition and exercise may be another
approach, although there is a risk of lack of followthrough if content is not reinforced. The combination of holistic health concepts, such as nutrition
and physical activity, with more traditional medical
approaches to weight loss may help women meet
their weight loss goals. Women can also be reminded
that to lose weight, they must have a negative calorie
balance. They need to burn the calories they take in
and more if they wish to lose weight.
Recommendations for Future Research

Future research should focus on developing
and testing interventions based on these womens
experiences to assist with weight loss during the

postpartum period. Issues related to both nutrition
and physical activity and ways to integrate these
health-promoting activities into the current lifestyle
are particularly important. The postpartum period is
fraught with new responsibilities and is a significant
period of adjustment. However, the perinatal period
is a teachable moment when women are interested
in learning about health-related behaviors. This is
also an ideal time to talk to women about avoiding
excessive weight gain during pregnancy. Additional
interventions are warranted that target this area. In
addition to developing interventions, the experiences of diverse groups of women should be investigated. Research that addresses these issues has the
potential to improve the lives of women and families. In addition to quantitative intervention studies,
further qualitative research that examines the trajectory of weight loss across the postpartum recovery
might reveal interesting data that could further
inform the development of successful interventions
for return to prepregnancy weight.
Summary
This article has addressed womens experiences
with postpartum weight loss through the discussion of
themes that included weight struggles, exercise,
breast-feeding, eating, and pregnancy contributions to
weight gain. Twenty-four women shared stories that
led to the development of these themes. Nurses are in
a key role to assist women with the transition to new
parenthood, including weight maintenance, healthy
eating behaviors, and adequate physical activity.
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Kristen S. Montgomery, PhD, RN is an assistant professor at
the School of Nursing, University of North Carolina at Charlotte.
Melissa Best, BSN, RN is a family nurse practitioner student at
the School of Nursing, University of North Carolina at Charlotte.
Tracy B. Aniello, MSN, RN, FNP is Manager of Student Health
Services, Francis Marion University, Florence, South Carolina.
Jennifer D. Phillips, MSN, RN, is a graduate of the family
nurse practitioner program at the College of Nursing, University
of South Carolina, Columbia.
Elizabeth Hatmaker-Flanigan, MS, is a PhD student in
Health Services Research at the University of North Carolina at
Charlotte.

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Journal of Holistic Nursing

Postpartum Weight Loss : Weight Struggles, Eating, Exercise, and Breast-Feeding

American Holistic Nurses Association

>> OnlineFirst Version of Record - Nov 21, 2012

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