A friend recently told me that she gained 30 pounds during the first trimester of her pregnancy. Because I work in obesity research, she asked me if that sounded like too much. I suggested that she talk to her doctor, and she said “Well, if it was a problem, wouldn’t my doctor bring it up with me?”
For almost everyone, weight is a touchy subject. Despite written guidelines and research on how clinicians can approach – and not offend – patients when discussing their weight, studies have long shown that both patients and providers are hesitant to bring up the topic during clinic visits.  Add the complicating factor of pregnancy, and it may not come as a surprise that this reluctance extends to discussing weight gain with pregnant patients

In an earlier blog post, Emily Oken illustrated the importance of appropriate weight gain during pregnancy, describing how gaining too much weight during a pregnancy can have negative health consequences for both the mother and the child. But despite this evidence, some women, like my friend, expect the doctor to initiate conversation related to weight gain limits and concerns. Doctors are hesitant to bring up the topic as well.

One of the research projects in our group aims to address this issue. Our investigators are recruiting both pregnant women and their providers to participate in a two-part trial aimed at facilitating these tough discussions.

In the first part of the study, researchers are providing physicians with training and tools so they feel more comfortable addressing excess weight gain during pregnancy. Physicians are coached on strategies for addressing weight issues with patients, as well as new tools in the electronic health record that display growth trajectories during pregnancy. These trajectories will give physicians a quick way to determine whether patients are on track to gain a healthy amount of weight during pregnancy. Together, these tools and strategies are intended to facilitate delicate discussions of excess weight gain during pregnancy.

In the second part of the study, pregnant women will be paired with a mobile app and a health coach.  The coach will work directly with the patient, discussing the woman’s weight goals, strategies to achieve those goals, and also noting whether her physician discussed weight gain with the patient.  Our goal is to empower both patients and providers to have these difficult discussions, so that no one is left wondering after an appointment, “is that something I should have brought up?”



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