Research Article: The effects of a pre-conception lifestyle intervention in women with obesity and infertility on perceived stress, mood symptoms, sleep and quality of life

Date Published: February 25, 2019

Publisher: Public Library of Science

Author(s): Lotte van Dammen, Vincent Wekker, Susanne R. de Rooij, Ben Willem J. Mol, Henk Groen, Annemieke Hoek, Tessa J. Roseboom, Nigel K. Stepto.


Obesity is an increasing problem worldwide and is associated with serious health risks. Obesity not only reduces physical health, but can also negatively affect levels of perceived stress, mood symptoms, sleep quality and quality of life (QoL), which may lead to further weight gain. We have previously shown that a pre-conception lifestyle intervention reduced weight and improved physical QoL in the short term. In the current study, we assessed the effects of this intervention in women with obesity and infertility on perceived stress, mood symptoms, sleep quality and QoL five years after randomization.

We followed women who participated in the LIFEstyle study. This is a multi-center randomized controlled trial comparing a six-month lifestyle intervention to improve diet and increase physical activity followed by infertility treatment, versus prompt infertility treatment. Participants were 577 women with infertility between 18 and 39 years of age with a body mass index (BMI) ≥ 29 kg/m2. For the current study we measured perceived stress, mood symptoms, sleep quality and QoL in 178 women five years after randomization. T-tests and linear regression models were used to assess differences between the intervention and control groups.

We found no evidence that a pre-conception lifestyle intervention improved female well-being five years after randomization.

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Obesity is an increasing health problem across the world, with rates as high as 40% among adults in the US [1]. In Europe the prevalence of overweight in 2014 has been estimated to be almost 40%, and obesity 16% [2]. Obesity not only reduces physical health [3], but may also have adverse consequences for mental health and quality of life (QoL). Obesity was associated with lower self-reported QoL in adults, and this lower QoL was even more evident in those with increased degrees of obesity [4]. Higher body weight in women was associated with higher levels of psychological and perceived stress [5]. Furthermore, depressive and anxiety disorders seem to be more prevalent in people with obesity, especially among women and those with severe obesity [6]. A bidirectional pathway might explain the causal links between obesity and depression, in which obesity leads to more depressive symptoms, and depressive symptoms lead to physiological and psychosocial alterations associated with weight gain [7]. Obesity was also associated with short sleep duration and low sleep quality, which in turn was associated with weight gain [8]. The higher prevalence of obstructive sleep apnea in adults with obesity is one of the possible causes of impaired sleep quality [8]. Low sleep quality was associated with lower QoL, more depressive symptoms and an increased cardiovascular disease risk [9–11]. These interrelations underline the importance of helping individuals not only with their obesity but also their associated mental health concerns.

We followed women approximately five (range = 3–8) years after participation in a pre-conception lifestyle intervention trial [19], the LIFEstyle study [20, 21]. The LIFEstyle study was a randomized controlled trial (RCT) carried out in 23 hospitals in the Netherlands between 2009–2012 (Netherlands Trial Registry (NTR 1530)). The study was approved by the medical ethics committee of the University Medical Center Groningen (UMCG) (METc code: 2008/284) and conducted following the principles of the Declaration of Helsinki. Women were eligible for the LIFEstyle study if they had a body mass index (BMI) of ≥ 29 kg/m2, were between 18 and 39 years of age and had infertility. The inclusion criterion for BMI was chosen based on previous research reporting declined pregnancy chances with a BMI of ≥ 29 kg/m2 [22]. Infertility was defined as: chronic anovulation; or, unsuccessful attempts to conceive for at least 12 months with an ovulatory cycle. In total 577 women with obesity and infertility provided written informed consent and were randomized between a six-month lifestyle intervention group, and a control group. The six-month lifestyle intervention aimed at 5–10% weight loss or a BMI < 29 [3] through a healthy diet, increased physical activity and behavioral modification. Behavior change was targeted by means of motivational counselling, which was effective in reducing weight in previous research [23, 24]. The motivational counselling was directed toward: In this five year follow-up visit of a pre-conception lifestyle RCT in women with obesity and infertility, we were unable to detect any effects on levels of perceived stress, symptoms of depression and anxiety, sleep quality and QoL among those who participated in the follow up.   Source:


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