{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T14:03:32Z","timestamp":1777039412761,"version":"3.51.4"},"reference-count":34,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2020,12,8]],"date-time":"2020-12-08T00:00:00Z","timestamp":1607385600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Weight loss after gestational diabetes (GDM) reduces the risk of type 2 diabetes (T2DM); however, weight loss remains challenging in this population. In order to explore perceptions of T2DM risk, barriers to weight loss, and views of diet strategies in women with previous GDM, a cross-sectional online survey of n = 429 women in Australia aged \u226518 years with previous GDM was conducted. Opinions of intermittent energy restriction (IER) were of interest. Seventy-five percent of responders (n = 322) had overweight or obesity, and 34% (n = 144) believed they had a high risk of developing T2DM. Within the Theoretical Domains Framework, barriers to weight loss were prominently related to Environmental Context and Resources, Beliefs about Capabilities, and Behavioural Regulation. Exercising was the most tried method of weight loss over other diet strategies (71%, n = 234) and weight loss support by a dietician was appealing as individual appointments (65%, n = 242) or an online program (54%, n = 200). Most women (73%, n = 284) had heard of IER (the \u201c5:2 diet\u201d), but only 12% (n = 34) had tried it. Open comments (n = 100) revealed mixed views of IER. Women in Australia with previous GDM were found to lack a self-perceived high risk of developing T2DM and expressed barriers to weight loss related to their family environment, beliefs about their capabilities and behavioural regulation. IER is appealing for some women with previous GDM; however, views vary.<\/jats:p>","DOI":"10.3390\/ijerph17249180","type":"journal-article","created":{"date-parts":[[2020,12,8]],"date-time":"2020-12-08T20:27:15Z","timestamp":1607459235000},"page":"9180","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Women\u2019s Barriers to Weight Loss, Perception of Future Diabetes Risk and Opinions of Diet Strategies Following Gestational Diabetes: An Online Survey"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7184-3668","authenticated-orcid":false,"given":"Kristy L.","family":"Gray","sequence":"first","affiliation":[{"name":"UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA 5001, Australia"},{"name":"Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA 5001, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lois","family":"McKellar","sequence":"additional","affiliation":[{"name":"UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA 5001, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3547-6634","authenticated-orcid":false,"given":"Sharleen L.","family":"O\u2019Reilly","sequence":"additional","affiliation":[{"name":"School of Agriculture and Food Science, University College Dublin, Belfield, D04 V1W8 Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6411-626X","authenticated-orcid":false,"given":"Peter M.","family":"Clifton","sequence":"additional","affiliation":[{"name":"UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA 5001, Australia"},{"name":"Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA 5001, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4788-3870","authenticated-orcid":false,"given":"Jennifer B.","family":"Keogh","sequence":"additional","affiliation":[{"name":"UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA 5001, Australia"},{"name":"Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA 5001, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,12,8]]},"reference":[{"key":"ref_1","unstructured":"Royal Australian College of General Practitioners (2016). General Practice Management of Type 2 Diabetes: 2016\u20132018, RACGP."},{"key":"ref_2","unstructured":"Australian Institute of Health and Welfare (2019). Incidence of Gestational Diabetes in Australia."},{"key":"ref_3","unstructured":"International Diabetes Federation (2019). IDF Diabetes Atlas 9th Edition 2019, IDF."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"m1361","DOI":"10.1136\/bmj.m1361","article-title":"Progression to type 2 diabetes in women with a known history of gestational diabetes: Systematic review and meta-analysis","volume":"369","author":"Vounzoulaki","year":"2020","journal-title":"BMJ"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1773","DOI":"10.1016\/S0140-6736(09)60731-5","article-title":"Type 2 diabetes mellitus after gestational diabetes: A systematic review and meta-analysis","volume":"373","author":"Bellamy","year":"2009","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.2105\/AJPH.2009.172890","article-title":"Percentage of gestational diabetes mellitus attributable to overweight and obesity","volume":"100","author":"Kim","year":"2010","journal-title":"Am. J. Public Health"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"177","DOI":"10.5001\/omj.2017.34","article-title":"Diabetes mellitus: A local and global public health emergency!","volume":"32","year":"2017","journal-title":"Oman Med. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"4774","DOI":"10.1210\/jc.2008-0772","article-title":"Prevention of diabetes in women with a history of gestational diabetes: Effects of metformin and lifestyle interventions","volume":"93","author":"Ratner","year":"2008","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1016\/j.pmedr.2015.05.009","article-title":"Lifestyle interventions for type 2 diabetes prevention in women with prior gestational diabetes: A systematic review and meta-analysis of behavioural, anthropometric and metabolic outcomes","volume":"2","author":"Gilinsky","year":"2015","journal-title":"Prev. Med. Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.diabres.2014.07.019","article-title":"Readiness for diabetes prevention and barriers to lifestyle change in women with a history of gestational diabetes mellitus: Rationale and study design","volume":"106","author":"Lipscombe","year":"2014","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1186\/s13012-017-0605-9","article-title":"A guide to using the theoretical domains framework of behaviour change to investigate implementation problems","volume":"12","author":"Atkins","year":"2017","journal-title":"Implement. Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1089\/jwh.2010.2233","article-title":"Barriers to and facilitators of postpartum follow-up care in women with recent gestational diabetes mellitus: A qualitative study","volume":"20","author":"Bennett","year":"2011","journal-title":"J. Women\u2019s Health"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1111\/dme.13926","article-title":"Women\u2019s views on lifestyle changes to reduce the risk of developing type 2 diabetes after gestational diabetes: A systematic review, qualitative synthesis and recommendations for practice","volume":"36","author":"Dennison","year":"2019","journal-title":"Diabet. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e7","DOI":"10.1016\/j.wombi.2014.09.002","article-title":"A review of interventions to prevent type 2 diabetes after gestational diabetes","volume":"27","author":"Peacock","year":"2014","journal-title":"J. Aust. Coll. Midwives"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e12990","DOI":"10.1111\/obr.12990","article-title":"An evaluation of the impact of lifestyle interventions on body weight in postpartum women: A systematic review and meta-analysis","volume":"21","author":"Lim","year":"2020","journal-title":"Obes. Rev."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/1748-5908-7-37","article-title":"Validation of the theoretical domains framework for use in behaviour change and implementation research","volume":"7","author":"Cane","year":"2012","journal-title":"Implement. Sci."},{"key":"ref_17","unstructured":"Michie, S., Atkins, L., and West, R. (2014). The Behaviour Change Wheel: A Guide to Designing Interventions, Silverback Publishing."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1080\/19325037.2008.10599016","article-title":"Using the smog formula to revise a health-related document","volume":"39","author":"Hedman","year":"2008","journal-title":"Am. J. Health Educ."},{"key":"ref_19","unstructured":"(2018, March 01). Australian Bureau of Statistics, Sample size calculator, Available online: https:\/\/www.abs.gov.au\/websitedbs\/D3310114.nsf\/home\/Sample+Size+Calculator."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Cowdell, F., and Dyson, J. (2019). How is the theoretical domains framework applied to developing health behaviour interventions? A systematic search and narrative synthesis. BMC Public Health, 19.","DOI":"10.1186\/s12889-019-7442-5"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1111\/j.1464-5491.2010.03032.x","article-title":"Perceived risk of type 2 diabetes in australian women with a recent history of gestational diabetes mellitus","volume":"27","author":"Morrison","year":"2010","journal-title":"Diabet. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2281","DOI":"10.2337\/dc07-0618","article-title":"Risk perception for diabetes among women with histories of gestational diabetes mellitus","volume":"30","author":"Kim","year":"2007","journal-title":"Diabetes Care"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"468","DOI":"10.3390\/healthcare2040468","article-title":"Prevention of diabetes after gestational diabetes: Better translation of nutrition and lifestyle messages needed","volume":"2","year":"2014","journal-title":"Healthcare"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1146\/annurev.psych.53.100901.135153","article-title":"Motivational beliefs, values and goals","volume":"53","author":"Eccles","year":"2002","journal-title":"Annu. Rev. Psychol."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Boyle, D.I.R., Versace, V.L., Dunbar, J.A., Scheil, W., Janus, E., Oats, J.J.N., Skinner, T., Shih, S., O\u2019Reilly, S., and Sikaris, K. (2018). Results of the first recorded evaluation of a national gestational diabetes mellitus register: Challenges in screening, registration, and follow-up for diabetes risk. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0200832"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1017\/S0954422418000070","article-title":"Weight loss after pregnancy: Challenges and opportunities","volume":"31","author":"McKinley","year":"2018","journal-title":"Nutr. Res. Rev."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Lim, S., Hill, B., Pirotta, S., O\u2019Reilly, S., and Moran, L. (2020). What are the most effective behavioural strategies in changing postpartum women\u2019s physical activity and healthy eating behaviours? A systematic review and meta-analysis. J. Clin. Med., 9.","DOI":"10.3390\/jcm9010237"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1249\/JSR.0000000000000619","article-title":"The health benefits of exercise in overweight and obese patients","volume":"18","author":"Garber","year":"2019","journal-title":"Curr. Sports Med. Rep."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Headland, M., Clifton, P.M., Carter, S., and Keogh, J.B. (2016). Weight-loss outcomes: A systematic review and meta-analysis of intermittent energy restriction trials lasting a minimum of 6 months. Nutrients, 8.","DOI":"10.3390\/nu8060354"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1534","DOI":"10.1017\/S0007114513000792","article-title":"The effect of intermittent energy and carbohydrate restriction v. Daily energy restriction on weight loss and metabolic disease risk markers in overweight women","volume":"110","author":"Harvie","year":"2013","journal-title":"Br. J. Nutr."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1111\/jhn.12571","article-title":"\u2018For me it\u2019s about not feeling like i\u2019m on a diet\u2019: A thematic analysis of women\u2019s experiences of an intermittent energy restricted diet to reduce breast cancer risk","volume":"31","author":"Donnelly","year":"2018","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_32","first-page":"117","article-title":"Intermittent fasting and weight loss: Systematic review","volume":"66","author":"Welton","year":"2020","journal-title":"Can. Fam. Physician"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/j.mce.2015.09.014","article-title":"Do intermittent diets provide physiological benefits over continuous diets for weight loss? A systematic review of clinical trials","volume":"418","author":"Seimon","year":"2015","journal-title":"Mol. Cell Endocrinol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1177\/1403494818761971","article-title":"A comparison of measured versus self-reported anthropometrics for assessing obesity in adults: A literature review","volume":"46","author":"Maukonen","year":"2018","journal-title":"Scand. J. 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