Dear Dr Rainford,

I weighed 140 pounds when I discovered I was pregnant, and, at nine months, I tipped the scale at 200 pounds. I gave birth to a nine-pound baby, I breast fed religiously until this baby was two years old and I have only lost about 40 pounds. I am very dissatisfied with this. What can I do?

Dear Reader,

Thank you for your letter. Let me congratulate you on breastfeeding your baby and for the 40 pounds that you have already lost. Unfortunately, your experience highlights some of the problems associated with excess weight gain in pregnancy (more than 25-35 pounds).

The two problems which you have mentioned is first, giving birth to a large baby (macrosomia) which is not only associated with an increased risk of Caesarean sections and other delivery related complications but places a child at a higher risk of birth injuries and obesity later in life. Second, is the extra 20 pounds that you are unable to lose. You have not mentioned if any additional methods were used to lose weight.

Change your behaviour

There are three components in the most successful weight-loss programmes. These are diet, exercise and behaviour modification. If you have not already done so, I encourage you to engage in a daily exercise programme. You could be placed on a specific programme at a gym or you may design your own. Tanny's exercise programme that has been published in The Gleaner Health section's weight-loss series may be helpful. However, even daily walking may be sufficient in helping you to achieve your goal.

Consult with a nutritionist

I would also recommend that you consult with a nutritionist to review your current eating habits and suggest changes if necessary. If you are unable to do so, decreasing the quantity of food that you eat at each meal will be helpful.

Behaviour modification involves using different techniques that are usually taught in a group setting to change the factors in your environment that influence the way you eat and exercise. Unfortunately, I am unaware if we have any such groups locally. Nevertheless, some examples of these strategies include not having ice cream or candy in your home and putting exercise equipment in a location where you are more likely to see and use them. Including supportive family and friends and/or a doctor in your plans may also be helpful. Good luck!

Dr Monique Rainford is a consulting obstetrician and gynaecologist; email: yourhealth@gleanerjm.com.