Why don't many obese pregnant and post-natal women engage with a weight management service?

Objective: This study investigated the views and experiences of obese pregnant and post-natal women who had declined or disengaged from an evidence-based weight management service, and their reasons for doing so. Background: Despite significant risks of maternal obesity to both mother and baby, the majority of obese women offered tailored weight management support during or after pregnancy declined to use it, and many women who accepted the service disengaged soon after. Methods: Semi-structured interviews regarding women's views and experiences were conducted with obese pregnant and post-natal women who declined the service (N = 7) and women who disengaged from the service (N = 11) and analysed thematically. Results: Four main themes were identified. 'First contact counts' related to inadequate explanation of the service by the referrer, being offended by the referral, and negative expectations of the service. 'Missed opportunities for support' describes what support declining women identified as desirable, such as regular weight monitoring. 'No need for help', and 'Service not meeting needs' related to personal choices regarding weight management, including not wanting support and preferring group-based services. Conclusions: While some obese pregnant and post-natal women did not want any type of weight management support, many did but failed to engage with the service on offer due to a variety of barriers. A more sensitive and transparent referral process and further tailoring of the service to meet individual needs may increase uptake and continued use of this service. The inclusion of non-participants and non-completers formed a valuable element of service evaluation.