Global status of cardiorespiratory fitness and physical activity - Are we improving or getting worse?

Despite heightened recognition of the importance of cardiorespiratory fitness (CRF) to cardiovascular (CV) health, along with updated international consensus guidelines for physical activity (PA) and sedentary behavior (SB), significant proportions of the global adult population are physically inactive, and do not meet the threshold for CRF. Physical inactivity is considered a surrogate for low CRF given that the former is defined as not reaching the recommended minimum level of PA per week to derive a health benefit. Physical inactivity remains a major global public health problem despite decades of work by various United Nations agencies, and members of the international community to improve PA levels. Given the common coupling between physical inactivity and poor health status, it is reasonable to suggest that for a significant proportion of the global population, CRF is compromised by physical inactivity. This poses a longer-term risk to morbidity and mortality. Here we provide an indicative summary of the global status of CRF and PA and reference the implications for global health. We briefly reference opportunities moving forward, including reinforcement of the importance of engaging in movement from an early age, discouraging SB, and taking a life course approach to optimise healthy living for all.

Infant growth and body composition from birth to 24 months: are infants developing the same?

BACKGROUND: Given the importance of infancy for establishing growth trajectories, with later-life health consequences, we investigated longitudinal body composition among infants from six economically and ethnically diverse countries. METHODS: We recruited mother-infant dyads using the WHO Multicenter Growth Reference Study criteria. We measured fat-free mass (FFM) in 1393 (49% female) infants from birth to 6 months of age (Australia, India, and South Africa; n = 468), 3-24 months of age (Brazil, Pakistan, South Africa, and Sri Lanka; n = 925), and derived fat mass (FM), fat mass index (FMI), and fat-free mass index (FFMI). Height-for-age (HAZ), weight-for-age (WAZ), and weight-for-length (WHZ) Z-scores were computed. Sex differences were assessed using a t-test, and country differences using a one-way analysis of covariance. We further compared subsamples of children with average (-0.25 > HAZ < +0.25), below-average (≤-0.25) and above-average (≥+0.25) HAZ. RESULTS: HAZ performed well between 0 and 6 months, but less so between 3 and 24 months. The stunting prevalence peaked at 10.3% for boys and 7.8% for girls, at 24 months. By 24 months, girls had greater FMI (10%) than boys. There were significant differences in FFM (both sexes in all countries) and FM (Brazilian boys, Pakistani and South African girls) by 24 months of age between infants with average, above-average, and below-average HAZ. CONCLUSION: In a multi-country sample representing more ideal maternal conditions, body composition was heterogeneous even among infants who exhibited ideal length. Having a mean HAZ close to the median of the WHO standard for length reduced FFM between-country heterogeneity but not FM, suggesting that other factors may influence adiposity.

Body composition assessment in 6-month-old infants: A comparison of two- and three-compartment models using data from the Baby-bod study.

BACKGROUND/OBJECTIVES: An appreciation of infant body composition is helpful to understand the 'quality' of growth in early life. Air displacement plethysmography (ADP) using PEA POD and the deuterium dilution (DD) technique are commonly used body composition approaches in infants. We evaluated the comparability of body composition assessed using both techniques with two-compartment (2C) and three-compartment (3C) models in 6-month-old infants. SUBJECTS/METHODS: Infant fat mass (FM) and percent fat mass (%FM) obtained from a 2C model using PEA POD (2C-PP) and a 2C model using the deuterium dilution technique (2C-DD) were compared to those derived from a 3C model, and to each other, using Bland-Altman analysis and Deming regression. RESULTS: Measurements were available from 68 infants (93% Caucasian, 53% male). The mean biases were not significant between any of the method comparisons. However, significant constant and proportional biases were identified in 2C-DD vs 3C and 2C-PP vs 2C-DD, but not in the 2C-PP vs 3C comparison. Furthermore, we observed significant associations between the mean differences and infants' percent total body water (%TBW). CONCLUSIONS: While no significant between-method mean differences were found in body composition estimates, some comparisons revealed significant constant and proportional biases and notable associations between the mean differences and %TBW were observed. Our results emphasise the importance of method choice, ensuring methodological uniformity in long-term studies, and carefully considering and regulating multiple pre-analytical variables, such as the hydration status of the participants.

An exploration of the determinants of overweight and obesity and the capacity to intervene in North-West Tasmania: A stakeholder consultation.

ISSUE ADDRESSED: The capacity of communities to develop effective obesity prevention initiatives varies and should be a focus for obesity prevention intervention planning and investment. This research aimed at engaging and consulting local community stakeholders to identify determinants, needs, strategic priorities and capacity to act on overweight and obesity prevention in North-West (NW) Tasmania. METHODS: A series of semi-structured interviews and thematic analyses was implemented to explore the knowledge, insights, experiences and attitudes of stakeholders. RESULTS: Mental health and obesity were identified as major concerns and were often reported to share similar determinants. This study has identified health promotion capacity assets (existing partnerships, community capital, local leadership and some pockets of health promotion activity), and a range of capacity deficits (limited investment in health promotion, a small workforce, limited access to pertinent health information). CONCLUSIONS: This study has identified health promotion capacity assets (existing partnerships, community capital, local leadership and some pockets of health promotion activity), and a range of capacity deficits (limited investment in health promotion, a small workforce, limited access to pertinent health information). SO WHAT?: Broad upstream socio-economic, cultural and environmental determinants underpin the conditions by which the local community develops overweight/obesity and/or health and wellbeing outcomes. Including stakeholder consultations as a significant technique within a comprehensive plan of action aimed at achieving a sustainable, long-term strategy for obesity prevention and/or health promotion, should be considered in future programs.

Active School Commuting in School Children: A Narrative Review of Current Evidence and Future Research Implications.

Active school commuting (ASC) has been proposed as a practical way to inculcate positive physical activity habits in children. This paper reviews the current evidence regarding ASC among children, highlights advances in research techniques and existing limitations in the field, and outlines future implications for research and promotion. A comprehensive literature search was conducted to identify English language studies on ASC among children aged 6-12 years, followed by a narrative review. ASC has witnessed a global decline, despite evidence of its contribution to physical activity levels. Context-dependent factors such as commuting distance and parental safety concerns are consistently identified as key determinants of ASC. Several promising interventions have been identified. Despite the limitations in intervention scope and quality, notable advancements in research techniques, such as multilevel regression and agent-based modelling, have been identified. Effective promotion of ASC to tackle childhood physical inactivity requires collaborative efforts among schools, parents, and the government, and should be tailored to address multilevel determinants within the local context. Future research should leverage recent advancements in research techniques to develop effective promotion strategies, while considering the context-dependent nature of ASC behaviours and addressing existing limitations, including the lack of standardised definitions and limited geographical and age coverage.

Habitual Diets Are More Expensive than Recommended Healthy Diets.

Understanding food prices and affordability is crucial for promoting healthy dietary habits and informing policy actions. We assessed changes in the cost and affordability of habitual and recommended healthy diets in Northwest Tasmania from 2021 to 2023. The recommended diet was 16-22% less expensive than the habitual diet during the period. Notably, 60% of the total cost of the habitual diet was spent on discretionary items. The cost of the habitual diet increased by 9% in this period, whereas the cost of the recommended diet increased by only 2%. The habitual diet was unaffordable for households with median gross, minimum wage disposable or welfare-dependent incomes. The recommended diet, however, was affordable for some groups but posed a risk of food stress for those with median gross and minimum wage disposable income and remained unaffordable for those who were welfare dependent. Our findings reveal that adhering to a healthy Australian Dietary Guidelines-recommended diet can be more cost-effective than following a habitual unhealthy diet. However, adopting a healthy diet can be challenging for low-income families. Interventions such as financial support, nutrition education, community gardens and food hubs, as well as price regulation and subsidies for farmers, can help address food insecurity in Northwest Tasmania.

Enhancing Food Literacy and Food Security through School Gardening in Rural and Regional Communities.

A qualitative case study approach with in-depth, semi-structured interviews of key school staff, and student feedback was used to assess a school kitchen and garden program in the regional area of North-West Tasmania, Australia. A detailed program description was produced to conduct a realist evaluation with a Context-Mechanism-Outcome configuration, followed by a program theory evaluation through the construction of a retrospective program logic model. Dedicated kitchen and garden spaces, knowledgeable teachers committed to the program, provision of sufficient materials and consumables, and support from the school and community were found to be the basic requirements to establish a program. Additionally, it is essential to integrate both the kitchen and garden teaching components into the school curriculum. The positive outcomes (e.g., engagement, participation, knowledge, skills, behavioral change) of the program were dependent on the underlying factors, including dedicated support of school leadership, teaching staff, and the parent body for effective student engagement in the teaching spaces and for wider engagement from families and the community. The students' feedback provided supporting evidence of increased food literacy with improvements in their understanding, abilities, and attitudes towards gardening, producing healthy food, and preparing food. This may further lead to enhanced food security for students' families and the broader community.

Strategies to Improve Physical Activity and Nutrition Behaviours in Children and Adolescents: A Review.

Despite widespread acknowledgement of the multifarious health benefits of physical activity (PA), including prevention and control of obesity, an overwhelming majority of children and adolescents are not sufficiently active to realise such benefits. Concurrently, young people are significantly impacted by the rapid global rise of sedentarism, and suboptimal dietary patterns during key phases of development. Regrettably, the cumulative effects of unhealthy behaviours during the growing years predisposes young people to the early stages of several chronic conditions, including obesity. Clear and consistent approaches are urgently needed to improve eating and activity behaviours of children and adolescents. Based on existing evidence of "best bets" to prevent and control obesity and its comorbidities, we present a set of non-negotiable strategies as a 'road map' to achieving prevention and improving the health of children and adolescents.

Body composition from birth to 2 years.

Providing all infants with the best start to life is a universal but challenging goal for the global community. Historically, the size and shape of infants, quantified by anthropometry and commencing with birthweight, has been the common yardstick for physical growth and development. Anthropometry has long been considered a proxy for nutritional status during infancy when, under ideal circumstances, changes in size and shape are most rapid. Developed from data collected in the Multicentre Growth Reference Study (MGRS), WHO Child Growth Standards for healthy infants and children have been widely accepted and progressively adopted. In contrast, and somewhat surprisingly, much less is understood about the 'quality' of growth as reflected by body composition during infancy. Recent advances in body composition assessment, including the more widespread use of air displacement plethysmography (ADP) across the first months of life, have contributed to a progressive increase in our knowledge and understanding of growth and development. Along with stable isotope approaches, most commonly the deuterium dilution (DD) technique, the criterion measure of total body water (TBW), our ability to quantify lean and fat tissue using a two-compartment model, has been greatly enhanced. However, until now, global reference charts for the body composition of healthy infants have been lacking. This paper details some of the historical challenges associated with the assessment of body composition across the first two years of life, and references the logical next steps in growth assessments, including reference charts.

Trends and associations between maternal characteristics and infant birthweight among Indigenous and non-Indigenous people in Tasmania, Australia: a population-based study.

OBJECTIVE: This study aimed to investigate the trends and associations of maternal characteristics and birthweight among Indigenous and non-Indigenous infants. STUDY DESIGN: This was a retrospective population-based study. METHODS: Fourteen years (2005-2018) of birthweight and perinatal health data of live-born singletons and their mothers obtained from the Tasmanian Data Linkage Unit were used to assess the trends and associations between maternal characteristics and infant birthweight using regression modelling. RESULTS: Compared with non-Indigenous mothers (n = 76,750), Indigenous mothers (n = 3805) had a significantly higher prevalence of risk factors during the 14-year period. Although the prevalence of prepregnancy obesity and gestational diabetes mellitus (GDM) markedly increased in both groups, the rate of increase was higher (P < 0.001) for Indigenous than non-Indigenous mothers. Smoking, alcohol consumption and illegal drug use during pregnancy reduced over the years, and there was no significant difference in the rate of reduction between the groups. Large-for-gestational-age (LGA) births increased while small-for-gestational-age (SGA) births decreased in both groups over time. In addition, high birthweight (HBW) births decreased while low birthweight (LBW) births increased. The rates of increase in LGA and LBW births and the rates of decrease in SGA and HBW births were significantly higher in Indigenous mothers compared with non-Indigenous mothers (P < 0.001 for all). The association between Indigenous ethnicity and LBW and SGA births weakened after adjusting for other confounding maternal and perinatal variables. LBW and SGA were positively associated with Indigenous ethnicity, age <18 years, smoking, alcohol consumption and illegal drug use, pre-eclampsia, underweight prepregnancy body mass index and low socio-economic status. Women with higher parity, pre-existing diabetes and prepregnancy overweight or obesity were more likely to give birth to an infant with HBW or LGA. CONCLUSIONS: The prevalence of risk factors for abnormal birthweight is higher among Tasmanian Indigenous mothers, contributing to a gap in birthweight outcomes between Indigenous and non-Indigenous infants. The dramatic increase in prepregnancy obesity and GDM in both groups highlight the importance of screening and management of GDM during pregnancy. Comprehensive programmes co-designed and co-managed in consultation with Indigenous people are needed to support healthy lifestyle choices among Indigenous women to address the barriers to individuals adopting behaviour change and to help close the health outcomes-related gap between Indigenous and non-Indigenous mothers and infants.

The Allied Health Expansion Program: Rethinking how to prepare a workforce to enable improved public health outcomes.

Improvements in global public health require universal health care supported by a health workforce with competencies appropriate for local population needs-the right capabilities, in the right place, and at the right time. Health inequities persist in Tasmania, and Australia more broadly, most notably for those people living in rural and remote areas. The article describes the curriculum design thinking approach being used to codesign and develop a connected system of education and training to target intergenerational change in the allied health (AH) workforce capacity in Tasmania, and beyond. A curriculum design thinking process is engaging AH participant groups (faculty, AH professionals, and leaders across health, education, aged and disability sectors) in a series of focus groups and workshops. The design process deals with four questions: What is? What if? What wows? and What works? It also involves Discover, Define, Develop and Deliver phases that continue to inform the development of the new suite of AH education programs. The British Design Council's Double Diamond model is used to organize and interpret stakeholder input. During the initial design thinking discover phase, stakeholders identified four overarching problems: rurality, workforce challenges, graduate skill set shortfalls, and clinical placements and supervision. These problems are described in terms of relevance to the contextual learning environment in which AH education innovation is occurring. The develop phase of design thinking continues to involve working collaboratively with stakeholders to codesign potential solutions. Solutions to date include AH advocacy, a transformative visionary curriculum, and an interprofessional community-based education model. In Tasmania, innovative educational innovations are catalyzing attention and investment in the effective preparation of AH professionals for practice to deliver improved public health outcomes. A suite of AH education that is deeply networked and engaged with Tasmanian communities is being developed to drive transformational public health outcomes. These programs are playing an important role in strengthening the supply of allied health professionals with the right capabilities for metropolitan, regional, rural, and remote Tasmania. They are situated in a broader AH education and training strategy that supports the ongoing development of the AH workforce to better meet the therapy needs of people in Tasmanian communities.

School Gardening and Health and Well-Being of School-Aged Children: A Realist Synthesis.

School environments can create healthy settings to foster children's health and well-being. School gardening is gaining popularity as an intervention for healthier eating and increased physical activity. We used a systematic realist approach to investigate how school gardens improve health and well-being outcomes for school-aged children, why, and in what circumstances. The context and mechanisms of the specific school gardening interventions (n = 24) leading to positive health and well-being outcomes for school-aged children were assessed. The impetus of many interventions was to increase fruit and vegetable intake and address the prevention of childhood obesity. Most interventions were conducted at primary schools with participating children in Grades 2 through 6. Types of positive outcomes included increased fruit and vegetable consumption, dietary fiber and vitamins A and C, improved body mass index, and improved well-being of children. Key mechanisms included embedding nutrition-based and garden-based education in the curriculum; experiential learning opportunities; family engagement and participation; authority figure engagement; cultural context; use of multi-prong approaches; and reinforcement of activities during implementation. This review shows that a combination of mechanisms works mutually through school gardening programs leading to improved health and well-being outcomes for school-aged children.

"An Ounce of Prevention is Worth a Pound of Cure": Proposal for a Social Prescribing Strategy for Obesity Prevention and Improvement in Health and Well-being.

BACKGROUND: Social and behavioral determinants of health are increasingly recognized as central to effective person-centered intervention in clinical practice, disease management, and public health. Accordingly, social prescribing (SP) has received increased attention in recent times. The rampant global prevalence of obesity indicates that the customary, reductionistic, and disease-oriented biomedical approach to health service delivery is inadequate/ineffective at arresting the spread and mitigating the damaging consequences of the condition. There is an urgent need to shift the focus from reactive downstream disease-based treatments to more proactive, upstream, preventive action. In essence, this requires more effort to affect the paradigm shift from the traditional "biomedical approach of care" to a "biopsychosocial model" required to arrest the increasing prevalence of obesity. To this end, an SP approach, anchored in systems thinking, could be an effective means of moderating prevalence and consequences of obesity at a community level. OBJECTIVE: The proposed SP intervention has the following three key objectives: (1) build a sustainable program for Circular Head based on SP, peer education, and health screening to minimize the incidence of obesity and related lifestyle diseases; (2) increase service and workforce connectivity and collaboration and initiate the introduction of new services and activities for obesity prevention and community health promotion; and (3) enhance health and well-being and minimize preventable adverse health outcomes of obesity and related lifestyle diseases through enhancement of food literacy and better nutrition, enhancement of physical literacy and habitual personal activity levels, and improvement of mental health, community connectedness, and reduction of social isolation. METHODS: This paper describes a prospective SP strategy aimed at obesity prevention in Circular Head, a local government area in Northwest (NW) Tasmania. SP is a prominent strategy used in the Critical Age Periods Impacting the Trajectory of Obesogenic Lifestyles Project, which is an initiative based in NW Tasmania focused on assessing obesity prevention capacity. A social prescription model that facilitates the linkage of primary health screening with essential health care, education, and community resources through a dedicated "navigator" will be implemented. Four interlinked work packages will be implemented as part of the initial plan with each either building on existing resources or developing new initiatives. RESULTS: A multimethod approach to triangulate insights from quantitative and qualitative research that enables the assessment of impact on individuals, community groups, and the health care system will be implemented within the initial pilot phase of the project. CONCLUSIONS: Literature is replete with rhetoric advocating complex system approaches to curtail obesity. However, real-life examples of whole-of-systems interventions operationalized in ways that generate relevant evidence or effective policies are rare. The diverse approach for primary prevention of obesity-related lifestyle diseases and strategies for improvement of health and well-being described in this instance will contribute toward closing this evidence gap. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/41280.

Serum leptin levels in patients with chronic kidney disease and hypertensive heart disease: An observational cross-sectional study.

Background and Aim: Adipocytes secrete a peptide hormone called leptin, which plays a crucial role in controlling appetite and energy expenditure. Alterations in leptin concentrations are associated with CKD-related cardiovascular problems such as hypertensive heart disease (HHD). Despite the link, data on the precise function of leptin in people with CKD and HHD is scant. Methods: An observational cross-sectional study involving a total of 108 participants (72 CKD patients with HHD and 36 healthy controls). Their demographic and anthropometric information was collected using a standardized questionnaire. Certain clinical measures such as blood pressure and body mass index (BMI) were assessed. Fasting blood samples were analyzed for levels of plasma glucose (FPG), lipids, creatinine, and leptin. Data were analyzed with SPSS v23. Results: Leptin, FPG, creatinine and triglyceride levels were all significantly higher in CKD patients with HHD compared to controls (p < 0.01 for all). Furthermore, advanced CKD status (being in stage 5), having a 6-year diagnosis of HHD, being female, having a higher BMI, and elevation in levels of HDL and FPG contributed significantly to the variance in serum leptin levels in the case group (ß = 0.37, 0.22, 0.19, 0.18, 0.27, 0.28; p < 0.05 for all). In the control group, the female gender had the biggest unique effect on circulating leptin levels, followed by BMI and eGFR (ß = 0.71, 0.34, -0.22; p < 0.01 for all). Conclusion: Patients with CKD who also had HHD reported considerably higher circulating leptin levels. Significantly higher blood leptin levels were shown to be associated with CKD stage 5 in the case group. These results are consistent with the role of leptin in the metabolic complexity seen in CKD patients. There needs to be more research into treatments that aim to lower leptin levels in CKD patients with HHD.

Cardiovascular disease prevention and management in the COVID-19 era and beyond: An international perspective.

Despite some indicators of a localized curtailing of cardiovascular disease (CVD) prevalence, CVD remains one of the largest contributors to global morbidity and mortality. While the magnitude and impact of the coronavirus disease 2019 (COVID-19) pandemic have yet to be realized in its entirety, an unquestionable impact on global health and well-being is already clear. At a time when the global state of CVD is perilous, we provide a continental overview of prevalence data and initiatives that have positively influenced CVD outcomes. What is clear is that despite attempts to address the global burden of CVD, there remains a lack of collective thinking and approaches. Moving forward, a coordinated global infrastructure that, if developed with appropriate and relevant key stakeholders, could provide significant and longstanding benefits to public health and yield prominent and consistent policy resulting in impactful change. To achieve global impact, research priorities that address multi-disciplinary social, environmental, and clinical perspectives must be underpinned by unified approaches that maximize public health.

Domains of Capacity Building in Whole-Systems Approaches to Prevent Obesity-A "Systematized" Review.

Despite increased awareness of its risks, for the most part, contemporary efforts for obesity prevention have been patchy at best. As such, the burgeoning interest in whole-systems approaches (WSAs) that acknowledge the complex, dynamic nature of overweight and obesity and operate across multiple levels of society is particularly timely. Many components of "community capacity building" (CB), an essential but often neglected aspect of obesity prevention, overlap with "best practice principles" in effective/optimal community-based obesity-prevention initiatives. Rhetoric urging WSAs and community CB in public health abounds although operative and efficacious contemporary examples of these approaches to reducing obesity levels are scarce. The aim of this investigation was to undertake a systematized review of the level of capacity building incorporated in published literature on WSAs targeting obesity to better understand how domains of CB have been incorporated. A PubMed search and a recently published systematic review were utilized to identify WSAs to obesity prevention between 1995-2020. A team-based approach to qualitative thematic data analysis was used to systematically assess and describe each intervention regarding explicit capacity-building practice. Despite not being specifically designed for building capacity, a significant proportion of the WSAs studied in the current report had implemented several CB domains.

Social justice equity in healthy living medicine - An international perspective.

Irrespective of geographical location, disadvantaged people are disproportionately affected by unnecessary disease and suffering caused by inequalities in health. Although equal access to opportunities for healthy living medicine regardless of legal, political, economic, or other circumstances should be a basic human right, it is increasingly improbable for scores of people, particularly in Africa, Asia, Latin America, and the Caribbean, to acquire this. In recent times, global initiatives have attempted to make 'healthy lifestyles' more equitable by pledging to be relevant to all economies, promoting prosperity, environmental protection, climate change interventions, and purposeful action to meet the needs of vulnerable populations, including women and children. Yet there remains much to be done to address and reduce the substantial international health equity gaps. Reducing disparities that disproportionately affect the lower end of social strata must entail collaborative and systemic action from important stakeholders across the whole system, an approach that translates theory and research into practice. Ideally, realist approaches that appreciate the importance of the context of problems and assume nothing works everywhere or for everyone, should be prioritised over linear/simple and non-scalable intervention strategies.

Physical Activity and Food Environments in and around Schools: A Case Study in Regional North-West Tasmania.

A better understanding of the physical activity (PA) infrastructure in schools, the walkability of neighborhoods close to schools, and the food environments around schools, particularly in rural, socioeconomically challenged areas such as the North-West (NW) of Tasmania, could be important in the wider effort to improve the health of school-age children. Accordingly, this research aimed to assess PA resources, walkability, and food environments in and around schools in three socioeconomically disadvantaged, regional/rural Local Government Areas (LGAs) of Tasmania, Australia. A census of schools (including assessment of the PA infrastructure quality within school grounds), a walkability assessment, and a census of food outlets surrounding schools (through geospatial mapping) were executed. Most of the schools in the study region had access to an oval, basketball/volleyball/netball court, and free-standing exercise equipment. In all instances (i.e., regardless of school type), the quality of the available infrastructure was substantially higher than the number of incivilities observed. Most schools also had good (i.e., within the first four deciles) walkability. Numerous food outlets were within the walking zones of all schools in the study region, with an abundance of food outlets that predominantly sold processed unhealthy food.

Gestational weight gain and postpartum weight retention in Tasmanian women: The Baby-bod Study.

Many factors can negatively impact perinatal outcomes, including inappropriate gestational weight gain (GWG). Despite having the greatest potential to influence maternal and infant health, there is a lack of consensus regarding the GWG consistent with a healthy pregnancy. To date, GWG in Northern Tasmania remains understudied. We investigated how maternal pre-pregnancy body mass index (BMI) is related to weight gain during pregnancy and weight retention post-partum, and how maternal pre-pregnancy BMI is related to the mode of delivery. Approximately 300 Tasmanian mothers (n = 291 for mode of delivery and n = 282 for GWG) were included in this study. Analysis of variance and chi square tests were conducted to assess differences in BW of mothers across BMI categories and differences between categorical variables; respectively. Based on pre-pregnancy BMI, mothers were assigned to one of three groups, with healthy weight (<25 kg m-2), with overweight (25-29.9 kg m-2), or with obesity (>30 kg m-2). Pre-pregnancy BMI and body weight (BW) were significantly associated (p<0.001) with post-partum BW at 3 and 6 months. Only 25% of mothers with a normal weight BMI, 34% with overweight and 13% with obesity, achieved the Institute of Medicine (IOM) recommendation for GWG. Interestingly, a number of women in our cohort lost weight during gestation (1.5, 9 and 37% in <25, 25-29.9 and >30 kg m-2 groups, respectively). Further, women with obesity showed the lowest level of BW fluctuation and retained less weight post-partum. The highest number of caesarean sections were observed in mothers who exceeded GWG recommendations. Most mothers either exceeded or failed to achieve IOM recommendations for GWG. To improve the generalisability of these findings, this study should be replicated in a larger representative sample of the Tasmanian maternal population.