Diets all around!

Well, here’s some research that can’t possibly be misconstrued: a new study published in The Lancet has documented an association between the amount of weight a mother gains during her pregnancy and the birth weight of her infant. Since birth weight can be used to predict adult BMI, cue the ZOMG! Obesity! commentary. “For babies, studies are just now beginning to show that the effects of tipping the scales at birth may linger throughout life. Many experts suggest that excessive nutrition in pregnancy creates an abnormal uterine environment that permanently changes the baby’s brain, pancreas, fat tissue and other biological systems, said a co-author of the study, Dr. David Ludwig.”

(A note: some of what follows may be triggering for people who have experiences with eating disorders.)

And, of course, since the womb is a baby’s first environment, this is one more thing that pregnant women can be policed on. “As more and more Americans struggle with obesity, the role of early prevention is key [and] early prevention may also extend to the development of the fetus,” said Dr. Jennifer Wu, an obstetrician/gynecologist. William Callaghan, acting chief of the maternal and infant health branch of the CDC added The Lancet paper “just adds more fuel to the fire that [managing weight gain] is an absolutely critical part of preconception care and prenatal care.” Of course, the doctors both go on to mention the importance of good nutrition and and exercise, serving once again to conflate weight with health.

When I was pregnant with A, I became highly attuned to the ever growing list of things I was and was not supposed to be doing. There were the obvious things (drinking alcohol, smoking cigarettes, using various controlled substances), and the less obvious things (not eating cold cuts). But the list went on and on and on. Restrictions on fish, cheese, processed foods, sprouts, spinach, caffeine, sugar substitutes, hot tubs, any activity where I might fall down, sleeping position, you name it. And every time I casually mentioned that I would give anything for a blue cheese burger and a beer, I would get a very stern “But the baby! You don’t want to risk it!” response.

I see a role here for practitioners to engage with their patients about eating habits, in no small part because pregnancy is enormously taxing on your body and it’s good to make sure you’re getting enough vitamins and drinking enough water. (I’m actually surprised that this isn’t already a part of what practitioners talk about with patients.) However, I do not recommend the strategy one of the midwives took with me early on in my pregnancy, which was to lecture me about my BMI and losing weight. (Keep in mind here that I’m on active duty: my job requires working out 5 days a week, passing regular fitness assessments, and maintaining either a specified weight or body fat percentage.) Ultimately, I gained very little weight during my pregnancy, and lost it all rapidly after delivery owing to some truly horrific medical complications from the delivery. When my daughter was two weeks old, I went back in for follow up and mentioned that I was really worried about how much weight I’d lost. In two weeks, I’d lost all of the weight I gained during the pregnancy plus another 10 pounds. The doctor laughed. “Oh, women don’t normally worry that they’ve lost weight after a pregnancy.” I glared. “I don’t care about that. I’m asking because I am worried. Losing thirty pounds in two weeks isn’t normal, even if you’ve just had a baby.” “Oh, well, I think you’re fine from a health point of view, but let us know if you keep losing weight. You’re really lucky.” In case anyone was wondering, being hospitalized for eight days and having hideous medical complications makes a girl feel really lucky that at least she lost weight.

I’ve got concerns about two different ways this could go. First, there’s even more pressure on women than there was before about losing weight, dieting, and the moralizing and guilt that follows. It’ll just be amplified when it comes to pregnancy: “Well, it’s fine if you want to be selfish and overweight, but think of your baby! Dooming a child to a life of being overweight!” We already live in a world where the word policed doesn’t just mean social pressure and stigma for some women for conduct during pregnancy: it means criminal prosecution. This has the potential to become just one more thing where pregnant women are judged, shamed, and guilted about not providing a perfect uterine environment. (As though there is such a thing and that women are able to control it like that. Environmental exposures, anyone?)

The study’s authors conclude “In view of the apparent association between birthweight and adult weight, obesity prevention efforts targeted at women during pregnancy might be beneficial for offspring.” Well, yes, it might, if done in a way that’s constructive, understanding of the fact that significant and sustained weight loss is not a realistic goal, and focuses on good eating habits as part of a healthy pregnancy. But I’m not particularly optimistic that’s how it’ll shake down. You’re likely to wind up with people saying truly asinine things like “The idea that a big baby is a healthy baby, and a crying baby is probably a hungry baby who should be fed, are things we really need to rethink,” Dr. Birch said. Spoken like someone who’s never had an infant.


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41 comments for “Diets all around!

  1. Daomadan
    August 5, 2010 at 10:37 pm

    I’m glad you brought this up. I was watching the news program where they highlighted this study and all I could think was “Great! Something else that we can police and blame (pregnant) women and mothers for!” And I know this is anecdotal but I’ve heard many of my friends mention how they were a “big baby” and yet struggle with being underweight, likewise some “average” or “small” babies now struggle with society telling them they’re at an unacceptable weight. I don’t understand how people can get money for research on troublesome topics like this while my high school can barely get enough money to transport kids to and from school.

  2. Jigae
    August 5, 2010 at 10:41 pm

    I hope guest poster Jay or another medical professional will respond to this, but in short.

    I think BMI is a crock of shit. Having said that there is a bunch of evidence that suggest a high birth weight baby (LGA or Large for Gestational Age) are more at risk for a number of conditions and can also result in more trauma to the mother during birth: http://www.merck.com/mmhe/sec23/ch264/ch264f.html

    LGA babies also result in a higher incidence of c-sections, which were discussed in another thread. I mainly know about this research due to radical midwifes. This isn’t bad science and I can dig up more research if you’d like.

    I have literally gotten in shouting fights with MDs and nursing professors about the oppression and bad science behind BMI, but the (possibly lifelong) effects of LGA on a child are a very real thing.

  3. August 5, 2010 at 10:59 pm

    The flip-flops on nutrition are astounding, and should serve as a reminder that a lot of this stuff is based upon assumption, poorly constructed research and guesswork, followed by a bandwagon effect. Who cares if these notions of prenatal nutrition and the feeding of babies is the obverse of what nutritionists were saying only a few years ago – trust them this time. And eat your oat bran.

  4. mightydoll
    August 6, 2010 at 12:29 am

    “excessive nutrition”? What IS that, even?

    well, my small sample size (2), one of my children (now 9) is very lean and athletic, and I gained nearly 50 lbs while pregnant with her (going from 135-40ish to 186). The other (now closing in on 12), I gained 25 lbs (going from 130-155), and now tends towards plumpness. I definitely ate better while pregnant with my older child.

  5. August 6, 2010 at 12:40 am

    A few years ago I heard about a study (forget where and the specifics) where the scientists had correlated low birth weight and low childhood body fat with high body fat later in life. As a scientist, I’m continually amazed with how medicine can take a couple studies that show correlation and then decide, aha! this is how we must live! And, usually, this is the new an exciting way we should blame and control women.

    For the record, I was a tiny baby. About 4 lbs. No, I wasn’t a premie. I was a perfectly healthy, though small and skinny baby. I’m a fat adult, in the OMG you’re going to die five minutes ago BMI category.

    I guess I’m just not sure how this study can actually be used to help women, instead of hurt us. Clearly more research needs to be done, but I worry that doctors will start treating these correlations as causative facts, and I worry that their treatment will hurt women.

    Also, um, couldn’t this totally work the other way around? Like, it’s not the mother who eats too much and grows ’em big, but, genetically, the baby is going to be big, which will, of course, lead to more weight gain during pregnancy? Because it’s a bigger baby!

    But I am but a lowly chemist. Perhaps this is incorrect logic, so some biologist/medical doctor should correct me if I’m thinking about this the wrong way.

  6. QoT
    August 6, 2010 at 12:50 am

    This story really strikes a nerve for me because my mother *lost weight* during the first trimester when pregnant with me (ED-related). And her doctor monitored her so closely for the rest of it to ensure she was healthy and eating and I got whatever it was I needed in utero. Darn, I guess that’s why I’m a fattie now! If only my mother had continued starving herself I could be a model now!

  7. August 6, 2010 at 12:53 am

    but the (possibly lifelong) effects of LGA on a child are a very real thing.

    If you can point me to some literature that’s not talking about LGA in conjunction effects of gestational diabetes, I’d be curious to see it. Most of what I’ve encountered regarding LGA babies and long term health effects seems to be wholly focused on gestation diabetes.

    I didn’t quote this portion of the WSJ write up, but The Lancet study included information about the amount of weight women gained during their pregnancy but not the mother’s weight or body mass index at the start of her pregnancy. So maybe it makes a difference if you start out overweight? If you gain weight in different ways during a pregnancy? If subsequent pregnancies are different? Also, thin women are supposed to gain more weight than average/overweight/obese women during pregnancy. It would be a strange conclusion if the thinnest women were gaining the most weight and having the biggest babies who then stayed large.

    As always, there are huge methodological issues with a study that tries to isolate one causative factor.

  8. August 6, 2010 at 1:54 am

    I find the use of the language of morality in association with food, and the suggestion that there might be ‘constructive’ anti-obesity measures really disturbing, particularly in feminist spaces. Both are present in this post.

    It’s always hard in posts like this if those ideas are intended by the author, or if they’re just a result of careless use of the framing in the article the author is responding to.

  9. August 6, 2010 at 2:04 am

    I accidentally double posted – thinking I’d lost the original, when I’d actually posted it, but it had ended up in moderation (too many browser windows opened). If the first comment could be deleted rather than coming out of moderation that’d be ace.

    Sorry about that.

  10. August 6, 2010 at 3:41 am

    So wait – baby with a high birth weight is doomed from the start to be obese and miserable, but the amount of weight an adult woman gains is her own fault and must be policed? Grah.

    I’m a scientist, and I’m constantly amazed by how studies in my field are taken out of context in the media and in public dialogue. In medicine, I can only infer it’s an even worse situation, where doctors can wave any piece of research they like in the defence of any thing they wish to do.

    (Hi, mass generalisation on my part. Sorry)

  11. August 6, 2010 at 4:46 am

    Huh. Not touching how horrible (and, as ever, counterproductive) the weight-policing is, because the more I think about it the more triggering it gets, but I will register a little surprise at the research that starts this off. As far as I was aware higher birth-weight babies were less likely to have weight problems compared to full-term low-weight babies, as the low-weight ones might have been undernourished in the womb for whatever reason, leading to appetite problems. But maybe my mom was lying to make us both feel better for 1) me being a skinny baby then a chubby kid and 2) my various concerns about pregnancy.

  12. abby_wan_kenobi
    August 6, 2010 at 6:23 am

    Holy sh*t.

    The policing of pregnant women always feels like another arm of the anti-choice movement to me. “You are not as important as the unborn child living in your uterus! ALL of your choices should reflect this reality!!”

    Research that links behavior and health is always suspect to me. Articles like this one that can make headlines (You’re fat and and you’re destroying the next generation!) are overrepresented and research that is less splashy doesn’t make it into the public forum. There is probably decades of medical papers linking higher birth weight to lower mortality rates, stronger immune systems and better overall health as an adult. But it isn’t new or fresh and so it isn’t being put into the public forum for a careful and nuanced discussion against the findings of this more recent research. It’s an unfortunate quality of the culture of news media today.

    For fun, here’s an article covering some irresponsible reporting of science news to fit a sensationalist agenda: http://www.wired.com/wiredscience/2010/08/the-brain-eating-vaccine-conspiracy/

  13. August 6, 2010 at 6:51 am

    Jigae: I read a very interesting study a while back showing that induction and C section risk was closely correlated with the presence of a (mis)diagnosis of macrosomia during pregnancy, but that if the provider was not expecting a macrosomic baby, maternal and fetal complications remained at baseline. Provider expectation/prejudice and unnecessary intervention (such as early induction) is, unsurprisingly, the biggest contributor to surgical delivery. For much the same reasons, we get C section rates of 50% or higher in private hospitals (and extremely provider-dependent), while it remains in the twenties in public hospitals, which treat a much higher-risk population.

    By the same token, I have never – _never_ – seen research on pregnancy and birth outcomes for fat pregnant women that has made any sort of decent, good-going attempt at eliminating or controlling for provider prejudice. Without this, the entire body of “science” is a load of crap.

  14. August 6, 2010 at 7:26 am

    I think that there are a lot of things that are not accounted for when talking about pregnancy and fat women, and that provider prejudice does play a part in the outcome. For instance, many providers assume that most obese women will need c-sections or be high risk pregnancies, and assume that their babies will be macrosomic, which indicated a c-section. C-sections lead to lower rates of breastfeeding, as does body-shaming and ignorant people suggesting that women who are larger or well-endowed cannot breastfeed. So,m the baby ends up being formula fed which, is likely to cause more weight gain in itself.

    I found the differences in providers to be a big factor. The first one I saw risked me out of midwife car and said I was high risk. The second told me they would go ahead and schedule a c-section at 36 weeks, and were talking about inducing at 35. The midwife and doctor that I ended up seeing said my weight shouldn’t effect anything, and were actually concerned that I gained too little (8 lbs total, but I had some wicked hyperemesis and lost 18 lbs between the 1st and 2nd trimester). He was born “big” at over 10 lbs, but was also 23 in long, and his weight now is considered well within average for his length.

    On the other hand, I was born at 6 lbs 3oz, and have been overweight since about 1st or second grade. My mom was not overweight when pregnant with me, so I can’t blame that. Same story with my parents though (they both became overweight in their 30s) – both of their mothers were small.

    I don’t know that birth weight necessarily does correlate with weight/BMI later in life. Also, I would assume that women with larger babies are usually going to gain more weight, because the child itself is larger and may need more fluid and such to cushion it. Also, with the high rate of inductions, there are many babies born a full month before others, so the ones that go to the end of a full term (40-42 weeks) are typically going to be larger than those born a few weeks earlier. I wonder if the number of babies delivered at 36-38 weeks because of the uptick in inductions and c-sections hasn’t skewed our idea of an average or normal birth weight as well.

  15. August 6, 2010 at 8:17 am

    None of these studies mention, either, how much effect stress has on both mother and baby. And nothing causes stress like being told you can’t eat any of the things you love.

    When I was pregnant, the food logging and constant pressure to Eat! More! Protein! in my childbirth class was so stressful that I quit the class and felt *so* much better afterwards.

    (Lest it not be clear, I’m not saying that a little reasonable attention to your food habits when you’re pregnant isn’t a good idea, but this? Takes it way, way too far, into the realm of being even worse for you.)

  16. August 6, 2010 at 8:46 am

    Right, what Debi Linton said. How is it that mothers are blamed for dooming their babies to a life of obesity they can’t possibly ever control, and yet the mothers (who might have once been the doomed babies) are supposed to control their own weight with ease? #logic

  17. Bushfire
    August 6, 2010 at 8:55 am

    What in the name of fuck is “excessive nutrition”? Do these researchers not realize that nutrients enter the fetus through an umbilical cord? They’ve painted a picture of fetii shovelling in the ice cream and pies.

  18. FashionablyEvil
    August 6, 2010 at 9:03 am

    I find the use of the language of morality in association with food, and the suggestion that there might be ‘constructive’ anti-obesity measures really disturbing, particularly in feminist spaces.

    Maia, I see the post as description of how things are, rather than an endorsement. I totally agree that we’d be far better off if we stopped conflating food and eating habits with morality.

  19. Emily
    August 6, 2010 at 9:10 am

    I’m 15 weeks pregnant now and so paranoid/anxious/stressed out about controlling my weight and then feeling like a failure when I have a cheese burger. The last thing I need to hear is that I’m dooming my baby to a life long battle with obesity over a cheese burger!

    You know – I want to meet these people who write these articles just to make sure they’ve actually carried a baby in their bodies. A pregnant woman feels totally body-hijacked. You do not belong to yourself. Your self control is totally reduced. You’re fatigued & taxed. This is a stressful time for a pregnant lady, so just back off.

    And if you happen to be a Meme Roth and can devote 80% of your time to nutrition and exercise (and blogging about it) good for you, but the rest of us have shit to do.

  20. August 6, 2010 at 10:21 am

    I find the use of the language of morality in association with food, and the suggestion that there might be ‘constructive’ anti-obesity measures really disturbing, particularly in feminist spaces. Both are present in this post.

    Maia, with respect to food and morality, I’m not suggesting that it should be used, just that it is. And in the US, it’s used emphatically and regularly. This is just one more point of access for moralizing.

    Sorry if I suggested that anti-obesity efforts could be constructive. I was thinking more along the lines of providers talking about nutrition, which I think could be constructive subject to some conditions as mentioned.

  21. sam
    August 6, 2010 at 11:00 am

    33 yrs ago, I was told by my ob-gyn that I shouldn’t wear loose maternity clothes early in pregnancy because too many women use pregnancy as an excuse to eat too much and get fat. I weighed 105 lbs. I still remember how hard it was for me to stand up to him and dress and eat as I wanted, but I did. The more things change, the more things stay the same.

  22. FashionablyEvil
    August 6, 2010 at 11:44 am

    Emily, if I had to guess, I would say being stressed out about the cheeseburgers is far worse than actually eating the cheeseburgers. Yet another reason for society to just leave pregnant women alone.

  23. Corbin
    August 6, 2010 at 12:13 pm

    My daughter weighed 11 lbs at birth. I was not diabetic. I was not overweight. I was in labor for a whopping 3 hours, no pain meds, and only pushed twice. No complications, no muss, no fuss. She is now 8, and, while she is VERY tall, she is actually very very thin. With all the contradictions we see in scientific research I think that all we can say is “Sometimes a big baby is a good thing. Sometimes its a bad thing”

  24. August 6, 2010 at 12:17 pm

    Emily: I’m 15 weeks pregnant now and so paranoid/anxious/stressed out about controlling my weight and then feeling like a failure when I have a cheese burger.The last thing I need to hear is that I’m dooming my baby to a life long battle with obesity over a cheese burger!You know – I want to meet these people who write these articles just to make sure they’ve actually carried a baby in their bodies.A pregnant woman feels totally body-hijacked.You do not belong to yourself.Your self control is totally reduced.You’re fatigued & taxed.This is a stressful time for a pregnant lady, so just back off.And if you happen to be a Meme Roth and can devote 80% of your time to nutrition and exercise (and blogging about it) good for you, but the rest of us have shit to do.  

    Emily –

    Right there with you. I’m 9 weeks pregnant, and have gotten so much conflicting advice about what to eat that I’m about ready to throw my hands up and just eat what I know. I bought a copy of What to Eat When You’re Expecting, and I read about a chapter and a half; the counting and the tallying seem obsessive and intrusive, and the “cheat with x no more than once a week/month” parts are crazy. Then I talk to my mother, who believes pregnancy is an excuse to eat whatever the hell you want, regardless of whether it’s too much, not in any way balanced or nutritive, or potentially dangerous for the kid. I can’t eat like that – when I eat more than my appetite really tells me I need, or I eat excessively fatty foods in particular, my body becomes very unhappy with me. Then the doctor who did my first ultrasound tells me that I should eat no starches. As in, no bread, pasta, rice, potatoes – none. When I looked at him like this was insane, he asked, “Do you eat a lot of whole grains?” And I told him I don’t really eat grain products that aren’t. “Don’t eat any,” he said. “It’s just third world filler.” That’s about as classist as it gets. Sniff sniff, my baby is too good for your inexpensive, wholesome oatmeal. Oh, and I told him I’ve lost a little weight since the estimated conception date. “That’s fine,” he said. “You can keep losing weight the whole pregnancy, if it’s due to lifestyle improvements.” Thanks, doc. Give me a complex if I don’t improve my lifestyle sufficiently and gain all of five pounds while pregnant with my first child.

    I wonder how we managed to turn out so many perfectly healthy, happy, well-adjusted people without all of this crap. I’ve decided that if anybody looks at me funny for something I decide to eat while I’m pregnant – and yes, I will be deciding what to eat – I’m going to tell them that I will no more allow them to act as proxy parent before my child is born than I will after.

  25. carovee
    August 6, 2010 at 2:42 pm

    Has anyone had a chance to read the original paper? From the summary it looks like they used a sibling comparison design and found that among her own children, the child with the highest birthweight corresponded to the pregnancy during which she gained the most weight. In theory that should control for a host of genetic and environment influences on weight gain during pregnancy and birthweight. I’m curious though if they attempted to assess why mom gained more weight during one pregnancy than another. As someone stated, the weight of the child itself would account for at least some of the difference. I wonder how much pregnancy weight gain varies among offspring in the first place.

  26. Emily2
    August 6, 2010 at 3:33 pm

    When my midwife was pushing protein and I expressed concern about my cholesterol (which has always been high with a family history of heart disease) she said “baby brains are made of cholesterol.” She would definitely approve of the cheeseburger.

  27. Jigae
    August 6, 2010 at 5:26 pm

    Hey:

    I searched PubMed and other scholarly sources and can’t find the research about bad outcomes for LGA children regarding academic achievement. I’m going to ask the person who told me about this research, but for the moment, I’m going to assume it doesn’t exist.

    It just stuck in my head because it went against the conventional wisdom that “bigger baby = smarter, healthier baby,” and I found it shocking.

    If I get an answer soon, I’ll be sure to post it.

    Apologies.

  28. ysabet
    August 6, 2010 at 7:17 pm

    Um.

    I, born 3lbs, and my brother, born 2lbs 4oz, have been overweight for the majority of our adult life. My husband, born 14lbs, has no hope in hell of getting out of the underweight range. His siblings, born 10lbs and 11lbs, also struggle with being overweight.

    That small sample alone would tend to make me doubt the results, somewhat.

  29. Kdel
    August 6, 2010 at 8:12 pm

    This takes me back.

    I have 4 children…ages 20, 14, and 2 & 2. We were trying for “just one more” and got the bonus package.

    With twins, the main concerns are low birth weight, and premature labor. If you actually read the studies, the most important thing a mom can do when pregant with twins, to avoid these complications, is to gain weight, eating nutritionaly dense food.

    Barbara Luke is a guru of this idea in regards to multiple births, and you can find her at http://www.drbarbaraluke.com/

    I was shocked to discover, as I read study after study that had been quoted in the media as obese mom=bad, that the actual data showed that the biggest risk to a fetus was when the mother was UNDERweight.

    So, I ate like crazy, and very carefully, a diet rich in things like raw nuts, avacados, eggs, and legumes. I ate FIVE times a day…this from someone who usually has a glass of juice with her coffee and calls it breakfast.

    I gained 55 pounds. Most of that was in the first 2 trimesters…I actually lost weight towards the end of the third (no more room to eat!). People freaked when I told them that…too much! Eek! But I was convinced that it was best for my babies.

    And my twins were born at full term, and both weighed 7 pounds, 7 ounces. The team that was present for the birth (because twin births are high risk, and I was old so double high-risk) was huge: 2 docs for me, 2 for each twin, and assorted nurses and such. A few actually had tears in their eyes, and they all told me that it was one of the most positive multiple births they had seen, and how joyeous it was.

    I lost 35 pounds, by the way, just giving birth. 15 pounds of baby, another 5ish of placenta, and lots and lots of water.

    I was back down to my pre-pregnancy weight within 6 weeks.

    So all I can say is this: eat well. Eat things that are rich in flavor (not the chemical kind!). Eat things that bring you joy. And don’t let the food police get to you. If I had only gained the 30 pounds that I was “supposed to” according to common thought, I doubt I would have had the strength and stamina to carry my babies that long, and to let them grow that well.

    Food for thought.

  30. Kdel
    August 6, 2010 at 8:17 pm

    lauredhel: By the same token, I have never – _never_ – seen research on pregnancy and birth outcomes for fat pregnant women that has made any sort of decent, good-going attempt at eliminating or controlling for provider prejudice. Without this, the entire body of “science” is a load of crap. lauredhel

    Just had to add… yes, this! Read the study yourself, please please please, before you believe that the reporters say. I was SHOCKED how many studies that got reported as “fact” that were poorly designed, poorly completed, had results that had no statistical significance, or that the reporter just plain GOT WRONG!

  31. August 7, 2010 at 1:30 pm

    *laughs* Too much nutrition? My mom was sick during her entire pregnancies. She could hardly keep anything down, and yet she gained about 60 pounds with each pregnancy. My brother and sister had birth weights of under 7 pounds, but mine was 8.2 pounds (I was the 3rd pregnancy). They know now that she probably had gestational diabetes (and eventually developed type 2 diabetes later), which caused her to gain weight while still hardly eating. And yes, my brother sister and I are all overweight as adults (and have type 2 diabetes).

    It amazes me that this study didn’t seem to control for such factors. But then, many obesity studies don’t control for such factors. When they do, they tend to find that weight has less to do with health than other premitigating factors.

  32. August 7, 2010 at 2:26 pm

    Honestly these studies almost make me laugh now.

    Actually this one did make me laugh because my partner fits the study perfectly. He was the second baby and at 9 and a half pounds, was both big and more than a pound larger than his older sibling. He’s now one of those overweight adults, 6’3″ and 202lbs.

    These studies are absolutely useless if they continue to use BMI. They reach a point of absurdity when it comes to taller individuals in a population that is continually getting taller. I’m willing to bet birthrate can also predict adult height in the same way.

  33. August 7, 2010 at 2:28 pm

    Ack! Sorry *birthweight.

  34. Rose
    August 7, 2010 at 4:57 pm

    There have been a couple of points raised so far that are of interest.

    BMI: BMI is a crude tool for assessing body size. It’s also fairly obvious when BMI shouldn’t be used as a measure of obesity. If I saw a body builder in the clinic, BMI is useless. But for most people, a BMI of 50 is indicative of extremes of obesity.

    It’s really hard to have a sensible discussion about body weight at the moment because we have the extremes of unnatural thinness promoted by the mainstream media as being desirable. That said, I’m not sure that the correct response to this is to embrace obesity as being a healthy body in response.

    I don’t berate the people who come to me seeking medical advice about their lifestyle choices, because the choices are the decisions of those people. However, if their lifestyle is going to impact on their health in a bad way, I feel I have to be honest about it. With regard to obesity, I think saying that this has no impact on healthcare delivery is to perpetuate a lie, and it’s important to let people know that it may affect what I can offer them in terms of investigations and treatment. That said, there’s ways and means of not being an arsehole about delivering this information.

  35. August 7, 2010 at 10:10 pm

    They reach a point of absurdity when it comes to taller individuals in a population that is continually getting taller.I’m willing to bet birthrate can also predict adult height in the same way.

    Higher birth weight and higher birth length are both correlated with adult height in this study: http://aje.oxfordjournals.org/cgi/reprint/149/8/726.pdf Note that the subjects are all male, and Danish.

    I was pregnant last year and found reading about macrosomia and LGA quite scary, You see, I am 193cm tall. My own birth weight was 4.5kg. I figured it was very unlikely that I would have a full-term baby below 4kg (especially since it was a male fetus, which have higher birthweights), and I was terrible worried that my size and his size would be regarded as inherently pathological. Luckily my own providers were fairly blasé about the whole thing (and he was born at 4.15kg). I think if I’d had gestational diabetes I would have been an inevitable elective Caesarean though: the diabetes and macrosomia guidelines make no allowances for tall mothers.

    One thing I also find frustrating about these kinds of conversations is the pathologising of the top 10%. Eg, Jigae at #2 says that LGA is correlated with problems. LGA is defined as the top 10% of babies by birthweight. There will always be 10% of babies LGA, including both myself and my son. If this group is at a higher risk of problems, then it’s probably a subgroup with additional risk factors. Otherwise there’s not a lot to be done, you can’t define 10% of babies away.

  36. evil fizz
    August 8, 2010 at 12:32 am

    With regard to obesity, I think saying that this has no impact on healthcare delivery is to perpetuate a lie, and it’s important to let people know that it may affect what I can offer them in terms of investigations and treatment.

    Can you provide an example?

  37. August 8, 2010 at 9:58 am

    Mary-
    That’s really interesting information regarding birth length/weight and height. For more anecdata, my mother is a short, fat woman, my brother is a short, broad man, and I’m a short fat woman. We were both > 5 lbs. We were pretty tiny babies. But we’re also short.

    Just so people are aware, the study did not go by BMI and it controlled for gestational diabetes, though the researchers admitted that they could not know about all gestational diabetes in their sample.

  38. Jigae
    August 8, 2010 at 12:54 pm

    Mary:
    Higher birth weight and higher birth length are both correlated with adult height in this study: http://aje.oxfordjournals.org/cgi/reprint/149/8/726.pdf Note that the subjects are all male, and Danish.I was pregnant last year and found reading about macrosomia and LGA quite scary,You see, I am 193cm tall. My own birth weight was 4.5kg. I figured it was very unlikely that I would have a full-term baby below 4kg (especially since it was a male fetus, which have higher birthweights), and I was terrible worried that my size and his size would be regarded as inherently pathological. Luckily my own providers were fairly blasé about the whole thing (and he was born at 4.15kg). I think if I’d had gestational diabetes I would have been an inevitable elective Caesarean though: the diabetes and macrosomia guidelines make no allowances for tall mothers.One thing I also find frustrating about these kinds of conversations is the pathologising of the top 10%. Eg, Jigae at #2 says that LGA is correlated with problems. LGA is defined as the top 10% of babies by birthweight. There will always be 10% of babies LGA, including both myself and my son. If this group is at a higher risk of problems, then it’s probably a subgroup with additional risk factors. Otherwise there’s not a lot to be done, you can’t define 10% of babies away.  

    I was told it was a specific subgroup of LGA babies — ones born over 4500g. I was speaking sloppily, and I apologize.

    I’ve been similarly frustrated when others define obesity as someone being larger than 90% of the population and then immediately saying 25% of America is obese. How does THAT math work?

  39. Jigae
    August 8, 2010 at 1:05 pm

    I finally found the paper I was referencing above. It is specifically about macrosomia (babies born weighing more than 4500g). The studyr is called “High Birth Weight and Cognitive Outcomes” and was written by Resul Cesur and Inas Rashad.

    http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1313805

    I’m still looking for free access. This is just the abstract.

  40. Rose
    August 8, 2010 at 4:34 pm

    evil fizz: With regard to obesity, I think saying that this has no impact on healthcare delivery is to perpetuate a lie, and it’s important to let people know that it may affect what I can offer them in terms of investigations and treatment. Can you provide an example?  

    Yes. Several patients have been too large to fit in scanners and we’ve been unable to stage their cancers. I’ve witnessed a few failed spinal anaesthetics because of extremes of obesity. I’ve also seen a couple of anaesthetic emergencies because patients could not maintain their own ventilation under general anaesthetic due to the difficulty of breathing under their own weight whilst under anaesthesia. I’ve also performed caeseareans on women whose BMI has been greater than 50, which makes for an extremely technically challenging operation. The rate of wound infections in patients with extremes of obesity is well documented and I’ve seen this reflected in my personal practice.

    Where I last worked, we had a pretty high cut-off for referring ladies with extreme obesity to the anaesthetists. We tend to refer anyone who has a medical condition that would affect their ability to undergo spinal or epidural anaesthesia so this also includes patients with severe spinal abnormalities, previous problems with anaesthetics etc. I don’t think it would be fair to pretend to any of these women that there are no barriers to anaesthetic intervention in pregnancy, and it’s important they get an opportunity to discuss what potential problems might occur and any alterations that need to be suggested. I don’t like dropping unexpected surprises on women entering labour, because they’ve plenty else to worry about that day.

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