Maternal Obesity Causes, Consequences, and Cures

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Maternal ObesityCauses, Consequences, and Cures

• Deborah Burch, R.N., B.S., C.P.C.E.
• Florida Department of Health

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When is extra body fat no longer cute?
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When it starts affecting the health of our nation.
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Key Points

• Obesity is a public health crisis.
• Obesity is treatable and preventable!

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Defining Overweight/Obesity

• Excessive body fat in relation to lean body mass.
  
• Measuring Standards
• 1) Height/Weight Tables
• 2) Waist/Hip Ratio
• 3) Skin-Fold Measurements
• 4) Body Mass Index

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Body Mass Index

• Calculation of BMI Formula weight (lbs.) /
  height (in.) 2 x 703
• Example Weight 150 lbs, Height 55
  (65")Calculation 150 (65)2 x 703 24.96

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Interpreting the BMI

• Underweight
• Normal 18.5 - 24.9
• Overweight 25.0 - 29.9
• Obese 30 39.9
• Morbidly obese 40

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ObesityPublic Health Crisis

• Healthy People 2010 named overweight and obesity
  as one of the top ten leading health indicators
  used to measure the health of the nation.

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Obesity Trends Among U.S. AdultsBRFSS, 1985
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data 11
Obesity Trends Among U.S. AdultsBRFSS, 1990
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data 12
Obesity Trends Among U.S. AdultsBRFSS, 1995
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data 1519
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Obesity Trends Among U.S. AdultsBRFSS, 2000
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data 1519 20
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Obesity Trends Among U.S. AdultsBRFSS, 2005
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data 1519 2024 2529
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Prevalence of Obesity in Children
AGE BOYS GIRLS 2-5
9.9 11 6-11 16
14.5 12-19 15.5
15.5 Slyper, A.H. 2004
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2005 Florida Statistics

• 208,235 women who gave birth with a known
• pre-pregnancy BMI
• 24 were overweight (pre-pregnancy BMI 25-29.9)
• 19 were obese (pre-pregnancy BMI of 30)
• Data Source Florida Department of Health,
  Office of Vital Statistics, Florida
• Birth Certificate

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Obesity has reached epidemic proportions!

• Epidemic an outbreak or sudden rapid spread,
  growth, or development.
• Merriam-Webster Collegiate Dictionary

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Where does it end?

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Where does it begin?

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Etiology of Overweight/Obesity

• Energy intake exceeds energy expenditure

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Etiology of Overweight /Obesity

• Familial/Genetic
• Environmental
• Psychological
• Socio-cultural
• Physiological

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Familial Factors

• Number/Size of fat cells dictated at birth
• Adoption studies
• Body type/Metabolism
• Eating Patterns/Diet

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Environmental Factors

• Portion Distortion
• Sedentary Lifestyle
• Eating on the Go
• Convenience Foods
• Availability of Nutritious Foods

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Physiological Factors

• Hypothalamus Disorders
• Endocrine Disorders
• Thyroid Disorders
• Glucocorticoids
• Medications

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Psychological Factors

• Stress
• Depression
• Medications
• Insufficient Sleep

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Socio-Cultural Factors

• Education level
• Socio-economic status
• Limited programs/resources
• Limited food options

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Why Does Weight Matter?
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Health Consequences in General

• Hypertension
• Dyslipidemia
• Type 2 diabetes
• Coronary heart disease, stroke
• Cholescystitis and cholelithiasis
• Gout, osteoarthritis
• Obstructive sleep apnea
• Some types of cancer (endometrial, breast,
  prostate, and colon)

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Health Consequences - Women

• Menstrual irregularity
• Infertility
• Urinary Stress Incontinence

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Health Consequences - Pregnancy

• Preeclampsia
• Hypertension
• Gestational diabetes
• Embolism and deep vein thrombosis
• Increased blood loss during delivery
• Prolonged first stage of labor
• Increase rate of cesarean delivery
• Increased risk of post-op infection
• Increased risk for maternal death

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• FASTER Trial Data
• 13,752 controls
• 1473 obese (BMI 30-34.9)
• 877 morbidly obese (BMI 35)

Weiss J, et al. AJOG 2004190(4)1091-7
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Morbid Obesity and Adverse Outcome

• Swedish study
• Morbid obesity BMI 40
• Morbidly Obese outcomes
• Increased preeclampsia (OR 4.82)
• Stillbirth after 28 wks. (OR 2.79)
• Cesarean OR (2.69)
• Shoulder dystocia (OR 3.14)

Cedergren M. Obstet Gyn 2004103219-24
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Cesarean Concerns
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Health ConsequencesBirth Outcome

• Increase risk for birth defects
• Macrosomia
• Neonatal hypoglycemia
• Preterm fetal loss/miscarriage
• Stillbirth
• Infant/Neonatal death

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Financial Cost of Obesity

• Obesity expenditures for adults in Florida
• are over 3.9 billion annually.
• Over half of these expenses are paid by Medicare
  and Medicaid.

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What can we do?
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5-A Framework

• Ask
• Advise
• Assess
• Assist
• Arrange

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ACOG 1st Committee Opinion on Obesity

• Recommended weight gain guidelines
• BMI on all women at initial visit
• Offer nutritional counseling
• Encourage exercise program
• Gestational diabetes screen first trimester
• Discuss potential pregnancy complications
• Suggest patients consult with anesthesiologist

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2006 ACOG Provider Survey

• Eighty percent assessed BMI - counseled on weight
  control
• Focused on portion control/dieting
• Majority stated inadequately trained
• Did not offer referrals for counseling or
  prescriptions for weight management drugs
• Reluctance to assist patients who lacked
  motivation

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Health Belief Model

• Knowledge alone will not produce change.
  People must
• Perceive they are at risk
• Perceive medical condition to be serious
• Believe in positive effect of treatment
• Have channels to address fears/concerns
• Believe they have skill/ability to perform new
  behavior

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Health Belief Model in Action

• Perceive they are at risk
• Educate
• Raise Awareness
• Individualize
• Invite them to share - Ask for their personal
  stories

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Health Belief Model in Action

• Believe in positive benefits
• Fun innovative strategies
• Focus on health not image
• Focus on nutrition not deprivation
• Rewards and incentives
• Balance, variety, moderation

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3 Goals for Weight Management

• Prevent Weight Gain
• Produce Weight Loss
• Maintain Healthy Weight

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Life Span Approach

• Infants
• Breast-feed
• Children-Teens
• Healthy eating patterns
• Nutritious snacks
• Physical activity

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Obesity Prevention Program Overview

• The Obesity Prevention Program is funded by the
  Centers for Disease Control and Prevention and
  focuses on evidence based programming that
  promotes overweight and obesity prevention
  activities in the areas of physical activity,
  nutrition, TV viewing, and breastfeeding.

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Obesity Prevention Program Goals

• Increase healthy nutrition choices
• Promote regular physical activity
• Encourage breastfeeding
• Decrease television and video game time

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Prime Opportunities

• Pre-pregnancy
• Pregnancy
• Postpartum

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Pre-Pregnancy

• Every woman Every Time
• Nutrition
• Physical activity
• Chronic disease prevention/control
• Family planning
• Vitamin/Folic acid supplementation
• Stress/Depression

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Pregnancy

• Assess BMI at initial visit
• Nutrition/Physical activity history
• Recommended weight gain
• Physical activity options
• Barriers
• Work together to set goals/follow-up

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Pattern of Weight Gain
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Exercise in Pregnancy

• Things to Consider
• Joints Pregnancy hormones cause the ligaments
  to stretch.
• Balance Center of gravity is shifted to the
  front of the body.
• Heart Rate Hormones, fluid shifts, and extra
  weight put more pressure on the heart to pump.

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Exercise Cautions in Pregnancy

• Dizziness or faintness
• Increased shortness of breath
• Chest pain
• Calf pain or swelling
• Severe headache
• Vaginal bleeding
• Uterine contractions that continue after rest

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Postpartum/Interconception

• Weight gain in pregnancy
• Weight retention postpartum
• Physical activity limitations/barriers
• Breast-feeding

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Postpartum Changes

• Post delivery reflex
• Body fluid shifts
• Fatigue
• Family relationships
• Hormone adjustments
• Infant attention
• Stress/Depression

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Grace Period

• Dieting and rigorous exercise should not start
  before six weeks postpartum.
• Breast-feeding women
• Pregnancy complications

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Successful Postpartum Programs

• Start with pregnant women
• Individualized plan for nutrition/exercise
• Group support and encouragement
• Team approach

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Promoting Healthy Weight forWomen of
Reproductive Age

• Florida was one of 8 states awarded to
  participate in a collaborative sponsored by
  AMCHP/City MatCH.
• Team consist of members representing
• Florida Department of Health
• Orange County Health Department
• Duval County Health Department
• Leon County Health Department

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Key Points to Remember

• Root of obesity is multi-factorial
• Be sensitive in your approach
• Be supportive
• Empower women to take an active role towards
  change
• Know your community resources
• Utilize a team approach

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• Thank You