President’s Letter – January 2012

The Obesity Challenge

Our speaker for November 2011 addressed the timely topic of obesity in pregnancy and its impact on mother and child. The statistics on obesity are sobering. Two-thirds of adults and one-quarter of children in the United States are obese or overweight. In the last twenty-five years the prevalence of obesity among U.S. adults has doubled; 33 percent of U.S. adults are overweight (BMI 25- 29), 34 percent are obese (BMI >30), 6 percent are extremely obese (BMI>40).

Obesity has become an important public health concern and remains a risk factor for morbidity and mortality.

The challenge is to devise effective strategies to curb the obesity epidemic. There are numerous projects underway which are trying to
tackle the problem.

In 2009 the CDC initiated the Common Measures for Obesity Prevention Project (“Measures Project”). Their report sets forth comprehensive guidelines aimed at fostering healthy eating and promoting an active lifestyle. The strategies (24 are enumerated) include such things as community involvement in making access to healthy food choices a reality (e.g., local farmers’ markets, supermarkets in underserved neighborhoods, vending machines with fewer sugared beverages and snacks). Initiatives to increase exercise in school and strategies for communities to organize for change are elucidated.
The Measures Project plans to disseminate its strategies and measurement guidelines to local communities and governments throughout the United States. For further details go to the CDC website MMWR July 24, 2009/58(RR07); 1-26. and cdc.gov/Features/halting obesity.

Guidelines and strategies are well intentioned but the implementation of such projects remains a challenge. Money is tight and conflicting interest groups have no desire to change the status quo. Recall Mayor Nutter’s proposal to tax sugared beverages sold at bars and restaurants and the outcry that followed from the beverage and bottling industries. A recent effort to ban the serving of french fries in school cafeterias was overturned when potato growers mounted their attack.

Efforts to curb the obesity epidemic will necessitate more research and education. Currently researchers are involved in studies designed to promote early intervention as a way to reduce the risk of chronic diseases which are linked to obesity. It will be interesting to follow a research project based at the University of Edinburgh, led by Dr. Jane Norman. Her study is a United Kingdom government-sponsored trial that is aimed at changing the intrauterine environment of infants “in order to program the child for a healthier life.” The study hopes to recruit 400 obese pregnant women over the next two years and provide the subjects with an intervention aimed at reducing the risk of obesity developing in the children born to these obese mothers. In this study obese pregnant women who are not diabetic will be given the drug Metformin throughout their pregnancies. The theory put forth is that Metformin will lower maternal blood sugar levels and set the fetuses’ size and metabolism such that they are not predisposed to developing obesity. It will be interesting to see whether or not “imprinting the fetus” in this fashion constitutes a viable strategy to help tackle the obesity dilemma.

It is clear to me that education in the form of counseling can make a difference. As obstetricians we provide pre-conception counseling to our patients. During such a visit we stress the importance of starting pregnancy at a healthy weight. Many women are motivated to change negative behaviors to increase the chance of having a healthy baby. We must point out to our patients the negative effects obesity can have on pregnancy outcomes.

As further evidence that counseling can effect behavioral changes, a study authored by Dr. John Morton, Director of Bariatric Surgery at Stanford
Medical School, and published in the Archives of Surgery on October 17, 2011, showed that nutritional counseling sessions for prospective bariatric patients and their families can have a positive effect on weight loss for the entire family. A year after undergoing a roux-en-y procedure, thirty-five patients recruited in the study lost an average of one hundred pounds and went from a BMI of 48.7 to 33.3 on average. Their spouses and other overweight family members lost an average of ten pounds and saw their BMI’s drop from 38 to 36.3.

To do a good job we must educate ourselves about recent research and current thinking about obesity solutions. How many of us are familiar with the recent U.S.D.A. guidelines released this summer which set forth the daily parameters of a healthy diet – (46 grams of protein/day; 2 – 2 ½ cups vegetables; 1 ½ – 2 cups fruit; 25 grams of fiber; and 1000 grams of calcium)? How many of us know that twenty percent of cancer deaths in women in the United States are linked to obesity?

The Pennsylvania section of ACO G District 3 has launched the “Obesity Project” which is designed to educate practitioners about the negative impact
of obesity on women’s health. Part of the project includes a Grand Rounds presentation which reviews the challenges and risks that obesity poses in all areas of our specialty – gynecologic cancers, infertility, urogynecologic problems, pregnancy, and contraception. Armed with the facts, we can do a better job educating our patients.

The second part of the Obesity Project will be to showcase the programs in area Ob-gyn clinics that are being established to work with obese, pregnant patients and women with polycystic ovarian syndrome in order to improve outcomes. Being informed about these projects and programs will enable us to do a better job counseling our patients and referring them to appropriate centers for care.

To make an impact on the costly endemic that obesity portends for our nation, we must start at the very beginning, keep at it, and empower our patients to take charge of their health.