"Pregnant, obese...and in danger"

[CTyankee]

"ONE recent night on my delivery shift, eight out of 10 of my laboring patients were too heavy, with two weighing over 300 pounds.

Over two-thirds of adults and about one-third of children in America now are overweight or obese. An obese pregnant woman is more likely to have a very large baby, weighing roughly nine pounds or more. And babies of obese mothers are more likely to grow up to become overweight or obese themselves.

Maternal obesity causes more immediate problems as well. Obese pregnant patients are more likely to have elevated blood pressure, gestational diabetes and babies with birth complications. They are more likely to need cesareans. And they are more likely to have serious complications from the surgery, such as infections, hernias or life-threatening bleeding.

Early that night on the ward, we had a patient with a “shoulder dystocia” — a scary situation in which the baby’s head delivers, but the shoulders are too big to pass through the birth canal. Shoulder dystocia is strongly associated with obesity and excess maternal weight gain during pregnancy, and can lead to permanent fetal injury, neurological disorders and even death."


Link to article here http://www.nytimes.com/2015/03/29/opinion/sunday/pregnant-obese-and-in-danger.html?ref=opinion&_r=0


Very sensitive and caring view from an obstetrician who has dealt with this health issue. With so much fat shaming in our culture, it can be a difficult line for a doctor to walk. I can see how obese patients can feel conflicted during their pregnancies. My experience with a co-worker who was obese and carried two pregnancies successfully to term and gave birth to two very healthy and beautiful kids was a joy. She was also one of the most radiantly beautiful women I have known.

[hlthe2b]

1. Major problem... as is the incredible increase in risk for major surgery of all types in the obese.

I don't think most people realize how much it increases their risk of complications or failure to survive even elective surgery.

[CTyankee]

2. My friend was young and extremely healthy (as she still is) when she gave

birth. But she has gotten heavier as she gets older. I worry about her.

[Snotcicles]

3. Although the first novel diet drug in over a decade has been FDA approved and has been having good

results, many insurance companies won't cover diet drugs.

[hlthe2b]

4. I think it is a result of our "blame" society... Some refuse to look at it as a medical issue,

rather than a mere "self-restraint" issue.

[Snotcicles]

6. You are absolutely right. IMO nt

[Freddie]

7. Which drug is that?

Thanks!
20 years ago I lost 60 lbs. with phen-fen. Naturally, it's fatal.

[ND-Dem]

35. the last one i remember well was fen-phen/redux; that had good results too -- until it didn't.

an acquaintance of mine is permanently disabled from that crap.

and still overweight. but now she can no longer even exercise.

[LeftyMom]

5. Some birth control methods are less effective if one is overweight.

And fully half of all pregnancies in our country are unplanned.

One way to get women in better shape (be that physical, emotional or financial) for their pregnancy is to make sure all women have access to reliable and affordable contraception.

[Runningdawg]

8. OBGYN

are starting not to accept patients who are overweight before pregnancy or who gain more than 25 lbs during pregnancy. But hey, lets blame the fat women for killing their children.

[CTyankee]

9. It's depressing.

I wish we as a culture could concentrate on finding some medical help for people who are obese. They've been shamed their entire lives for what can be an eating disorder. If it is a question of getting the right foods, that should be helped by providing affordable healthy food (and stop subsidizing unhealthy food). Some people can't lose the weight even if they eat healthy.

I heard Chris Christie blaming his poor diet for his obesity. Typical Republican "I overate so it's all your fault if you are fat, too." He's always a major pain in the ass.

[laundry_queen]

10. That's horrible. Also fat phobia causes some of the problems

I had an OB with my first child that was so scared shitless that I was overweight, that he interfered so much that he caused many of the problems he was dreading. He was convinced my baby was 12 lbs at 37 weeks and tried many ways to induce me short of giving me an oxytocin drip. When one of those methods finally took at 40 weeks, after 30 hours of labor he freaked out it was taking so long and gave me a c-section. Baby was 6.5 lbs. Not 12.

He was also so convinced that I would have gestational diabetes that even though I passed 2 screenings, he kept sending me for screenings. Now, generally, a woman's blood sugar does climb steadily during pregnancy. It's why the screening is supposed to be done at 24 weeks. But my doctor sent me every 3 weeks for screenings starting at 20 weeks until, not surprisingly, I failed at 34 weeks. He then sent me for further testing and even thought THAT was borderline normal, he officially stated I had gestational diabetes and decided I needed to document everything. I was a first time mom and terrified. He told me about all the awful things that would happen now that I had GD. I had to test my blood sugar 8 times a day and he wanted me to keep it below 5 after a meal (not sure what that is in US measurements) when most women with GD are able to keep it between 6-7. I kept it pretty low, but if I had 1 reading that was too high for him (5.8 was high for him) he accused me of not being compliant.

At any rate, when my baby was born at 6.5 lbs, not 12 lbs, I think he knew he had overreacted. He dismissed me as a patient when I started asking questions.

My second child I had a different doctor. I wasn't diagnosed with GD at all, and I went on to have a normal labor and delivery - no c-section. And another smallish baby. (7lbs even).

My first doctor, I know now, caused my crappy delivery and c-section because I was fat. So perhaps a lot of these bad outcomes happen because doctors are implementing interventions based on their prejudices. Not saying all outcomes are because of that, but it wouldn't surprise me if a large percentage were due to doctor's opinions on fat women. My second doctor told me he hadn't seen that being fat caused horrible outcomes or anything and told me he would treat me like any other woman. And he did. And I had a much better outcome.

[REP]

11. My mother was 5'6" and 108lbs when she had her first child

He weighed 10lbs, 6oz at birth. She did not have gestational diabetes. I was her smallest one at 8lbs, 8oz.

Some women have big babies.

But if show up with a broken arm and be an overweight woman, well, maybe better diet and exercise would have prevented that

[laundry_queen]

18. omg I can relate

about the whole broken arm thing. BTDT with doctors and my parents. So many times.

My grandmother was tiny when she had her first baby - she was 90 lbs, 4'11". Her baby was 9 lbs. No GD at all. She went on to have 8 babies, most around 10 lbs. The smallest was 8 lbs 6 oz.

I agree some women just have big babies. Heck, my own mother had smaller babies than her mom, and she was taller but thin still. I was the fatty, and with the exception of my 3rd baby who was 2.5 weeks overdue, I had smaller babies than my own mother. So, in our family the larger you get, the smaller the babies get, lol.

[LeftyMom]

33. I'm not even sure what my kid weighed at birth- the hospital falsified the record.

Seriously, my mother was looking while he was being weighed and saw that the scale that the first digit on the scale was a one. The records say 8 lbs 5 oz. He was 24" long and all fat rolls, so that clearly wasn't even close to correct.

In any case, at his first pediatrician visit on his third day of life he weighed in at thirteen pounds even, and my milk hadn't even come in yet, so I'm sure he hadn't put on over a pound a day.

I'm tiny but I put on 45 effing pounds while pregnant and had a totally healthy pregnancy and a long first stage but an otherwise uneventful labor and a healthy kid. I think they fudged his weight because my weight gain, his weight and my being postdates looked a lot like gestational diabetes and whoever looks over their data might have raised an eyebrow.

My family just has a long history of tiny women having enormous babies. I'm fortunate my care provider didn't freak out over my weight gain or the size of my kid, but it concerns me that doctors would put women on a strict pregnancy weight limit without taking into account their usual patterns (if this isn't their first) or their family history. I can't imagine how I could have possibly gained twenty pounds less than I did and had the same healthy kid.

[REP]

57. These pregnancy weight gain limits are fairly new

And by "new," I can remember when they became a thing because I remember my mother talking about what a stupid idea that is to try to limit the weight difference during pregnancy to 15-20 pounds. For some women, that may be perfectly reasonable and result in a baby with a healthy birth weight, but it doesn't seem like a good way to ensure a healthy pregnancy with a good outcome for mother and child.

Maybe one day the care of pregnant women will be concentrated on the best possible outcomes for women and their children and not the convenience of doctors and current fads.

[LeftyMom]

67. It's defensive medicine:

If a doctor's demands are unreasonable enough that no woman is fully compliant, then every woman is a non-compliant patient and the doctor has a ready defense in any malpractice case.

[CTyankee]

12. the great thing about this article is that it talks about the medical issues involved.

There is good science behind it, not personal antipathy to overweight women.

I think this is a plea to stick with good science and not go with cultural fat phobia. I don't believe that the OB who wrote this piece is anything like the doc you had to deal with...

[laundry_queen]

16. The article is full of fat phobia

if you can't see it you must not have ever been obese and had a baby. I know a lot about both, and I know a ton about birth, and I know that doctors, ESPECIALLY fat phobic doctors, cause a lot of the problems they see.

YES, there are certain risks to being obese and pregnant. It's harder on your heart, labor may not be as efficient due to fatty tissue, babies may be bigger. However, fat women can and do have normal, healthy pregnancies, births and babies all the time. *IF* doctors believe that a fat woman needs to be treated 'differently' from the start they are more likely to intervene when they don't have to (like my doctor who was petrified about gestational diabetes). In the article it mentions shoulder dystocia. This is a problem that can be tied to larger women because they naturally have larger babies, but it's also a big problem due to how women are 'managed' in labor - tied up to fetal heart rate leads, ivs, BP monitors, etc. One of the best ways to resolve shoulder dystocia is to get the mother to turn onto her hands and knees. A larger women hooked up to 10 different wires and tubes is going to be less likely to be able to move. However, she's also more likely to be hooked up to those things because a doctor is worried about her fatness and feels the need to 'manage' her labor more closely. See where I'm going with this? You may think the article is full of science, and I'm telling you there are phrases in there that are indicative of the doctor's POV on fat women (as an obese woman, I've heard these words before) and that have nothing to do with science.

Some things in the article I agree with - yes, labor suites should be equipped with equipment needed for larger women. Even though I'm not as large as the women in the article, my last c-section (scheduled for reasons having nothing to do with my weight) I was uncomfortable beyond belief as the operating table was quite narrow and I felt like I was constantly about to fall off. A wider table would've been better.

I think some people, including this doctor, have so many prejudices against fat women that they think they are being sensitive and non-judgmental but they really aren't. They just can't see their own biases.

[CTyankee]

20. I had my babies when I was 5'6" and weighed 130 lbs. and I was in my early 20s.

There wasn't much in the way of obese pregnant women in those days that I saw. I had one obese friend with a couple of kids (she didn't mention any issues with pregnancy) but that was all.

Now we see this as a health issue and I wonder what happened. How is this a phenomena? I look at this article and I see the doctor is looking at outcomes and talking and I see you questioning those findings. I am confused. It does not seem to me that she is being judgmental so I wonder what is missing here. She is giving us clinical data and you are questioning it. Which is fine, but I can't seem to find the truth in all this...are her findings about obesity in pregnancy false? Please clarify.

[laundry_queen]

25. I will try this point by point

I don't know if it will make it any clearer for you, because it IS difficult to understand the 'catch words' if you haven't been in that position. Not all my issues are with fat shaming, but the whole article does have an undercurrent of blame and I don't agree the doctor is giving strictly 'clinical data'.

First - the title of the article - "Pregnant, obese and in danger". It's a generalization. Not all obese women are unhealthy enough to be in danger while pregnant. Most aren't in danger while pregnant. Can you imagine if the title was "Pregnant, type 1 diabetic and in danger"? Or "Pregnant, Old and in danger"? How about "Pregnant, little person and in danger"? It sounds like hyperbole to me. Yes, some of those conditions are choices and some aren't. However, women can choose to be pregnant or not. Can you imagine the outrage if there was the same headline with "Old" in the title?

Also, the term "more likely to" is used numerous times in the article. "more likely" is meaningless in a scientific sense. Same with "twice as likely". So, if 1 in 100 thin women get it and 2 in 100 fat women get it, are fat women now 'in danger'. KWIM? Numbers are more useful in this case. Something like (these are made up btw) "5% of thin women get high blood pressure needing treatment during pregnancy, but that jumps to 45% in obese women" is far more accurate and helpful. The only reason this probably wasn't used is because the differences, when put into numbers, are less scary and thus don't make as convincing of an argument. "3% of thin women get pre-eclampsia and 9% of obese women" does not sound as scary as "three times more likely". Interestingly, smoking reduces the incidence of pre-eclampsia (one of the reasons the rates are going up - less pregnant women smoking) but I don't see anyone urging pregnant women to smoke.

Then there is talk of shoulder dystocia, again talking about how it is 'more common' in obese women. But there is no resolution to that paragraph. Again, we are not told how big of a difference 'more common' is. I learned in some midwifery courses that doctors yanking on heads can cause some cases of SD. Doctors often panic and tug (ever watch "A Birth Story" on TLC? You'll see it there). Most doctors won't, mind you, but there are those who graduated at the bottom of their class. And they are more likely to panic if they are fat phobic and have it in their head that fat women are going to inevitably have SD.

The whole pre-eclampsia part made me angry - the patient wasn't monitored carefully enough while she was being induced, obviously. At any rate, blaming being unable to intubate etc on her obesity instead of the preeclampsia (have you ever seen swelling with that? it's unreal. Likely it was the swelling NOT the obesity) - or that the ultrasound couldn't see the baby is ridiculous. With my 3rd pregnancy I gained an amazing amount of weight (and yes, that child was heavier, and the reason I gained weight was I had 24 hour a day morning sickness that only felt better if I ate something every 30 min or so) and I would've been only 20 or 30 lbs lighter than the woman in the article when I went and had several ultrasounds. There was zero issue with seeing the fetus. I still have the pictures, including the picture of the 4 chambers of the heart. Seriously, I question the veracity of this story if the doctor cannot see a fetus on ultrasound and blames it on the patient's weight.


"Notably, those who were told were more likely to have tried losing weight." Were they successful at losing weight? This paragraph is quite meaningless because it assumes that if only fat people know they are fat, they will then diet which then will result in weight loss. That's not how it works in reality. Also, the author talks about 'managing' obesity the same way as high BP And diabetes. I agree with that but probably not in the same way the author means it. Managing obesity is NOT the same as the other 2 issues. There is no medication for obesity as there is for the other 2 conditions. Obesity is far more multi-faceted and involves emotional issues that require therapy in many cases. As well, obesity treatments, short of getting a gastric by-pass, are not covered by insurance. That makes it costly. And treatments for obesity require lots of free time - something most people in the modern world do not have.

You know, just like it's hard for me to explain how my seemingly lovely mother manipulates and insults me when to outsides it looks like she is just a loving, caring person who wants to help, it's hard for me to explain the fat shaming in this article. It's partially in the tone, but it's how random non-facts are interjected in order to make the births in the article seem even more scary and that it's all because of obesity. The underlying premise is that these women can choose to not be fat, and by not choosing to lose weight they are a danger to their children.

While it CAN be a health issue, I think that the risks are highly exaggerated. Many years ago, when I was having my first child at age 22, there was a HUGE big deal about 'geriatric pregnancy' aka pregnancy over 35 and how there were HUGE risks, and how it would tax the health system to the breaking point...and so on. Women went forward having babies later in life and it was realized that most older women have healthy pregnancies and babies and that the dangers had been overblown. I see that happening here as well. While super obesity (which the article was mostly talking about, not 'regular' obesity) can cause some issues, the overlying panic and fear will no doubt cause more problems than it is solving. I'll never forget the story of the 42 year old woman going in for an amniocentesis because her doctor urged her to because of her advanced age. She lost her baby due to an infection caused by the amnio needle and her baby's genetics deemed the lost baby 'healthy' genetically. My aunt and 2 cousins had heard that story, and all 3 had their first babies at age 38 and went on to have more children even later and none chose amnios and none had any issues at all. Had they been to doctors that pushed them into interventions because of their ages, outcomes may have been different. Doctors also generally don't blame older women for waiting to have children and thus putting their kids in danger, but that's what the article says about obese women. I find that offensive.

I hope I've been able to make myself clear - it's not always easy to explain something that becomes intuitive when you face it every day. Being discriminated against means I can pick up things that others can't see (and sometimes, yes, I can see things that may not be there due to past experiences) so not everyone is going to see it the same way.

[ND-Dem]

36. 1 in 100 and 2 in 100 are percentages: 1% and 2%. So not sure why you think

something like "5% of thin women....jumps to 45% in obese women" is a "far more accurate and helpful" use of numbers.

[laundry_queen]

44. huh?

I'm pointing out the use of 'twice as likely' can mean 1 or 2 percent which is not a large difference, not large enough to scare people. I'm saying using words instead of percentages can make a small risk look larger. Percentages/or numbers are more helpful than 'more common' or 'more likely' etc.

[kcr]

41. I agree with you. The article started right off with a personal anecdote for one thing.

Because that's science. Another article from a fat phobic doctor.

[CTyankee]

46. In the early 60s when I was having my 3 kids, I was told to only gain 20 libs

in my pregnancies because it would be harder for me to shed more than that after giving birth. I remember crying at night from hunger pangs. Obviously my body was telling me something. But breast feeding took the weight off very quickly (and also I smoked back then because docs didn't look at smoking the way they do today).

Then the pendulum swung back and women were told to go ahead and gain more than 20 lbs. Women were gaining a lot more weight each pregnancy. And older moms found it harder than younger ones to shed the weight after.

I think we're now somewhere in between the two extremes and look upon both anorexia/bulemia and extreme overeating as eating disorders. And the stories were coming out in the media of people having those disorders. Frank Bruni of the NYT was one. He was obese as a kid and then became bulemic in college. He wrote about it and was on TV shows talking about his disorder and how he finally made his peace with food. I found it very moving.

Maybe because I am now in my 70s I am not being told by my doctors that I should lose weight, altho I am 30 lbs. heavier now. Maybe they "give up" once you get to a certain age...

[Manifestor_of_Light]

27. Pelvic bone structure is separate from obesity.

Your bone structure is not going to be changed by obesity.

The hole in the mother's pelvis has to be 4 inches (10 cm) in diameter or the baby's head is too big to come out. Shoulder dystocia is an indication that the hole in the mother's pelvis is too small. I am too small to have a vaginal delivery because I have a normal pelvis, but I'm just a small person. I had my one child by C-section which was planned because my doctor was smart enough to figure this out before I went into labor. In the old days I would have died without question. I had no dilation and no dropping. My kid was eight pounds, which I thought was huge.

Some midwives think that all babies can be rotated so they will come out vaginally, but that is not true. My kid was jammed in a diagonal lie. Some people do not believe me. It's not how tall you are or how much you weigh--it's how wide your pelvis is and the size of the hole.

Obesity relates to this as far as gestational diabetes making the baby larger than normal. A certain percentage of women have to have a C-section or they will die due to the size of the baby. I was one of them.

[Spacemom]

54. I had the same problem

With my second child. I was overweight and the doctor was certain I was having a huge baby. Even though I only gained 14 pounds the entire pregnancy. Where was this huge baby? This was 15 years ago, and maternity was paid as one lump sum to doc for all care and deliverly. When I called my insurance to see about changing docs, they said they wouldn't pay for a new doc. I cried for days because I didn't trust the doc I had.

He insisted to be induced 2 weeks early. I was no where near ready to have this baby. Kept pumping me full of pitocin, to the point that the nurses refused to increase the dose anymore and made the doc do it. Horrible labor. Finally delivered a huge 6lb 10oz baby.

[laundry_queen]

71. ugh. So sorry you had to go through that too.

Unreal the power those doctors have over us when we are vulnerable and pregnant. I could go on a feminist rant here, but I'll leave that to another thread, for some other time

[Bettie]

55. I've been pregnant 7 times

Full term intra partum birth was my first, due to a variety of things, none of which had to do with my weight. Mostly, it was due to a doctor who didn't answer a page and caused my emergency c-section to be delayed by nearly half an hour.

In any case, with 3 miscarriages were in there, I have three healthy boys, all delivered after pretty much textbook pregnancies even with my weight and "Advanced Maternal Age" with the last two.

However, fat phobia did almost cause me to die after the birth of my youngest.

I gave birth to him via c-section and was recovering well, until my second day in the hospital. I began to swell up. My blood pressure went up to the 120/80 range, which was really high for me.

I couldn't breathe when I lay down, I could barely breathe when I stood up.

They released me with the explanation that I'd be fine if i just worked on losing some weight after my release.

The next day, I started having visual disturbances (clouds of glowing fireflies that would come and go). Still couldn't breathe.

Husband took me to the ER where I spent over 10 hours with my 5 day old baby while they explained to me that I was having heart failure because of my weight. They checked for all sorts of things (including drugs) but never once called my OB even though I requested it multiple times. With every stage of testing, someone told me my weight was killing me.

They sent me home with a diuretic and some antibiotics (I had gained a nasty upper respiratory infection during my hospital stay...baby had it too) and told my husband to prepare for me to die of heart failure because of my weight (literally, that is what they told him).

Next morning, I began to see lights in my peripheral vision and had a terrible headache. I was more swollen than before, even with the water pills they had given me.

I had a seizure in my living room. Turns out I had post partum eclampsia. It is very uncommon, but happens.

If they had called my OB office, it would have been obvious to them, had I been thin, it would have been obvious, but because I was fat, there were assumptions made all along the line that nearly killed me.

Those assumptions kill.

[laundry_queen]

72. Dear god

that is horrible what you had to go through, but I can't say I'm surprised at the fat phobia being used to dismiss something more serious. (well, I AM surprised no one even thought of post partum eclampsia. DUH! I've taken enough courses on birth to know that is always the first possibility when a woman's BP goes up post partum. ugh! I'm so angry for you.)

I agree those assumptions kill. I'm glad you made it through.

[daredtowork]

13. Fat Shaming Doctors

The real problem is doctors who treat obesity as a matter of patients "failing to realize" the problem. Some specialists won't see obese patients. Some will only do procedures if patients lose X amount of weight first: as if all the patient needed before now is the right incentive.

The ironic thing is that once obesity is a matter of fact, health problems contribute to difficulty in losing weight. Patients with mobility problems may not be able to exercise enough. Patients with cardiac problems may not be able to "work up a sweat". Patients with fatigue may continually reach for high energy foods.

I'm personally a believer in hormonal/brain chemistry theories of weight as well. I was on a medication regime that put me in a state of anorexia for about a month last year: absolutely not hungry. Thus I'm thinking that people who want or need to lose weight can be put in a similar state without having to go through "stomach stapling" procedures.

So, in short, doctors STFU about how patients "need to lose weight" and stop "incentivizing" them when they've been trying for years but have obvious obstacles that get in the way. Instead, all forms of insurance should pay for the medications that hormonally induce appetite control and mobility issues should be addressed up front without waiting for patients to "lose weight first" - that may never happen! Doctors should do their job and *help* patients lose weight.

[CTyankee]

14. I wish medication could help but I don't think we are there yet.

Perhaps people can't be put in a healthy weight state, not anorexic? I really don't know...

Also some obese people do overeat but some do not so nobody can judge exactly what's going on. Then we get into eating disorder issues. They are as important to the obese as they are to the anorexic, only our culture won't accept that...

And I see your point about waiting for patients to lose weight first. But the pregnant obese patient needs care now, not later, and that is the dilemma that the doctor is addressing.

[daredtowork]

61. To clarify - I don't think induced anorexia is the answer

I was just giving that example to say I know that it's possible to work with medications instead of surgery to deal with weight loss and insurance should fun that. Taxpayers screaming about dealing with the results of eating disorders on the anorexic side wouldn't be a pretty picture either.

Also, I appreciate that many weight problems are a factor of exercise rather than diet, especially for disabled people. Doctors should drop the "exercise" part of the speech ("you should...&quot and instead frame it more as "are there any health problems that inhibit you from getting exercise...". The doctor's job is to fix those health problems, not to lecture the patient on things they may not be able to do for appointment after appointment.

Above all, doctors shouldn't make assumptions about diet or exercise. They should also probably drop the word "compliance" from their vocabulary all together as well - it doesn't dovetail with patient dignity.

[CTyankee]

62. Yeah, I hate "compliance." It actually sounds threatening. There should be a

friendlier atmosphere to talk about these issues. Patient dignity is the way to go. It engenders trust and trust engenders willingness to try to solve the problem. It is terrible that obesity can be such a lifelong burden on people.

[joshcryer]

15. Doctors not speaking up is the issue.

I was shocked to learn Penn Jillette lost a pound of weight every day over a period of a few months.

People on his podcast were astounded, and he basically admitted that he didn't know it was a health problem.

He was on a half dozen of high blood pressure medications, the doc told him if he lost 20 lbs he'd be able to reduce it to a couple of pills. Penn asked what if he lost 50 lbs and the doc said he might not need any pills! He was shocked and didn't realize the weight was the problem, because the doctor didn't out and say it.

Listen to episode 158 about 40 mins in: http://pennsundayschool.com/episodes/

[daredtowork]

58. I'm willing to bet this is the exception

I worked in healthcare at one point, and doctors were sick to death of using up their short appointment time giving the "diet and exercise" speech. They were frustrated because they didn't see their patients "complying" with their speech.

The thing is the patients usually can't comply with mere speech unless the doctor can also listen to what the patient is saying about what makes them obese. Unfortunately the picture is usually more complicated than mere medical problems - the patient's entire environment is a factor. While the doctor can't be blamed for this, the doctor should attribute this to the patient not "complying" with their "speech" either. Instead, they should try their best to LISTEN to the patient, who knows best what is going on, and attempt to work with the patient to make losing weight feasible.

[eridani]

17. 10,000 years ago, those women would have been the only women in the tribe--

--able to give birth to normal-sized infants during times of famine. That's why insulin resistance is so widespread among the population, despite the fact that it is so harmful in a society where there is enough to eat most of the time.

[CTyankee]

21. Wow, that is interesting! I had no idea. I thought our cave people were rather

lean, having to rely of an ineffecient delivery system of protein...

[eridani]

24. I'm talking the genetics behind insulin resistance

If you had to chase your uncertain food supply, you wouldn't gain huge amounts of weight even if insulin resistant. Not to mention which, you would most likely die of something else well before insulin resistance resulted in lack of blood sugar control.

The following is a quote from an article in the New York Review of Books "Godot Comes to Sarajevo" (Vol XL #17, pp 52-59, October 21, 1993) by Susan Sontag. She went there to put on the play "Waiting for Godot" when Sarajevo was under daily bombardment--people wanted artistic diversion as much as they wanted food. The quote is an aside from the main topic.

"The only actor who seemed to have normal stamina was the oldest member of the cast. Ines Fancovic, who is 68. Still a stout woman, she has lost more than 60 pounds since the beginning of the siege, and this may have accounted for her remarkable energy. The other actors were visibly underweight and tired easily. Lucky must stand motionless through most of his long scene but never sets down the heavy bag he carries. Atko, who plays him (and now weighs no more than 100 pounds) asked me to excuse him if he occasionally rested his empty suitcase on the floor throughout the rehearsal period. Whenever I halted the run-through for a few minutes to change a movement or a line reading, all the actors, with the exception of Ines, would instantly lie down on the stage.

"Another symptom of fatigue: the actors were slower to mem- orize their lines than any I have ever worked with. Ten days before the opening they still needed to consult their scripts, and were not word-perfect until the day before the dress rehearsal."

It's pretty obvious to me that Ines was energetic not because of weight loss, but because she had the weight to lose. Note that she is still fat after having endured famine conditions for a couple of years. It seems to have been much easier for her to tolerate going from 300# to 240# (my guess) than for Atko to go from 160# to 100#.

This is a good illustration of why people are fat--more of their ancestors than usual had to withstand conditions like this. It pays to have at least a few people in every society who are still mentally alert and physically capable under high stress conditions that make every one else temporarily weak and stupid, even if they are disadvantaged when times are good. (Think sickle cell anemia and malaria resistance.)

If you have a metabolism like Ines, the only hope for coming close to "normal" weight is a lifetime commitment to recreating famine conditions, and for some people even that isn't going to work. Society in general seems to think that fat people ought to be required to live under a lifelong state of siege, even though they, like most people, would rather have a real life.

[haikugal]

29. This is what I tell my son...

Our ancestors were survivors and insulin resistance was part of it. We are what is known in the horse world as easy keepers...we are very efficient and short of starvation (we already don't use sugar and I can't have gluten or casein so no bread or cheese) and hard labor we carry extra weight. I also am not able to walk or work up a sweat...so I'm not as thin as I once was. Still, I appreciate you bringing this information to the discussion.

I have old style Morgan horses...the equine easy keepers...and they have a tendency to Cushings. Just an aside, I'm familiar with this in many ways.

[eridani]

38. All too many other people notice stuff like that about horse breeds--

--but think that the same thing can't possibly apply to people

[haikugal]

40. My mare

Is never fed sweet feed or anything approaching 'horse hay'..she gets what cows eat and low sugar beet pulp pellets in winter, nothing but pasture in summer with a taste of pellets to keep her sweet...and she gets fat.

It's the same thing as we deal with. Back when horses were so important to us they were highly valued for their ability to be so efficient. She's not ridden anymore so she's my little butterball.

It's exactly the same as people and not recognized, you're so right.

[TexasMommaWithAHat]

52. Yeah, but a 240 pound, 5'4" woman was not likely to move very fast, either

And with shorter lifespans, she may have never gotten to the point where she needed a hip replacement and knee replacement.

[eridani]

65. As a specialist in gathering, she didn't have to run

Venus of Willendorf, dated 30,000-25,000 BC

[malaise]

19. I seriously don't know how

countries are going to deal with obesity, but it is a major drain on health services.
All the junk food should be taxed heavily

[laundry_queen]

22. Conversely

healthy food should be subsidized. And people work too much - stress leads to weight gain, lack of free time means little time to exercise. I'm a single parent of 4 and I have hardly anytime to exercise. I'm gone from the house 10.5 hours a day (thanks to a long commute) and I still have to cook, clean, get the laundry done, help the kids with their homework, sign permission slips, read 20 emails from their schools/teachers/coaches, go online to pay for whatever stupid field trip they are doing now, baths, stories, bedtime. My work has very little provisions for time off. I try to walk at work during lunch, but weather can be crappy. Still I manage to walk for 30 min at least 3-4 times a week.

Anyhow, people need more realistic work hours, more affordable healthy foods and mental health support if we are really serious about this. I doubt many are - it's easier to blame than to come up with solutions.

[CTyankee]

23. I agree with that!

Healthy food should definitely be subsidized and people do work too much. it's a vicious circle. When I was still working I had to force myself to leave the office and get to the gym for my workout each evening. Fortunately, it worked out OK. I credit my nearly 20 years with Jazzercise with my health today. It was fun and it was dancing and I loved to dance!

But I do think the doc who wrote this is trying to come up with an answer. I don't agree that she is fat shaming at all. She just wants women to have healthy pregnancy and birth outcomes. Don't we all?

[LeftyMom]

34. The article struck me as fat shaming,

and for the record I'm not fat.



There are a lot of things that can make for a more difficult pregnancy: weight (too much or not enough,) age (too old or too young,) fertility (pregnancies resulting from fertility drugs can be higher risk, many infertility problems also result in issues with maintaining the pregnancy once it occurs,) genetic factors, any number of health problems including very minor ones, overall build and muscle tone, previous medical history including accidents and other trauma, drugs the mother takes and even some drugs the grandmother took while pregnant with the mother that can cause reproductive tract problems, fetal anomalies that pop up at random or run in families... That's not even considering external factors like money, work conditions, family situation, stress level.

Long story short we all have some risk factors. We can control some things, at least in an ideal situation where a pregnancy is planned and wanted, but the idea that women need to reinvent themselves or their bodies to become worthy mothers is strange at best. edit: Especially because reversing obesity is a multi-year project and delaying pregnancy can carry it's own significant risks.

It's also important to remember that for working class women dedicated time to exercise is often a luxury they simply can not afford and that the proposed "free" alternatives may be impractical or dangerous. Likewise access to healthy food is not a given in this country.

[CTyankee]

47. Because I got "scared straight" due to eating high sodium prepared foods last

year which sent my blood pressure skyrocketing (and landing me in the hospital overnight for testing), I am now on a very low sodium diet. I know the sodium milligrams of everything I put in my mouth and do a rough estimate on how many milligrams I am eating each day. As a result, I tend to eat fresher foods and prepare them with as little sodium as possible. It's a way of life now. I try to keep to about 950 mg of sodium a day. And it's easier to eat low sodium in the summer when I can get fresh grown food than in the winter. I must say we are eating better in our household as a result and my last bp reading was normal.

[KittyWampus]

53. Is talking about the dangers involved in smoking cigarettes "Tobacco Shaming"?

And if you have a computer- all you have to do is search for professional free Youtube "Walking Videos" you can do in 15 minutes at home, in the office. Heck, I even do them standing in line at the store.

And for most people, access to healthy food is a matter of choice. There is a small segment of us who live in food deserts. But most people CHOOSE crap food due to habit, emotional issues, ignorance or whatever.

Just check out threads on DU about food. Many, many people have chosen to like crap food or have decided it's what they prefer. Because it's such a habit, any discussions on changing diet ends up making many people feel threatened.

[LeftyMom]

68. Why the hell are you taking that tone with me?

I'm a healthy size, I'm active and I'll bet you cash money I eat better than you do. I don't need and didn't ask for a lecture. My pointing out that there are complicating factors was not an invitation for a complete stranger to suggest a workout regimen. If I have a question about my diet or need for physical activity I'll ask an expert (conveniently enough I have one on speed dial for entirely unrelated reasons.)

Christ Almighty, how do fat people put up with that "well meaning" passive aggressive scolding?

[haikugal]

30. Absolutely!

You tell them LQ. Damn girl

[malaise]

42. I agree that people should have time to exercise

We walk at least 20K a week

[KittyWampus]

48. going to tuck this in right here- look into Leslie Sansone's walking exercise dvd's. Many on Youtube

You can get them free on Youtube. Some only 15 minutes. It's literally walking in place to a set pace using music to help you keep the pace and gives you the distance equivalent as if you were walking outside. 15 minutes = 1 mile.

The movements can be limited to "in place" if you are in a cubicle.

Walking in place, stepping side to side, front kicks, back kicks. You can add leg weights and/or hand weights for added resistance.

Even if it's not for weight loss or maintenance, it's good for heart health AND knee health. Aerobic exercise is also good for mental health.

It's very low impact but reaps great rewards.

I think it should be mandated that every workplace has the option to take one 20 minute break for EXERCISE as well as one break for food.

[snooper2]

56. no, people need to get off their ass and stop watching tv and using elevators

even 30 years ago people weren't as fat as they are these days-

It isn't all food...or work...the meme "fat lazy americans" exist for a reason-


Had a sleepover this weekend and my daughter (5) wanted to treck through the woods behind a park near our house. Had to drag one kid off the PS3 and say look, it is beautiful outside, lets get going! And he is already chubby at 9 years old...

Parents that have obese 5 year olds that look like they have breasts already should be monitored by the county and have forced routines and exercise classes.

[laundry_queen]

70. disagree

around our area kids and teens are more active than ever. Parents have them in soccer, dance, hockey, baseball, swimming....some kids are in all of them. And even 'fat' kids are in these sports. Our schools discourage junk food - no halloween parties, or Christmas parties with treats...no, parents must bring fruits and vegetables, yogurt and cheese only. And yet there are more fat kids than I was in school, even though they are more active. I don't know about you, but every kid I knew had 'Atari' in their house back then - and they also played it for hours on end. It's nothing new.

30 years ago people weren't as fat because they weren't being fed garbage and your average family could afford healthy food (and had the time to cook it). I remember exactly the percentage of what my parents spent on food when I was a kid, and what I spend on food. Huge difference. My parents, even though they made crappy wages, barely lower middle class, were able to afford a side of beef every year. I can't even afford ground beef once a week. So, I buy fillers - cheap starches. I try to keep it healthy because I know someday soon I'm going to be diabetic so I myself just eat the meat and veggies. My parents loaded up on veggies because they were CHEAP. Not so much anymore. When I started to concentrate on adding more fresh vegetables to our meals (and less grains/starches), my grocery bill went up by $300/month (I do have 4 kids - now I try to grow my own vegetables). And they now put sugar in everything. 30 years ago that wasn't the case. I bought some hot dogs the other day for a campfire and didn't realize until I got home there were 8 grams of sugar per wiener. THERE'S FUCKING SUGAR IN HOT DOGS FER CHRISSAKES. Sure not the most healthy food on earth, my WHY does it need sugar added? WTF? And even in healthier options there's added sugar. In spaghetti/tomato sauce, in whole grain crackers, in yogurt (some yogurts have more sugar than a piece of cake), in peanut/nut butters (did you know Nutella has more sugar than the same amount of FROSTING??), in whole grain bread, in cereal, in oatmeal, in granola bars...need I go on? Every single food that we used to think of as healthy, is now full of sugar. But no, people are lazy.

Can you explain to me why, even when accounting for the weight of the mother, babies are born heavier now than 30 years ago? It's been hypothesized there is something environmental going on. To pass off something as complex as obesity as 'lazy asses' is incredibly short sighted, but not surprising considering the source.

[eridani]

39. On the contrary, obesity and smoking reduce overall health care costs

When fat smokers drop dead at age 50, that is the end of their health care cost to the system.

http://www.nytimes.com/2008/02/05/health/05iht-obese.1.9748884.html

Preventing obesity and smoking can save lives, but it does not save money, according to a new report.

It costs more to care for healthy people who live years longer, according to a Dutch study that counters the common perception that preventing obesity would save governments millions of dollars.

"It was a small surprise," said Pieter van Baal, an economist at the National Institute for Public Health and the Environment in the Netherlands, who led the study. "But it also makes sense. If you live longer, then you cost the health system more."

In a paper published online Monday in the Public Library of Science Medicine journal, Dutch researchers found that the health costs of thin and healthy people in adulthood are more expensive than those of either fat people or smokers.

[malaise]

43. Interesting

Guess they've engineered a 'cost-trimming' way to 'cull' the population

[TexasMommaWithAHat]

49. Statistics, damn statisics, and lies. :)

I see a nephrologist for a neurological defect. The majority of his patients are obese (many severely obese), and most of them are undergoing expensive dialysis mainly due to obesity related diabetes 2. These patients can live for years on this expensive treatment (thankfully).

Knee replacements and hip replacements are more common in the obese patients.

I have about 45 pounds to lose and I am determined to lose it because I don't want to suffer the same diseases. There are numerous complications to obesity, and I'm not going to be blinded by terms like "fat shaming" to my very real risks, while I huff and puff in my self righteousness.

[REP]

59. You may not know why they're there

Let's hope you don't have kidney disease. I am in Stage III kidney failure from primary idiopathic FSGS.

Advanced kidney disease does some delightful things to you. It causes some profound bloating from edema. It causes extreme fatigue. It damages your bones.

Dialysis, by the way, isn't done in the nephrologist's office. It's either done off-site or at the patient's home.

[TexasMommaWithAHat]

63. I'm sorry to hear about your disease.

I have a nuerological kidney defect that is monitored, but I've been fortunate so far.

And, yes, I do know that dialysis is done in a dialysis clinic, generally. My doctor never has morning hours, because he is always at the clinic Monday through Friday in the a.m.

And, yeah, at least half of his patients have diabetes related kidney disease, because he told me so. He's been very encouraging (in the right way) of my weight loss, so I don't find myself in the same situation they are. Most of his patients are African American, and they have a higher incidence of weight-related diabetes.

Peace.

[REP]

64. I wouldn't trust a doctor who violates privacy and HIPAA like that

My nephrologist does not discuss his other patients with me, not even in general terms or use such lazy phrasing as "weight related diabetes." It's generally called Adult-onset or Type II diabetes, and being overweight is not a guarantee one will become diabetic (in fact, research has shown that the cause of the diabetes is also what causes the weight gain, not the other way around).

I'm surprised that so many of his patients are being treated from ESRD from DMII; the leading cause of kidney failure is untreated high blood pressure. I wouldn't be surprised if many of his Black male patients have the same disease I do (only theirs would not be idiopathic).

[TexasMommaWithAHat]

69. He is an excellent doctor

And since I have never been to the clinic, I have no idea who is receiving dialysis or not. And frankly, the discussion was so long ago, I have no idea what phrasing he used; just that he indicated that my weight is a factor leading to poor health (high blood pressure, diabetes, etc.) He diagnosed my condition when two other very reputable doctors did not. I'll stick with the guy who doesn't speak English very well, over those renowned Houston Medical Center doctors.

Best wishes to you.

(BTW, I worked in a hospital lab, and am well aware of HIPAA laws. Should my oncologist make a casual remark about his patients with colon cancer, I'm pretty sure he's not violating any HIPAA laws, either.

[eridani]

66. The "majority of his patients" are the ones still alive

Lots of people with similar conditions are dead and no longer incurring medical costs.

[phylny]

26. I am currently obese - 70-80 pounds overweight.

I just started seeing a doctor who specializes in functional medicine. He views obesity as a disease and we are doing everything from having my stool analyzed to a complete and in-depth blood test to starting an elimination diet tomorrow. Because I'm defeated.

Let me tell you, I've done it all and tried it all, including exercise, dieting, Weight Watchers, Jenny Craig, the weight loss drug Qsymia (did not help me!) and a physician-supervised weight loss program - 800 calories a day with phentermine. I lost weight, but after months and months where I WAS NOT CHEATING and followed the program to the letter, I still had over 30 pounds to lose.

For the first time in my life, I have a physician who is helping me, not blaming me. This is the biggest problem in my life, thank goodness, but it's been horrendous. So now, I have some hope.

[liberal_at_heart]

28. There is still so much we don't know scientifically about why simply dieting and exercising doesn't

work for the majority of over weight people. I hope the science will catch up soon. I am about 30 lbs over weight and am addicted to sugar. I have time periods where I eat healthy and exercise, but it always comes right back to the same old thing especially if I am stressed. I'm even meditating right now, which helps but still doesn't keep me from eating sugar.

[haikugal]

32. Sugar is addicting...

But you probably already know that. If you stop using it you have withdrawal symptoms that can last several days. It's hard. Unless you can afford good food and time to cook from scratch you have to read labels because so much of our food has HFCS.

We have too much stress on top of it all!

[phylny]

37. Interesting you mention meditation, because this doctor is a big advocate

of meditation as part of your routine.

He surmises that the food you crave is the one that gives you inflammation, or that you have an allergy to. He's not some quack - he teaches at the local medical school.

Best of luck to you in your endeavors.

[KittyWampus]

50. liberalatheart- post here if you'd like some good recipes for sweet stuff that are not high glycemic

I have a sweet tooth too and was leptin resistant at one point…

There are ways to make sweet stuff so it's low glycemic and very high in nutrients.

[peace13]

45. My best to you!

I hope your new doctor helps you find an answer! : )

[TexasMommaWithAHat]

51. Good luck!

You are fortunate to have a good doctor, and smart to recognize that obesity is a serious health risk.

I also have weight to lose, and am determined to lose it.

[LiberalAndProud]

60. ((phylny))

I wish for you a long and healthy recovery.