Sidestepping Obesity in Women Having Children

For decades now, we’ve been talking lots about preventing childhood obesity, but not doing much. Could it be that a shift is beginning? Two papers this week tell us this is possible. For too long, we’ve drawn an arbitrary line between obesity treatment and prevention. But the truth is that for women having children, the distinction is absurd. Both of these papers tell us that prevention and treatment of obesity are inseparable for women having children.

Having children puts a mother at risk for obesity that will persist long after pregnancy. A child of a woman with untreated obesity has a much higher risk for obesity.

Obesity Care for Women of Reproductive Age

In JAMA this week, Michelle Ogunwole, Chloe Zera, and Fatima Cody Stanford tell us that healthcare providers are missing an opportunity for women of reproductive age. U.S. obesity guidelines ignore pregnancy history and intention. They do not account for the risk of obesity-related adverse pregnancy outcomes either. This is a big miss because:

1. This is often the lifestage of greatest weight gain.
2. Weight management can reduce adverse pregnancy outcomes.
3. Obesity in the mother predicts metabolic health of the child.

Their recommendation is hardly radical. It is simply to consider pregnancy history and plans in guidelines for obesity. In fact, the new Canadian obesity guidelines already do this. They devote an entire chapter of the guidelines to this. So a good template already exists.

Preventing Transmission to the Next Generation

Katherine Sauder and Natalie Ritchie make a vital point with their new paper in Diabetologia. Obesity care for women having children is vital. Because without it, preventing obesity in the next generation will be difficult or impossible. In fact, good care for the mother can prevent having a baby with excessive weight. The reduction is 20 to 40 percent. Furthermore, such care reduces the risk of excessive weight gain and diabetes for the mother. Clearly a win-win.

But of course, more research is necessary. We need more attention to longer term outcomes – both for mother and child. Scalability is important, too.

All of that will only come when providers and health systems take this challenge seriously. If we’re serious about preventing childhood obesity, we’ll get serious about better obesity care for young women having children.

Click here for the viewpoint in JAMA and here for the review in Diabetologia. Bill Dietz offers further perspective in JAMA on the importance of attention to obesity in young adults here.

Motherhood, painting by Kuzma Petrov-Vodkin / WikiArt

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January 8, 2021