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FAT & Pregnancy

  • Nov. 6th, 2009 at 8:42 PM
Thoughtful


Talk to me about fat.

Talk to me about obesity.

Is it really an epidemic that's sweeping the nation, as some folks would have it?

Is fat the last "acceptable" prejudice? 

Why do I ask? Well, I was noodling about looking for topics to inspire me for the Wichita Pregnancy Fitness Examiner blog, and I ran across a couple of articles talking about the Institute of Medicine (who?) issuing guideliness on how much an obese woman should gain during her pregnancy.

Instantly all kinds of bells and flags started going off in my head.

For a singleton pregnancy, they recommend 15 - 25 pounds for an overweight woman and 11-20 pounds for an obese woman.

Really? Really, IOM?

Of course, 'overweight' and 'obese' are determined by that old chestnut, the BMI scale, which is CRAP.

It's true that there are health risks in pregnancy if the woman is obese. Obese women are declared to be at greater risk or conditions and situations such as hypertension, gestational diabetes, caesarian section, and postpartum infection.

But non-obese women fall victim to these as well. And I can't help but wonder how many of these instances arise from other causes than the woman's weight. It is so much easier to point fingers at the most visible non-"normative" condition rather than dig deeper.

I found a March of Dimes article from 2004 that quoted Laura Riley, M.D. (Director of Obstetrics & Gynecology Infectious Disease at Massachusetts General Hospital, Boston, and Assistant Professor of Obstetrics & Gynecology and Reproductive Pathology at Harvard Medical School) as saying that in the pregnancies of obese women, the "fetus is at increased risk for neural tube defects, birth trauma, and late fetal death."   And it's still being cited.

Well, that's a hell of a stick to add to the flail that overweight women beat themselves daily with.

You know, I'm of two minds about this.

If folks are so worried about obese women, why not make it easier in this economy to be slimmer? Get the subsidy for fruits and vegetables going rather than the same goddamn Vitamin Wow for the corn farmers (from where we get high fructose corn syrup, which is Satan's sperm, I shit you not). Get some kind of watchdog on junk food advertising to stop the marketing of food as entertainment.

Conversely--the reason for the increased chance of neural tube defects? Not because being fat causes them--it's because due to the inability of ultrasound machines to achieve decent resolution through the body composition, defects are more difficult to detect. So, lazy fucks, build a better ultrasound machine.

The folks who are saying lose weight before you get pregnant are the ones I tend to listen to most. Why? Because this infers that people can and must plan their pregnancies. We have the technology now to decide when we want to be pregnant, or at least to decide when we don't want to be pregnant.  We know what causes this. 

We know what causes quite a bit now.  We can exercise, control our eating habits, and take prescriptions for a lot of things that people once thought were irrevocably locked to the human condition. 

Unfortunately, clear thinking about women, weight, and pregnancy  is not as easily managed.

Comments

( 16 comments — Leave a comment )
[info]jauncourt wrote:
Nov. 7th, 2009 04:16 am (UTC)
Search for information on how it's actually normal and healthy for obese women to LOSE some weight during pregnancy because it raises the metabolism. I LOST 15 lbs between month 0 and month 8 during one pregnancy.
[info]marydell wrote:
Nov. 7th, 2009 05:28 am (UTC)
We went to a training about prenatal drug exposure during our adoption process. One thing we learned is that the March of Dimes says that cocaine use increases the risk of miscarriage, when apparently there's no evidence to support that. The specialist who did the training said they really hate that the MoD says that, because in a small community with a lot of drug users, it becomes obvious that it's a lie. So then women in those communities won't listen to anything the MoD says. But the lie persists, because cocaine use is bad for fetuses (just not as bad as the PTB would like everyone to think).

It sounds like the MoD is pursuing a similar tack in regard to obesity...using the threat of birth defects to encourage changes that might not be related to those specific birth defects. My understanding is that neural tube defects are prevented by taking piles of B vitamins, not by losing weight.

Starting a pregnancy while overweight or obese is fairly common among infertile women, since fertility treatments tend to cause weight gain, and some infertility-causing conditions also cause weight gain (particularly PCOS). Most of the bloggers I read who deal with that don't get the same level of hassling from their docs, since there's an assumption of a high-risk pregnancy going into the process already.
[info]bronx_baroness wrote:
Nov. 7th, 2009 05:30 am (UTC)
I agree with you totally about corn syrup being satans' sperm. It is evil and it's in almost everything.

During my nutrition classes I started severely limiting what products with corn syrup in them were allowed in the house and rearranged just a few things with regards to eating less fat and I lost 32 lbs. John lost almost the same amount. I even felt so much better not having the ever present corn syrup in everything I ate.

And oh yes. I really do believe that people should PLAN their pregnancies. But that's just me.
[info]baronalejandro wrote:
Nov. 7th, 2009 05:30 am (UTC)
A lot of people rail against that old BMI scale, but it's not the source of the trouble.
[info]silk_noir wrote:
Nov. 7th, 2009 02:59 pm (UTC)
No, but it is a PITA.
[info]sparkymonster wrote:
Nov. 7th, 2009 04:54 pm (UTC)
Yes but BMI is used as a bludgeon, a diagnostic tool, and many other things it was never intended to be used for. BMI is a load of horse shit.
[info]evil_fionn wrote:
Nov. 7th, 2009 01:14 pm (UTC)
Just making a comment on one line...
The comment about fruits and vegetables.
I don't think that the issue with society's eating habits are totally having to do with the high cost of fruits and veggies. Yes, I'm sure that's PART of the issue, but not all of it.
I think it also has to do with our addiction to processed, easily prepared food... The key here being that it's FASTER, and most people are so pressed for time that they will, even if they can afford to cook something other than processed crap, choose to do it any way because its faster and easier.
I also have some issues with the attempt for someone else to regulate anyone else's health by limiting activity or purchases. But that's just me.
[info]silk_noir wrote:
Nov. 7th, 2009 02:58 pm (UTC)
You know, you are right about that--we *are* addicted to it--guilty. But I also know I personally have been deterred from buying foods that were healthier jsut because of price. Sucks.

I don't want to limit anyone's activity or purchases. I want to make it just as easy to acquire the healthy stuff as it is the non-healthy stuff.

[info]pickledherring wrote:
Nov. 7th, 2009 01:59 pm (UTC)
Shh. Making sense never got anyone anywhere.


Sigh.
[info]silk_noir wrote:
Nov. 7th, 2009 02:59 pm (UTC)
*snort*
[info]sparkymonster wrote:
Nov. 7th, 2009 04:53 pm (UTC)
Fat is not the last acceptable prejudice. For reals.

Um. I have so much to say about fatphobia and fat acceptance I almost don't know where to start.

First, fat is not a moral issue. Health is not a moral issue.

Second, there is not a way to reliably make a fat person skinny or a skinny person fat. No for reals.

Third, eating delicious healthy fruits and veggies is not something that will make you skinny. I direct you to the many fat vegetarians and vegans I know. Including: http://fatvegan.com & http://twitter.com/zaftigvegan among many

Being a vegetarian doesn't make you lose weight. Cutting out all meat doesn't make you lose weight. Exercising an hour or two a day doesn't make you lose weight. I know fat marathoners and fat triathletes. I know fat weight lifters, fat kayakers, fat hikers, fat martial artists and fat exercise class instructors.

And and.

OK lets say that being obese (like me!) was a negative factor. There isn't a way to reliably make a fat person thin, so it's moot. I already eat fresh veggies every day. I've been known to sit down to mixing bowl sized salads. My kitchen has little if any HFC. I rarely eat processed foods. I don't eat a lot of red meat. I walk a couple miles a day. etc. etc.

But don't just take my word for it:
http://www.fatnutritionist.com/
http://junkfoodscience.blogspot.com/

oh and

www.therotund.com
www.fatshionista.com (I blog there periodically)
http://laurietobyedison.com/discuss/?cat=44
[info]silk_noir wrote:
Nov. 7th, 2009 05:13 pm (UTC)
By acceptable, I didn't mean acceptable. I'll go back and put quotes on that.

And I am so glad you posted here--I was hoping you would.
[info]welamom wrote:
Nov. 7th, 2009 04:56 pm (UTC)
I've got some observations on this that you might find interesting, or maybe disturbing, as I did. However, it's not a conversation we can have here. We'll talk when next we see each other--if you have the time, of course! Cool?
[info]summersdream wrote:
Nov. 7th, 2009 07:59 pm (UTC)
Obesity/weight are not things that bring out my logical side. Some of my friends blame it on our growing up in the age of Kate Moss and heroine chic. One girl in my dance class announced in 5th grade she'd only eat what Prince did (I don't remember exactly what the diet was but mostly it was like tea and half a piece of fruit or something)- she proceeded to follow that diet til her parents started forcing her to have actual meals again. So I got on this thin==perfection early in life.

In high school most girls I knew listed 'getting fat' as the major issue they had with the idea of being pregnant. It was ok to be pregnant but OMG don't get fat.

There was a time in my life I'd rather have had a fatal disease than gain 10 lbs. It was not as long ago as I'd like to pretend.

The best sign I've got that I've grown up is that I don't judge other people by their weight. I was guilty of that in HS- I judged myself too, mind- if I weighed more than 120 I was clearly a worthless excuse for a human. Even through most of college I could hear that voice in my head- one of my best friends was a bigger girl and even as I got to understand what she went through, I couldn't exorcise the ideal of the Photoshop-thin model in my head.

It does seem like people who make an effort to overcome other prejudices will still make fat jokes. Just like people still make crazy-pregnant-lady jokes.

My bff just commented the other day that I freak out way less about my weight now. Being around ladies who are not runway-thin and yet are gorgeous has helped check the influence of the elusive Size 0 in my head. So I guess I'm learning to be rational about this... And yet.

My point is that if I'm honest, I'm still petrified of getting pregnant because of all the weight. In my head, I'll be big. I'll never lose it. I'll read a thousand 'how to lose the baby fat' articles and it will never help. Never mind having to take care of a newborn being scary, but I'll be huge and whoever I'm married to will leave me because that's what happens right?
... Look, I told you logic wasn't allowed in this.

It's what goes on in my brain, and I've heard the same freak-out rant from friends often enough to know I'm not alone. Even from friends who are obese or over-weight by the BMI index. Probably the weight isn't the issue at all, of course, but it's the one we all point at so it's an issue on some level.

I hope some of that is useful and sorry to ramble. :)
[info]hkneale wrote:
Nov. 8th, 2009 10:51 pm (UTC)
Yes, I think fat is an epidemic. A lot of people are far fatter than they need to be, purely through lifestyle choices. (Granted, not everyone is fat because they're slack. But that fat-for-other-reasons is a small percentage of the population.)

I'm a tad overweight (but not grossly overweight). I've fought being fat my whole adulthood. Even as a child, while I was within "normal" weight, I had genetically determined fat deposits that made me believe I was always overweight. I had chunky thighs, a pot belly and I am, literally, big-boned. The older I got, the more my metabolism slowed down. Then when a dramatic change happened to my life (generally moving), it took a month or so of a disrupted schedule and poor-ish diet to pile on weight that I could not shift.

Because I'm larger than I think is healthy, I do my best to ensure I don't have any other factors that could lead to obesity-exacerbated health problems. Luckily my annual bloodwork is normal and I get regular exercise and good diet.

Fat can affect fertility.

Fat generates estrogen. Too much fat generates too much estrogen.

Too much estrogen can interfere with conception. Telling an overweight woman who's trying for a baby to lose weight is not necessarily because being fat will affect her health (because it can) but because it can increase her chances of conception.

Here in Perth, women whose nine-month weight is over 130kg can only attend a certain hospital when giving birth because the beds in the birthing suite of most other hospitals are only weight-rated to 130kg.

With both my babies, I gained zero personal weight during pregnancy. I was the same weight one month after giving birth as I was on the day of conception. I found that quite cool.

My skin, on the other hand, stretched something fierce, thus making my belly look big and saggy. I hate it.

As for diet and nutrition, I believe that it is better to avoid the processed foods. The HFCS is concentrated evil. And it seems to be in everything!

I share a personal trainer with about five other women. The other week she took us shopping and I was appalled at the junk the other women had on their shopping lists. They were feeding their kids corn chips and high-sugar granola bars and those little cheese-and-cracker packs, and the fruit rollup thingies... and a whole lot of really expensive highly-processed junk.

I rarely buy that sort of stuff for my kids. (Okay, I buy it for them once, because they see the other kids at school eating it, but after a few days, they go off it and won't eat the rest of the pack. They hate it.)

My daughters' lunches consist of a sandwich (preferrably on whole wheat or wholemeal bread) and at least two fruits/veggies.

People may talk about "convenience" when it comes to food. Nothing is more convenient that grabbing an apple or a carrot. Throwing a sandwich together takes less time than the five minutes it takes to nuke a pre-packaged dinner.

Anyhow, my PT told us the best way to shop was to roam around the outside edge of the shops. One rarely needs to go into the aisles, except for certain staples, like flour.

But all the healthy stuff is located around the outside of the shops: the fresh fruit/veggies, the meats, the dairy, the bread. Everything in the aisles tends to be the processed stuff.

I hate being overweight. But I can't seem to lose weight with normal diet and exercise. But I can't put my life on hold for the extreme exercise I need to readjust my metabolism. It sucks.
[info]haddayr wrote:
Nov. 9th, 2009 03:29 am (UTC)
The only person I know who developed pregnancy-induced diabetes is skinny as fuck.

When I got pregnant with Arie, I was already considered "overweight." I proceeded to gain 50 pounds, and then I refused to step onto the scale no matter how hard they pushed. "Pick me up and put me on," I'd growl at the nurse. I'm sure I gained plenty more after that. No one said a word to me about my weight gain. Not a goddamned word. I realize now that this was probably an unusual experience.

I did not develop diabetes. I did not develop hypertension or joint problems or anything. Arie is now very low on the weight charts.

When I got pregnant with Éiden, I was considered "normal weight." I only gained about 30 pounds, maybe 35. I also didn't develop diabetes or hypertension. I had some ligament problems, though. Éiden is now very high on the weight charts.

OMG
OMG

I just realized it: Being fat gives your kid autism and Tourette's!!!!!
( 16 comments — Leave a comment )

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