The 5As of Healthy Pregnancy Weight Gain
Yesterday, the Canadian Obesity Network released the 5As of Healthy Pregnancy Weight Gain. This follows the release of the 5As of Obesity Management (adults) and the 5As of Pediatric Weight Management. The 5As of Health Pregnancy Weight Gain, was developed by a working group of nurses, midwives, primary care physicians, obstetricians, researchers and policy makers convened by the Network. It is based on the best available evidence on this topic and is intended to help primary care practitioners discuss and manage gestational weight with their patients. The 5As of Healthy Pregnancy Weight Gain is based on the following 5 key principles: Discussion about gestational weight gain should occur with every pregnant women and with every woman planning a pregnancy. Achieving healthy gestational weight gain is about improving the health and well-being of both mothers and babies. Early action means addressing root causes and removing roadblocks. Pregnancy related health beliefs can be powerful influences on weight gain in pregnancy. Achieving goals is different for every woman. The 5As of Health Pregnancy Weight Gain can be downloaded here – pdf – ppt @DrSharma Edmonton, AB p.s. if you did not receive the Obesity Network Newsletter with this announcement due to Canada’s new anti-spam legislation, please click here.
Prebiotic Fibre Alters Mother Milk and Offspring Gut Bacteria in Rats
With all the attention to the role of gut microbiota and the ongoing debate as to the role of breast feeding in obesity prevention, a study by Raylene Reimer and colleagues from the University of Calgary adds an interesting spin. Their study, now published in OBESITY shows that feeding female rat a diet high in prebiotic fibre (21.6% wt/wt) throughout pregnancy and lactation, compared to a control or high-protien (40% wt/wt) diet, results in a lower oligosaccharide content of the milk with a higher content of bifidobacteria in the offspring. Although this did not lead to any marked differences in body composition or other metabolic parameters, the study proves the point that (at least in rats) maternal diet can affect the composition of gut bacteria in the offspring (which may or may not have metabolic benefits). There is no reason to believe that in humans maternal nutrition may well impart a similar influence via breast feeding on the microbiota of infants. This certainly sounds like a promising field for future research. @DrSharma Edmonton, AB Hallam MC, Barile D, Meyrand M, German JB, & Reimer RA (2014). Maternal high protein or prebiotic fiber diets affect maternal milk composition and gut microbiota in rat dams and their offspring. Obesity (Silver Spring, Md.) PMID: 25056822 .
Birth Control And Obesity
Although obesity is a well-recognised factor for female infertility, the vast majority of women with excess weight are probably more interested in effective birth control. That this is not as simple as it seems is evident from an article by Sheila Mody and Michelle Han from the University of California, San Diego, published in Clinical Obstetrics and Gynecaology. The paper succinctly reviews a wide range of issues related to birth control and obesity. To begin with, the authors points out that unintended pregnancies in obese women are often a problem simply because obese women are far less likely to use effective contraception than non-obese women. This non-use may in part be attributable to fear of weight gain, when most studies show that modern hormonal contraception is associated with almost no weight gain. The exception appears to be depot-medroxyprogesterone (DMPA), which may cause about 5 lb weight gain in the first year of use. As for efficacy, the data show that unintended pregnancy rates among overweight women using oral contraceptives are similar or slightly higher than that among nonoverweight women. The reasons for these higher rates are not exactly clear. Fortunately, the efficacy of intrauterine devices (IUD) appear no different between obese and non-obese women although the insertion of an IUD maybe more difficult in obese women because of poor visualization of the cervix and limited assessment of uterine position (a problem that can often be solved with the help of an ultrasound). The paper also discusses the suitability of the vaginal vaginal contraceptive ring, which has been hypothesized to offer higher hormone levels for obese women than oral contraceptives because the hormones are absorbed directly into the vaginal mucosa and do not go through the first- pass liver metabolism. Finally, the paper discusses issues around contraception for women who have undergone bariatric surgery (who have a particularly high rate of unintended pregnancies) as well as best practices for emergency contraception. This is clearly information that all clinicians who counsel obese women should be aware of. @DrSharma Edmonton, AB Mody SK, & Han M (2014). Obesity and Contraception. Clinical obstetrics and gynecology PMID: 25029338 .
4th Canadian Obesity student Meeting (COSM 2014)
Over the next three days, I will be in Waterloo, Ontario, attending the 4th biennial Canadian Obesity Student Meeting (COSM 2014), a rather unique capacity building event organised by the Canadian Obesity Network’s Students and New Professionals (CON-SNP). CON-SNP consist of an extensive network within CON, comprising of over 1000 trainees organised in about 30 chapters at universities and colleges across Canada. Students and trainees in this network come from a wide range of backgrounds and span faculties and research interests as diverse as molecular genetics and public health, kinesiology and bariatric surgery, education and marketing, or energy metabolism and ingestive behaviour. Over the past eight years, since the 1st COSM was hosted by laval university in Quebec, these meetings have been attended by over 600 students, most presenting their original research work, often for the first time to an audience of peers. Indeed, it is the peer-led nature of this meeting that makes it so unique. COSM is entirely organised by CON-SNP – the students select the site, book the venues, review the abstracts, design the program, chair the sessions, and lead the discussions. Although a few senior faculty are invited, they are largely observers, at best participating in discussions and giving the odd plenary lecture. But 85% of the program is delivered by the trainees themselves. Apart from the sheer pleasure of sharing in the excitement of the participants, it has been particularly rewarding to follow the careers of many of the trainees who attended the first COSMs – many now themselves hold faculty positions and have trainees of their own. As my readers are well aware, I regularly attend professional meetings around the world – none match the excitement and intensity of COSM. I look forward to another succesful meeting as we continue to build the next generation of Canadian obesity researchers, health professionals and policy makers. You can follow live tweets from this meeting at #COSM2014 @DrSharma Waterloo, Ontario
US Obstetricians and Gynecologists Weight In On Ethical Obesity Care
This month the the Committee on Ethics of the American College of Obstetricians and Gynecologists released a position statement on obesity that advices its fellows to be prepared to meet the challenges of women with obesity with compassion and without bias. The statement offers the following recommendations and conclusions: Physicians should be prepared to care for obese patients in a nonjudgmental manner, being cognizant of the medical, social, and ethical implications of obesity. Recommendations for weight loss should be based on medical considerations. An understanding that weight loss entails more than simply counseling a woman to eat less and exercise more and a willingness to learn about the particular causes of a patient’s obesity will assist physicians and other health care professionals working with them in providing effective care. Physicians can serve as advocates within their clinical settings for the necessary resources to provide the best possible care to obese women. It is unethical for physicians to refuse to accept a patient or decline to continue care that is within their scope of practice solely because the patient is obese. However, if physicians lack the resources necessary for the safe and effective care of the obese patient, consultation or referral or both are appropriate. Physicians should work to avoid bias in counseling regardless of their own body mass index status. Obesity education that focuses on the specific medical, cultural, and social issues of the obese woman should be incorporated into physician education at all levels. The entire statement is available here. It would certainly be nice to see similar statements from other professional bodies (e.g. orthopedic surgeons). Hopefully, these recommendations will soon be reflected in clinical practice. @DrSharma Edmonton, Alberta
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