I promised last month to come back to our discussion about obesity and midwifery, and I am keeping that promise. Our discussion is going to stay focused on pre-pregnancy obesity, and we will start today by discussing the increase in obesity. Tomorrow we will begin to talk about the increased risks for mother and baby, along with the physiology behind those risks and how to reduce risks. Friday, we will wrap up our discussion by considering how pre-pregnancy obesity affects midwifery care.
So to start, let us consider some surveillance information from the Centers for Disease Control and Prevention (their public data is published in maps so it is easy to see changes). Scroll down a bit and check out the slideshow for the History of State Obesity Prevalence. You can stop the slideshow and move to the first slide representing 1985 and notice how no state had an obesity rate greater than 15%. Slowly move the slideshow forward and watch what happens once you pass 1990.
You may be aware the definitions of obesity and overweight have changed over the years, or more likely have been inconsistently used and regularly re-evaluated to move toward international standard usage. This causes some question of the legitimacy of estimations of obesity increase. However, national surveys such as the National Health and Nutrition Examination Survey (NHANES) have tracked height and weight of participants since 1960 allowing tracking of changes over time regardless of the cut-offs or calculations used. Because the NHANES is a nationally representative survey we can be confident the rates of adult overweight and obesity have increased since 1990.
The Youth Risk Behavior Survey (YRBS) allows us to watch the same pattern with high school students. I personally like to watch this age group because you lose the effect of the menopausal women – younger women have a lower obesity rate and they are the ones who will use midwifery services. So when we look at high school obesity, we are looking at the next group of women to get pregnant. Notice on the 2011 map, only four reporting states had a high school obesity rate less than 10%.
This is not unique to the United States. You can see similar trends throughout the developed and developing world. Check out these data from the UK , Australia , and from the World Health Organization.
This brings us to key point number one: Midwives need to understand obesity. If at least 1 in 5 women will enter pregnancy obese, this isn’t an issue midwives can ignore. Tomorrow, we will look at the increased risks with pre-pregnancy obesity.