The Challenge Arrives Before the Baby

Sam the Pregnant. Bless.

Lately, childhood obesity research has been turning up a lot of results that include the word “pregnancy.” New studies appear with frightening regularity, demonstrating various kinds of harm that can be done to a fetus by parental ignorance or disregard.

There was pretty good evidence already that a high birth weight predicts an overweight adult, but how far back does the causation go? Apparently, the vigilance needs to start before conception. A woman needs to be at a healthy weight before even thinking of a getting pregnant.

In Norway, the University of Oslo and the Norwegian Institute of Public Health studied 58,383 pregnant women, wanting answers about the association between maternal weight before a baby is even conceived, the mother’s weight gain during pregnancy, and the baby’s weight at birth. ScienceDaily says:

Results of the study showed that birthweight of the newborn child increased with increasing maternal pre-pregnant BMI, and that offspring birthweight also increased with increasing weight gain of the mother during pregnancy.

Disturbingly, the study also found that the most educated women in Norway tend to give birth to the heaviest children. While that is disappointing, it also gives hope, because people with a higher education level might be easier to persuade and re-educate.

Tracy Connor elaborated on that same news item by speaking with a couple of American physicians, one of whom was Dr. Jennifer Wu of Manhattan’s Lenox Hill Hospital, who said:

You should try to reach your ideal body weight before pregnancy, and during pregnancy stick to the recommended weight gain, which is 20 to 25 pounds.

Dr. Jill Rabin of Long Island Jewish Medical Center brought up another possible complication: the likelihood that a baby of more than 10 pounds will make a Caesarean section delivery necessary. In the U.S., about one-third of births are accomplished by that method, and many health care professionals believe that too many C-sections are performed. In general, non-surgical solutions are preferable to surgery, and there is suspicion that often, operations are performed not for the patient’s good, but for the profit they generate.

In the United Kingdom, Jane Brewin reported for The Scotsman:

Studies have shown that part of the reason behind this is the poor diet of the mother while pregnant, which in turn makes the baby more likely to crave a similar diet themselves. The baby as such is ‘programmed’ in the womb by an adverse fetal environment during pregnancy.

Brewin also notes the astonishing statistic that in the U.K., 50% of the women of childbearing age are overweight or obese. That’s half!

And it’s not just Britain. In Utah, Joni Hemond told a reporter that at the Teen Mother & Child Program, of which she is pediatric medical director, 54% of her clinic’s teenage mother clients are overweight or obese. That’s more than half! Of the children already born, 28% are overweight or obese. So serious is the problem, it engenders headlines that sound downright hostile. “Clinic attacks obesity by targeting pregnant moms” does not have the aura of comfort we would prefer to associate with articles about motherhood.

The University of Utah clinic carries out this “attack” by educating teen moms about the “5-2-1-0” nutrition and exercise guidelines. The hope is that not only will babies be born with normal birth weight, but that their young parents will start right from the beginning to raise them within those guidelines:

That means eating at least five servings of fruit and vegetables, spending less than 2 hours watching TV or a computer screen, getting 1 hour of exercise and drinking no sweetened beverages.

Meanwhile, research at Dublin’s University College and the National Maternity Hospital of Ireland, sugar has been indicted:

Women with high blood sugar at 28 weeks of pregnancy were three and a half times more likely to give birth to babies weighing more than nine pounds and 15 ounces than those women with the lowest levels of blood sugar.

We said that in Norway, the farther a mother proceeded in school, the more likely she is to have an overweight baby. There is another reference to highly educated mothers, this time in Brazil, where the more extensively schooled have a tendency to deliver their children by C-section rather than vaginally.

Amy Norton reported for Reuters that Brazilian researchers looked at more than 2,000 young people age 23 to 25. About a quarter of the subjects were obese, made up of the group (10%) who had been born naturally, and the group (15%) who had been delivered by C-section. The researchers do not claim a cause-and-effect relationship, because there are too many other variables they were unable to account for. Chiefly, it was impossible at this time to go back and discover what the mothers’ weights were when their children were born and before.

But Dr. Helena Goldani points out something else that might be meaningful, related to previous studies of the gut bacteria residing inside of obese adults. Their intestinal flora tend to be sparsely populated with microbes called Bifidobacteria and others that probably influence metabolism, and thus the body’s regulation of fat. By strange coincidence, these are exactly the friendly bacteria that children born by C-section are lacking, because they were not able to acquire them in the usual way, via a trip through the birth canal. The place occupied by these intestinal bacteria is of extreme interest to obesity researchers.

Your responses and feedback are welcome!

Source: “Mothers’ Weight Before and During Pregnancy Affects Baby’s Weight,” ScienceDaily, 12/13/11
Source: “Study: Mother’s pre-pregnancy weight can influence baby’s birth size,” NY Daily News, 12/13/11
Source: “Analysis: Babies will crave the kind of food mother ate,” Scotsman.com, 04/03/12
Source: “Clinic attacks obesity by targeting pregnant moms,” KSL.com, 10/16/11
Source: “Study: Childhood obesity linked to sugar intake of pregnant mothers,” Irish Examiner, 11/21/11
Source: “Are C-sections fueling the obesity epidemic?,” Reuters, 05/12/11
Image by philcampbell (Phil Campbell), used under its Creative Commons license.

Comments

  1. The issue of the effect of maternal obesity on newborns is much more complicated than focusing on weight. Because obesity is defined as excessive body fat—essentially a body composition issue, weight and BMI don’t always tell you when someone is storing excessive body fat. After taking thousands of body composition readings on my patients, I found that many “normal” sized people and even some thin people have excessive body fat.

    Thin obese people—how is that possible? We now know that excessive fructose primarily from sucrose and HFCS is the driving force behind insulin resistance and central obesity. When you have insulin resistance and then consume high glycemic carbohydrates, your brain is exposed to magnified glucose spikes. Because neurons have no insulin gate, over time these toxic magnified glucose spikes appear to trigger a chronic brain disorder with symptoms reflecting low levels of monoamine neurotransmitters such as dopamine, norepinephrine and serotonin.

    We call this brain disorder Carbohydrate Associated Reversible Brain syndrome or CARB syndrome. People with CARB syndrome are often miss-diagnosed with depression, ADHD, PTSD, anxiety disorders, eating disorders, PMS, fibromyalgia, bipolar II or similar conditions. Because your brain plays a role in auto-regulating fat stores, with CARB syndrome you slowly lose this ability and start to store extra fat at any caloric intake.

    Because the first symptom you develop when you have CARB syndrome is craving for food loaded with sugar, HFCS and high glycemic carbohydrates, you end up bingeing on the very food that is frying your brain. When you have CARB syndrome and become pregnant, your fetus is also exposed to these magnified glucose spikes and your infant will be born with an early form of the disease. Inappropriate fat storage soon follows, passing the obesity legacy on to the next generation. Learn more about this disease at: http//carbsyndrome.com.

    • Robert A. Pretlow, MD says:

      Thank you for your comments, Dr. Wilson. Attributing dependence on highly pleasurable foods (food addiction and resulting obesity) to a direct biochemical effect of food substances, such as sucrose or fructose, on brain chemistry seems unnecessary and overdone. Fast sensory signals, e.g. taste and texture, acting on the brain are sufficient to induce dependence. For example, bulimic individuals immediately purge foods eaten, yet still become addicted to the foods.

      • Thanks for your reply. Although I agree that many are looking at the effect of highly palatable foods on dopaminergic pleasure centers including David Kessler in “The End of Overeating” and Eric Braverman and The Reward Deficiency Syndrome, it is far from clear exactly how food affects the brain. The CARB syndrome concept isn’t particularly complicated and in my opinion it fits very well what my patients are experiencing. When I go down the list of 21 brain dysfunction symptoms that we have identified as being associated with CARB syndrome, patients are almost universally surprised when they have most or all of the symptoms, yet no other healthcare provider has ever asked them about these symptoms before.

        From my perspective those with anorexia fit the CARB syndrome pattern—they have the same brain dysfunction symptoms as other people with the disease and they have excessive body fat when you actually measure their body composition. It would be hard to say that anorexics are highly addicted to food in the same way that someone who is morbidly obese. They share many other symptoms of monoamine neurotransmitter deficiencies that are typical of all CARB syndrome patients—excessive fatigue, sleep disturbances, mood swings, anxiety, obsessive-compulsive tendencies, difficulty concentrating and focusing and other symptoms.

        I agree that individuals with excessive body fat appear to be addicted to food because of their cravings and diminished satiety but we have learned to shut these cravings down very quickly with treatment strategies strictly focused on the brain. I have used these techniques to treat thousands of patients over the past 20 years with a great deal of success. As a scientist I will use whatever theory give me the best results. If it is true that food addiction is the cause of obesity, than I don’t see any easy way to use this information to help my patients other than to tell them to lock themselves up in a closet and throw away the key!

        The patients I treat continue to live in an environment full of highly pleasurable yet if they comply with my recommendations they do very well—their brain dysfunction symptoms slowly disappear and they slowly lose excessive body fat with traditional calorie restricted dieting or having to use excessive willpower. Because they no longer crave highly pleasurable food, it’s easy for them to not eat it.

        Theories are useful but I am a practicing physician that lives and dies by the results my patients experience when I treat them. I will continue using the CARB syndrome model as my guide until somebody shows me a different model that gives me better results.

        A recent article in JAMA compared various diets varying in their protein and carbohydrate content. All groups were overfed and all groups gained about the same amount of weight. The resulting headlines claimed that high protein diets don’t work for weight loss. If you looked carefully at their data, the high carbohydrate group was the only group to actually lose lean body mass, increasing the relative amount of fat in their body. In other words even though all groups gained the same amount of weight, this group became more obese based on the more valid body composition readings. I’m not sure how these results square with the food addiction model.

        Dr. Pretlow, I greatly appreciate all the great work you have done in the field of obesity and my goal is for all of us who are interested in this field to interact and learn from each other. I would be happy to discuss these issues with you in more detail and I can be reached at: docww@aol.com.

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