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Should Treatment of Obesity Begin Before Birth?

Fifty percent of pregnant women in America are overweight or obese.

by
Theodore Dalrymple

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December 17, 2013 - 10:00 am
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Prevention is better than cure provided (which is not always the case) that prevention does less harm than the disease it prevents. Since obesity is now of epidemic proportions all over the world, and it is estimated that in just over a decade’s time there will be 500,000,000 people with type II diabetes consequent upon obesity, prevention of obesity is devoutly to be wished – which is not to say that it will be easy or even possible.

An article in a recent edition of the New England Journal of Medicine asks the question of how early in life prevention of obesity should begin, given that once it is established it is refractory to treatment. Although the epidemic may have peaked in the United States, there is no room for complacency because the proportion of fat people is already enormous. A half of American pregnant women are seriously overweight or outright fat, and fat women tend to have fat children. They gain even more weight during pregnancy, and women who gain weight excessively during pregnancy are especially likely to have fat children.

The article is a typical example of what might be called risk factor medicine. A disease or disorder is found to be associated statistically with some independent variable which may or may not be causally related to that disease or disorder, so that doctors hope that by reducing the prevalence of the risk factor in some way they will also reduce the prevalence of the disease or disorder. Since many of the risk factors are behavioral rather than biological, and there is nothing as difficult to change as human behavior, doctors’ hopes are often frustrated.

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All Comments   (10)
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When the government got involved in our diets (in the 70's) that is when the problem started. Watch this presentation (Health, Diet and the Wisdom of Crowds) , it is eye-opening: https://www.youtube.com/watch?v=KzPnnDDCIjo
15 weeks ago
15 weeks ago Link To Comment
Dr. Dalrymple: "Since many of the risk factors are behavioral rather than biological, and there is nothing as difficult to change as human behavior, doctors’ hopes are often frustrated."

Actually, the so called risk factors boil down to one overriding factor. The Standard American Diet.

Humans the world over have been given false information since the early 1930's about what to eat and we have developed the endemic health issues over the decades into what we see today.

Garbage in, Garbage out.
16 weeks ago
16 weeks ago Link To Comment
One of the first things that shocks my European relatives upon visiting the US is how fat everyone is. The same levels of obesity do not exist there. They have a better approach to food – more whole foods and less instant meals high in sugar, salt, and calories. Less eating out too.

Which is why I am convinced the obesity epidemic is primarily related to diet.

The other problem is that people wait too damn long to go on a diet. You’ve got to get serious about removing the excess as soon as the belt starts feeling tight. If you wait until you’re 30 pounds overweight, it becomes almost impossible to get it off and keep it off.
16 weeks ago
16 weeks ago Link To Comment
I tire of the, 'but European's diets..' shtick.

The primary reasons most Euros are thinner than Americans is because their crummy takeaway, dining out is ridiculously overpriced.

The majority of UK's takeaway is MSG-laden Indian, Paki food (roti and bland red sauce is England's most popular dish/ go to for takeaway). There's a 'tad' bit of sugar, salt in the aforementioned fare.

Also the Euro's 'grocery stores' if you want to call them that are most often mini 7-11 like-sized. These 'stores' have a smidgen of selection of food, again grossly overpriced and located in the most ridiculous of places. Underground beside subway stations, tubes. The 3rd floor of a department store etc.,

Not to mention most Euros live in tiny, cramped apartments with waist-high fridges.

Or if said Euros indeed live in a flat, house they often times take on multiple roommates to help lessen their sickeningly high mortgage and have commune-like grocery plans.

Though I do applaud the Euros for banning EDTA in their foods I'd hardly pat them on the back for 'eating right'. Their smoking, drinking (not binge drinking for the US outpaces our Euro neighbors in great part to do with accessibility at a younger age thus drinking more responsibly.. usually) is more prevalent than the US.

Though yes diet is thee reason for lard a sses in the US.

15 weeks ago
15 weeks ago Link To Comment
'Though I do applaud the Euros for banning EDTA in their foods I'd hardly pat them on the back for 'eating right'. Their smoking, drinking (not binge drinking for the US outpaces our Euro neighbors in great part to do with accessibility at a younger age thus drinking more responsibly.. usually) is more prevalent than the US.'

Who are 'The Euros'? Are you talking about a currency or the population of a continent. And Europe is a continent, not a country.

'Though yes diet is thee reason for lard a sses in the US.'

Lack of exercise may play a part too.
13 weeks ago
13 weeks ago Link To Comment
Finally proven - all doctors are out of their minds. You might think this stupid but I would think again. For example it is no small part of the installation of Obamacare that many many doctors already were talking about if this or that group of people should receive care - if they are sick or too old - on any grounds and especially because treatments are expensive.

The doctor who wrote this article says 50 percent of pregnant American women are seriously heavy or fat. "A half of American pregnant women are seriously overweight or outright fat"

I will now tell everyone why some people are obese. Its the American government's pro-starch anti-protein diet. Some fact. The demographic that is getting heavier and also having children are young black women.

Their behavior over time - from when they did not tend to fat and when they started to tend to fat - did not change; their diet did.

In accounting for general obesity one often hears - the modern generation are couch potatoes. In NYC when I was a child the city maybe had 100 gyms - boxers and training police went there.

Now we have literally thousands of health clubs in NYC and a million or so members. If that generation is putting on weight, its diet as well.

Some lawyer said that doctors are really nice people - they just don't know anything.
16 weeks ago
16 weeks ago Link To Comment
Probably most important factor is heredity. It must be a nightmare trying to do a controlled study on such a thing. That said, women who are pregnant would want the best for their kids and would be easier than the average population to adapt their diet to protect their child. I also have anecdotal. 8 kids, not a bad sample size… mother overweight in all but 1st pregnancy. 1st kid, born less than average weight, now overweight. Rest of kids, no weight problems and most are not especially active or fit, except one in the army. All children were breast fed, from 9 months -3 years.
16 weeks ago
16 weeks ago Link To Comment
This is a minefield.

('It's not a pregnancy thing or a female thing because I say so' -- bullsh*t, Queen Canute)
Menopausal women squawk about having to pay for maternity coverage under Obamacare, but never seem to ask why men of normal weight should be compelled to subsidize the 'lifestyle choices' of gargantuan, lardy women with zero impulse control. Those tubs'o'lard stuck in Walmart's front door certainly ain't all 'glandular' cases, you know. Put bluntly, why should I have to pay for your self-esteem problems? Fix your own wagon, fatty.

While we're at it, what about banning rancid fat women from elevators during summer months, and grounding wide-loads with thighs so fat their panty-hose squeak with every step? And as for behemoths doused in cheap perfume....

Away from gender wars, the alleged perils of secondary smoking have just been dismissed as nonsense by a massive meta-study, yet where are the retractions, apologies and lawsuits? No shrill finger waggers on deck now, just sullen silence while the lawyers figure out where they can make money.

Behavioral modification is a nightmare, made worse by sanctimonious behavior, cheesy assertions, and stupidity. No surprise doctors don't know what to do; nobody else does either.
16 weeks ago
16 weeks ago Link To Comment
So hard to separate the physiological causes of obesity from the lifestyle causes...

It's better for pregnant women not to be obese for many reasons. Full stop. That said, all doctors should encourage all their parents, male, female, pregnant, not pregnant, to achieve and maintain a healthy weight and lifestyle habits. It's not a pregnancy thing or a female thing.

Re the breastfeeding factor -- I didn't breastfeed my kids at all (back in the 80s), and neither I nor they are even remotely overweight, much less obese. Super healthy kids, all athletic, all very fit, not an ounce of breast milk. My SIL's kids were breastfed 'til they could practically walk over, unbutton her blouse and whip out her boobs for her, all overweight, one quite obese. Anecdotal, but just goes to show you that childhood obesity is probably due to a bunch of factors and how they interact with each other rather than any one thing, as is childhood fitness and health.
17 weeks ago
17 weeks ago Link To Comment
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