What are the experiences of women with obesity receiving antenatal maternity care? A scoping review of qualitative evidence

ProblemObesity is a major public health problem and is rising in prevalence in child-bearing women. The complications of pregnancy in women with obesity are well documented. Pregnant women with obesity require different maternity care considerations to normal weight women. How women respond to the care of health professionals, determines how likely they will be to engage with it, and thus research into the current care experiences of women with obesity is valuable.ObjectiveThe purpose of this scoping review was to examine the evidence of the antenatal maternity care experiences of women with obesity (BMI ≥ 30 kg/m²).MethodA systematic literature search was conducted for English language publications 2008–2018 using Medline, Scopus, PsycINFO and CINAHL. Following critical appraisal, and a search of the reference lists of primary articles, 17 articles resulted for this review. A thematic synthesis process was used to collate the findings.FindingsFour major themes were identified: 1) inconsistent or absent information regarding weight management, 2) the stigma and stereotyping associated with their obesity, 3) medicalisation and depersonalisation of pregnant women with obesity, and 4) a desire for information and need for change.ConclusionThe findings suggested that based on women’s experiences there is a need for improved education and communication for health care professionals when caring for pregnant women with obesity. Some conflicting information from women in the studies highlight the need for further research in the area, and the implementation of individualised care and continuity of care for pregnant women with obesity.     

Socioeconomic determinants of obesity and hypertension at the county level in China

In a nationally representative database, the risk of obesity and hypertension in China is significantly associated with age and the socioeconomic environment. Women in China are more likely obese and less likely to have hypertension than men. Education mitigates the risks of obesity and hypertension.     

Relationship Between Sarcopenia and Fracture Risks in Obese Postmenopausal Women

ABSTRACT

It is known that obesity is inversely correlated with fracture risk. It remains unclear if a low muscle mass (sarcopenia) modulates the relationship between obesity and bone mass density. Twenty-seven obese women were matched for total fat mass (± 0.5 kg) and age (± 4 yrs) and divided in 3 equal groups: class II sarcopenic, class I sarcopenic, and nonsarcopenic. Body composition (DXA) and dietary intake were measured. Our results suggest that obesity may offer some protection against osteoporosis, even in sarcopenic postmenopausal women. However, further studies are needed to examine the actual implication of these results on a clinical standpoint.     

Weight loss and related behavior changes among lesbians

Overweight and obesity are known risk factors for several modifiable, if not preventable diseases. Growing evidence suggests that lesbians may have higher rates of obesity than other women. This study was designed to describe weight loss and behavior changes related to food choices and exercise habits among lesbians who participated in a predominantly lesbian, mainstream, commercial weight loss program. Behavioral changes were recorded in exercise, quality of food choices, and number of times dining out. Although there were several limitations based on sample size and heterogeneity, the impact of a lesbian-supportive environment for behavior change was upheld.     

An Age-Structured Model for Childhood Obesity

An age-structured model for childhood obesity at population level is fitted to empirical data in order to predict the proportion of overweighted and obese children in the 6–8 and 9–12 year old classes in the region of Valencia, Spain.     

Pregnancy care and birth outcomes for women with moderate to super-extreme obesity

PurposeTo describe the health service utilisation and birth outcomes of pregnant women with moderate to super-extreme obesity.BackgroundMaternal obesity is increasingly recognised as a key risk factor for adverse outcomes for both women and their babies. Little is known about the service utilisation and perinatal outcomes of women with obesity beyond a body mass index of 40.MethodWomen with a self-reported pre-pregnancy BMI of 40 or more, who had received care and birthed a baby at the study site between 1 January 2009 and 31 December 2010. Clinical audit was used to identify the health service utilisation and birth outcomes of these women.Results153 women had a BMI of 40 or more. Women saw 6 different health professionals during pregnancy (1–16). Most of their visits were with a medical practitioner, often with limited experience, and almost all women only saw a midwife once at their booking visit (n = 150, 98.0%). While the majority of women experienced a normal pregnancy, free from any complications, almost half the women in this study experienced a caesarean section (n = 74, 48.4%).ConclusionClinical audit has been useful in providing additional information which suggests current maternity care provision is not meeting the needs of this group of women. The model of antenatal care provision may be a mediating factor in the birth outcomes experienced by obese women. The development of effective, targeted antenatal care, designed to meet the needs of these women is recommended.     

An integrative review of interventions for limiting gestational weight gain in pregnant women who are overweight or obese

ProblemExcessive gestational weight gain in women who are overweight or obese puts them at risk of poor short- and long-term outcomes for maternal and neonatal health. Several interventions have been trialled to encourage women who are overweight or obese to limit gestational weight gain during pregnancy.AimThe aim of this review was to analyse the evidence on interventions to limit gestational weight gain in pregnant women who are overweight or obese.MethodAn integrative review guided by the Joanna Briggs Institute approach was conducted. An unlabeled search query of pregnancy, weight, and obesity was conducted in Medline, Scopus and CINAHL, limited to English language, 2010–2020 publications, and primary research on humans. Unlabeled search query of “((pregnancy outcome) OR (prenatal care) OR (pregnancy complications)) AND ((weight loss) OR (weight gain) OR (weight management)) AND (obesity) was used. Additional 9 records were identified through reference lists. Following a critical appraisal, 21 primary research articles were included in this review. A thematic synthesis was undertaken.FindingsFour major themes were identified. These are (1) mixed findings of lifestyle interventions for weight management, (2) ineffectiveness of probiotics or metformin for weight management, (3) psycho-behavioural interventions for weight management, and (4) midwifery role as an integral component in multidisciplinary intervention for weight management.ConclusionThe literature suggests a need for longer duration of behavioural lifestyle intervention sessions led by the same midwife trained in motivational interviewing to limit weight gain in pregnant women who are overweight or obese.     

Urban Form,Heart Disease,and Geography: A Case Study in Composite Index Formation and Bayesian Spatial Modeling

Recent studies indicate a relationship between measures of urban form as applied to urban and suburban areas, and obesity, a risk factor for heart disease. Measures of urban form for exurban and rural areas are considerably scarce; such measures could prove useful in measuring relationships between urban form and both mortality and morbidity in such areas. In modeling area-level mortality, geographic relationships between counties warrant consideration because geographically adjacent areas tend to have more in common than areas farther from each other. We modify county-level indices of urban form found in the literature so that they can be applied to exurban and rural counties. We then use these indices in a Bayesian spatial model that accounts for spatial autocorrelation to determine if there is a relationship between such measures and cardiovascular disease mortality for white males age 35 and older for the time period 1999–2001. Issues related to the formation and usefulness of the indices, and issues related to the spatial model, are discussed. Maps of observed and expected relative risk of mortality are presented. Jimmie Givens retired from his service.     

Perceived Sexual Orientation of Men and Women with Eating Disorders and Obesity

ABSTRACT

The present study explores the perceived sexual orientation of hypothetical men and women with various eating disorders and obesity. Undergraduates were randomly provided with one vignette describing a male or female with anorexia nervosa (AN), bulimia nervosa (BN), binge-eating disorder, or obesity and were asked about the target’s likely sexual orientation. Significant differences emerged between male and female targets with AN and BN on the forced-choice question, with a greater percentage of participants indicating that the male targets were probably non-heterosexual. On continuous items, participants rated the female targets as significantly more likely to be heterosexual and significantly less likely to be homosexual than male targets. The general public may be more likely to perceive men with eating disorders as gay or bisexual relative to females with eating disorders. Perceived sexual orientation might be an important factor to consider when exploring the potentially unique perspectives of men with eating disorders.     

The effects of race,ethnicity, and age on obesity

About 30% of Americans are obese, which is roughly a 100% increase from 25 years ago. This study examines the effects of changes in the racial/ethnic composition and age distribution on the prevalence of obesity, identifies the portion of the increase in obesity caused by these changes, and projects the effects of future racial/ethnic and age changes on obesity using National Health and Nutrition Examination Survey data. Results indicate that racial/ethnic composition changes and age distribution changes have accounted for about 10% of the increase in obesity over the last 25 years. However, future racial/ethnic and age changes are not projected to increase obesity substantially.      

Decomposing Trends in Child Obesity

We unravel the absolute level and relative prominence of two demographic processes that are relevant for childhood obesity, and that will ultimately determine the long-term course and pace of change in child obesity rates. We leverage data from the National Health and Nutrition Examination Survey to decompose change in child obesity from 1971 to 2012. We partition change into that attributable to (1) healthier, more nutritionally and economically advantaged cohorts in the population being replaced by cohorts of children who are less advantaged (between-cohort change), and (2) the health habits, nutrition, and social and economic circumstances of all cohorts of children worsening over time (within-cohort change). The rise in obesity among children aged 2 to 19 years is solely due to intracohort change driven by variation in food security composition and in the diet of the population over time. Child obesity in the population rose largely because of individual increases in weight status that are broadly distributed across age and cohort groups. Smaller but significant cohort replacement effects slightly attenuated these intracohort change effects over the study period, leading to a more gradual increase in obesity. Our results provide some reasons for optimism. Given that population estimates of child obesity rose because the typical member of all cohorts became heavier over time at all stages of the early life course, successful policy and health interventions that focus on changing health habits across all ages and generations have the potential to quickly slow or reverse the upward trend in child obesity.

     

Projecting the Effect of Changes in Smoking and Obesity on Future Life Expectancy in the United States

We estimate the effects of declining smoking and increasing obesity on mortality in the United States over the period 2010–2040. Data on cohort behavioral histories are integrated into these estimates. Future distributions of body mass indices are projected using transition matrices applied to the initial distribution in 2010. In addition to projections of current obesity, we project distributions of obesity when cohorts are age 25. To these distributions, we apply death rates by current and age-25 obesity status observed in the National Health and Nutrition Examination Survey, 1988–2006. Estimates of the effects of smoking changes are based on observed relations between cohort smoking patterns and cohort death rates from lung cancer. We find that changes in both smoking and obesity are expected to have large effects on U.S. mortality. For males, the reductions in smoking have larger effects than the rise in obesity throughout the projection period. By 2040, male life expectancy at age 40 is expected to have gained 0.83 years from the combined effects. Among women, however, the two sets of effects largely offset one another throughout the projection period, with a small gain of 0.09 years expected by 2040.     

Mortality attributable to obesity among middle-aged adults in the united states

Obesity is considered a major cause of premature mortality and a potential threat to the longstanding secular decline in mortality in the United States. We measure relative and attributable risks associated with obesity among middle-aged adults using data from the Health and Retirement Study (1992–2004). Although class II/III obesity (BMI _ 35.0 kg/m2) increases mortality by 40% in females and 62% in males compared with normal BMI (BMI = 18.5-24.9), class I obesity (BMI = 30.0-34.9) and being overweight (BMI = 25.0-29.9) are not associated with excess mortality. With respect to attributable mortality, class II/III obesity (BMI _ 35.0) is responsible for approximately 4% of deaths among females and 3% of deaths among males. Obesity is often compared with cigarette smoking as a major source of avoidable mortality. Smoking-attributable mortality is much larger in this cohort: about 36% in females and 50% in males. Results are robust to confounding by preexisting diseases, multiple dimensions of socioeconomic status (SES), smoking, and other correlates. These findings challenge the viewpoint that obesity will stem the long-term secular decline in U.S. mortality.     

A Demographic Profile of Obesity in the Adult and Veteran US Populations in 2008

Obesity is increasing in the US population and seems to be disproportionately burdening disadvantaged groups. Veterans using the Veterans Healthcare System (VHS) tend to be more disadvantaged socioeconomically than the general population and in poorer health. It is important to understand how the veteran population differs from or is similar to the general population and whether the VHS is able to mediate obesity risk among veterans. This research assesses the sociodemographic, behavioral, and health risk factors for obesity in the US adult and veteran populations in 2008. We use data from the 2008 Behavioral Risk Factor Surveillance System (BRFSS) to empirically assess predictors of obesity risk. We find that women have lower odds of obesity than men once controls for sociodemographic, behavioral, and health conditions are included in our models. We also observe a veteran obesity disadvantage in the full adult sample when conducting bivariate tests, but no significant association with the odds of obesity in the logistic regression models among veterans and non-veterans. Gender specific models indicate that male veterans have increased odds of obesity compared to non-veterans, but no difference in obesity risks among veterans and non-veterans are noted for women, controlling for all variables. Further, we find no significant differences in the odds of obesity of veterans using VHS for all, some, or none of their health care needs; further no significant gender differences in obesity risk were observed among VHS usages and non-users. Based on the strong, positive association between the number of chronic health conditions and the odds of obesity, we suggest that health policy should focus efforts on weight management counseling for obese patients that have obesity related co-morbidities, and more targeted attention to male veterans would help to address the high level of obesity in this vulnerable population group.     

Obesity and breastfeeding: The strength of association

Obesity and attendant co-morbidities are an emergent problem in public health. Much attention has focused on prevention, especially during the perinatal period. Breastfeeding is considered a possible protective factor for obesity in childhood, influencing gene–neuroendocrine–environment–lifestyle interaction. Therefore, breastfeeding and its longer duration are probably associated with lower development of childhood obesity. Through human milk, but not formula, the child assumes greater bioactive factors contributing to immunological, endocrine, development, neural and psychological benefits. Contrarily, other studies did not confirm a critical role of breast milk. Confounding factors, especially maternal pre-pregnancy overweight, may influence breastfeeding effects. This review summarises what is known about the possible relationship between breastfeeding and prevention of obesity development.ConclusionBreastfeeding appears to represent a protective factor for obesity in childhood, although evidence is still controversial and underlying mechanisms unclear. Further research is needed to improve knowledge on overweight/obesity and breastfeeding.     

Gestational weight gain in obese women by class of obesity and select maternal/newborn outcomes: A systematic review

BackgroundObesity and gestational weight gain impact maternal and fetal risks. Gestational weight gain guidelines are not stratified by severity of obesity.AimConduct a systematic review of original research with sufficient information about gestational weight gain in obese women stratified by obesity class that could be compared to current Institute of Medicine guidelines. Evaluate variance in risk for selected outcomes of pregnancy with differing gestational weight gain in obese women by class of obesity.MethodsA keyword advanced search was conducted of English-language, peer-reviewed journal articles using 3 electronic databases, article reference lists and table of content notifications through January 2015. Data were synthesized to show changes in risk by prevalence.FindingsTen articles met inclusion criteria. Outcomes assessed were large for gestational age, small for gestational age, and cesarean delivery. Results represent nearly 740,000 obese women from four different countries. Findings consistently demonstrated gestational weight gain varies by obesity class and most obese women gain more than recommended by Institute of Medicine guidelines. Obese women are at low risk for small for gestational age and high risk for large for gestational age and risk varies with class of obesity and gestational weight gain. Research suggests the lowest combined risk of selected outcomes with weight gain of 5–9 kg in women with class I obesity, 1 to less than 5 kg for class II obesity and no gestational weight gain for women with class III obesity.ConclusionsGestational weight gain guidelines may need modification for severity of obesity.     

Familial obesity as a proxy for omitted variables in the obesity-mortality relationship

In a conventional survival analysis of a sample of the U.S. population in 1971-1974, the association between mortality and obesity is compared with the analogous risk from the presence of an obese person in a household. The two factors have similar risk profiles, with a hazard ratio of 1.44 for nonmorbid obesity and 1.48 for nonmorbid familial obesity in one sample. If "familial obesity" cannot directly affect personal longevity, and if shared factors determine both personal and familial obesity, the mortality risk of family and actual personal obesity is similarly overstated. This false positive in the estimated risk arises from correlations among obesity and unobserved environmental, behavioral, or genetic factors.     

One Size May Not Fit All: How Obesity Among Mexican-Origin Youth Varies by Generation,Gender, and Age

Immigrants’ health (dis)advantages are increasingly recognized as not being uniform, leading to calls for studies investigating whether immigrant health outcomes are dependent on factors that exacerbate health risks. We answer this call, considering an outcome with competing evidence about immigrants’ vulnerability versus risk: childhood obesity. More specifically, we investigate obesity among three generations of Mexican-origin youth relative to one another and to U.S.-born whites. We posit that risk is dependent on the intersection of generational status, gender, and age, which all influence exposure to U.S. society and weight concerns. Analyses of National Health and Nutrition Examination Studies (NHANES) data suggest that accounting for ethnicity and generation alone misses considerable gender and age heterogeneity in childhood obesity among Mexican-origin and white youth. For example, second-generation boys are vulnerable to obesity, but the odds of obesity for first-generation girls are low and on par with those of white girls. Findings also indicate that age moderates ethnic/generational differences in obesity among boys but not among girls. Overall, ethnic/generational patterns of childhood obesity do not conform to a “one size fits all” theory of immigrant health (dis)advantage, leading us to join calls for more research considering how immigrants’ characteristics and contexts differentially shape vulnerability to disease and death.     

Secular declines in the association between obesity and mortality in the United States

Recent research suggests that rising obesity will restrain future gains in US life expectancy and that obesity is an important contributor to the current shortfall in us longevity compared to other high-income countries. Estimates of the contribution of obesity to current and future national-level mortality patterns are sensitive to estimates of the magnitude of the association between obesity and mortality at the individual level. We assessed secular trends in the obesity/mortality association among cohorts of middle-aged adults between 1948 and 2006 using three long-running US data sources: the Framingham Heart Study, the National Health and Nutrition Examination Survey, and the National Health Interview Survey. We find substantial declines over time in the magnitude of the association between obesity and overall mortality and, in certain instances, cardiovascular-specific mortality. We conclude that estimates of the contribution of obesity to current national-level mortality patterns should take into account recent reductions in the magnitude of the obesity and mortality association.     

Obesity, disease, and functional limitation in later life

Little is known about the effects of obesity late in life. Using data from the Longitudinal Study of Aging and the Assets and Health Dynamics of the Oldest Old Survey, this study finds an increased prevalence of obesity, over time, among those 70 and older. Obesity is related most strongly to limitations in activities of daily living (ADLs) for women and to activities related to mobility. One ADL, eating, has a negative association to obesity. Obesity is associated with an increased prevalence of arthritis, diabetes, and hypertension. These results are cross-sectional and are based on self-reports of height and weight; they must be interpreted cautiously.