to think that the NICE guidelines on obesity and pregnancy are just yet another way of pissing off pregnant women?

[PerfectDromedary]

I'm 9 weeks today, and trying to enjoy a first, very much longed-for pregnancy. But as far as I can work out, NICE is out to get me - and the 40% of pregnant women who are overweight/obese when they conceive.

Am I being unreasonable to think that the medical profession has just put on their judgy pants about yet another aspect of women's behaviour while pregnant? It seems highly unlikely that going on a diet while pregnant is a good idea - plus, if I don't have something in my stomach at all times, I'm quite likely to throw up...

(NB I may also be a little bit hormonal. But seriously, ffs.)

YANBU Drom. Of course.

Speaking as someone who has all the understanding of feminist politics of a garden snail (and a boy-snail too!), even I can see that this is yet another point on the endless continuum of patriarchal, infantilising attitudes towards women - especially pregnant ones. Whatever its origins - perhaps benevolent in intention - it's going to result in unnecessesarily stressing out and disturbing women who otherwise would have a happy and healthy pregnancy (OMG! I walked past a smoker/ate a Dairylea cheese triangle/sat next to someone opening a bottle of Budweiser, Will no-one think of the CHILDREN?!?!? ).

It's another way of exercising control, partly I suspect so that a PCT Trust somewhere can get their Change 4 Life budget increased by 54% because Bingo!, they got three women to reduce their post-pregnancy BMI by 2.3%.

It also focuses, completely unscientifically, on BMI, which we all know is a completely discredited way of assessing someone's health. For instance, I have a BMI of 32 (clinicall obese OMG!!1!!1), and yet if you use the new method of assessing body-health (waist-to-hip ratio) I am very firmly within the 'absurdly healthy' range.

I am TTC, and have been driving myself insane by telling myself I can't have a baby because I've eaten myself into a state of infertility. Which is preposterous: I have low blood pressure, low cholesterol, low blood-sugar, eat twice my 5-a-day, and cycle 4 miles to work and 4 back. The absurdly reductive NHS/NICE guidelines are doing nothing but adding unnecessary stress to the whole business (not exactly something you need when TTC...).

Don't be fooled - this is another way of target-setting, list-making and headline-grabbing.

OP, you are more than capable of setting your own standards for the good health and safe happy future of your body and your pregnancy.

It's a bit stable-door-after-the-horse though, isn't it, nagging PG women about their weight.

I mean, with the best will in the world, no-one's going to end up with a lower BMI after PG than before it.
(Unless they're ill - I have only put on a few pounds so far (28 weeks), but if anyone wants to swap a fully-functioning liver for low weight gain, I can give you my number? )

So they really are just going to make ladies grumpy and resentful.

I notice the BBC article goes on to say;

"NICE also wants local authorities to offer women more opportunities to exercise, at an affordable price, and with creches for their children."

Yeah, that'll happen.

I blame the typos in my post on TheCoalition, whose elegant manner of spraying bile all over the thread has made me feel bilious.

well personal;ly I think it is easier to be pregnant and fit healthy beforehand. When I had my first two i was very fit and slim but for my third (who was unplanned) I was overweight and not very healthy and it really made a difference in terms of how I coped with the pregnancy and birth and the early days. I don't think it is wrong to say it helps if you are healthy

I'm sure they would love women to lose weight, stop smoking, cut down on alcohol etc before they ever ttc. But, the time that young women come into contact most with health services (and remembering that only a third of pregnancies are planned) is when they are pg, so it is a time that they are able to give more advice.

Also, if you look at womens stories of being overweight, loads of women say that they put weight on in a pregnancy and then never shifted it - so talking to women about not 'eating for two' can help to avoid that. I certainly know lots of people that used being pg as an excuse to eat loads, and ended up 2 stone or more heavier once they had given birth.

FWIW, I weighed the same when I'd just given birth as I did before I was pg, and I wasn't ill during pg

So Headbanger - do you dispute the clinical outcomes showing higher risks attached to overweight/obese women giving birth?

BMI is contentious, yes. It should be used as an indicator. What is does show is that people with a higher BMI do have increased risks attached to pregnancy - this doesn't appear to be in doubt. Perhaps there is other research showing that those people with high BMIs but low cholestrol/waist to hip ratio actually have the same health outcomes - that would be really helpful and allow us to narrow down the risk factors. I like to think if it was there then we would have seen a story on it, but I realise that might not be the case.

Quite understand that there are probably different/more effective ways of influencing people's behaviour, but your post implies that we should stop altogether and not point out to people the proven risks in what they are doing.

Are they really picking on women? I dont think so. They release guidance to a range of 'groups', including the risks attached to various BME groups etc. Or should they keep it all under their hat because it might upset people? Obviously knowledge isn't power...??!!

Nope notyummy. What I dispute is the persistent extrapolation of findings to encompass thousands of women not at risk. It's the same with alcohol.

Heavy drinking in pregnancy can cause fetal alcohol syndrome - THEREFORE YOU MUST NOT DRINK.

Serious obesity in pregnancy has shown higher risks/complications - THEREFORE YOU MUST NOT BE A LITTLE OVERWEIGHT BEFORE EVEN TRYING TO CONCEIVE.

Alas, we are no longer credited with having the brains or common sense to assess for ourselves the risks we are taking, and so they err on the side of not so much caution but absolute supression. And you know perfectly well that I'm not exaggerating: you only need to read the recent risotto post to see how damaging it is to put stress and anxiety on women who will almost always do what's best for their child.

I am absolutely convinced that before long we will see the weight equivalent of the risotto post - "Oh my GOD! I am 7 months pregnant have gained a stone; my midwife will be angry, I'd better start counting the calories!".

If it has happened with booze, nuts, cheese, pate, liver and mayonnaise, why shouldn't it happen with BMI?

Further more, don't you think that given women spend their entire lives being judged on their appearance, and that that judgement is based almost entirely upon how much space they happen to take up in the room, it would be nice if just for nine months at a stretch other priorities then their weight were put first?

Two of my good friends are currently pregnant. They are both absolutely shining with good health and happiness, and look completely beautiful. Yet both have already been made to fret about weight gain - there is something seriously wrong here.

Diclaimer: neither is obese, which rather proves my point.

My issue is with the use of BMI to define who is and isn't healthy in such a black and white way. My BMI was 34 when I got pregnant, which makes me in the very obese category and not allowed to go to the birthing centre (although I exercised regularly, entered 10k races and ate healthily). ALL of the midwives express astonishment at my BMI, because I don't look huge, I am a size 14 (not slim but not massive). I have always been heavier than I look and when a size 10 at the age of 15 would have been classed as overweight according to BMI (I was captain of the hockey and netball teams at school and played badminton at club level so not exactly unfit). I am active and eat healthily, have low blood pressure and (touch wood) have had no issues during my pregnancy. However I am immediately categorised as dangerously unhealthly because of my BMI and my options are taken away. And while I understand that the NHS has to use statistics and draw a cut off point somewhere, it is very annoying to be put in the "very unhealthy" camp with my choices taken away when all health care professionals I have seen have said BMI is a load of rubbish, I look perfectly fine and to ignore it!

So far I have only put on about a stone and plan to go on a diet after giving birth to get my BMI under 30 just to avoid being put into this bracket in future as it's so irritating to have my choices removed.

Rant over, but Drom, I feel your pain.

Headbanger that was an interesting post, and I do agree that reducing some of these messages to their most simplistic form is both annoying and unhelpful.

I had the occasional glass of wine in pregnancy for example, without it having any repercussions - and I am sure the majority of slightly overweight women do too. Perhaps we would be better focussing on the very high risk groups.

Headbanger - So the question is, is the harm of a little extra stress and anxiety amongst the worried well outweighed by the effect of more aggressive advice on those whose lifestyles are not healthy?

Because you can't have one set of advice for 'people who actually follow advice' and another set for 'people who won't follow advice but on whom it might have a moderating effect'.

Reducing alchohol consumption from low to none is not likely to have any major effect. Reducing it from high to moderate will though. So we have to live with advice that is calibrated to influence those with the worst habits.

I am obese too...my BMI at my 12 weeks scan was 31.5 which came as a bit of a shock as I am 5'7'' and am usually a 12 but have crept up to 14 over the winter.

In my area you are under consultant care if your BMI is over 35 but due to an admin error they are doing it to me too! They have said i need the blood pressure cuff "for larger ladies" etc.

My midwife has written to try and sort it out for me, so am still waiting to hear if the consultant will release me...

Coalition, tempting as it is to not reply to you because you're too thoroughly spiteful for words, I say this: it's essentially a political position. I do not approve of blanket regulation restricting the freedoms of the many in order to prevent the poor decisions of the (very) few.

Absurd as it seems, I see this as being part of the same mindset that brought in CRB checks for fathers driving their children's friends to Sunday football in order just in case they turn out to be a paedophile.

Disclaimer: of course I realise NICE guidelines are not regulations...

Firstly, you do not have to be weighed at book in. Yes, they will try, but if you dont want them to weigh you and therefore know your BMI, politely decline. "Okay then lets step on the scales, please". "Oh, no thank you, I'd like to decline that part of the book in process". Etc.

Secondly, if anyone presumes to lecture you on your weight, say "Would you like to make some recommendations?". When they say "eat a healthy diet in moderation" say "Thank you, I can assure you I am already doing that" and change the subject.

There is no reason why you have to go round and round in circles about this at your medical appointments. If you are doing all you can, ask that they focus on another part of your care.

Headbanger - that would be fine if the costs of the poor decisions of the few fell on those few. But it doesn't - the impact falls on their children and the financial cost falls on all of us.

The difference with the CRB checks is that in that case there was no evidence that the CRB would make any difference to safety at all whether as there IS evidence that the NICE guide lines will reduce harm.

It's a politcal posistion for me as well. I would like us to do what works, not what is dictated by ideology. Sometimes that involves putting up with things we don't like very much. I would LIKE the NHS to provide personalised care at all times throughout the system. We can't afford it, so we need to set the systems up as efficently as possible.

Altinkum, glad I made you laugh . I do know what a CRB does though, thanks awfully - administered enough of the fuckers. It was however brought in in the wake of the Sarah Payne murder.

Camel, is that you? If so then yippee! You're PG! If not then huge congrats anyway of course.

I do think YABU on this issue - for the same reasons everybody else said.

But yippee, well done, and enjoy your PG.

On a wider note, I think the word 'diet' has been monstrously abused over the years. Eating a healthy diet isn't 'going on a diet'. My 'Ready Steady Baby' book (Scottish PG NHS guide) says that in pregnancy you should be eating fresh produce, lots of fruit and veg, wholegrains etc.

To many people, this is indeed the equivalent of 'going on a diet'. And it is recommended in PG because it is the heathiest ideal for mother and baby.

If your current diet is, say, mainly made up of processed carbs, fried food etc, then yes you should change your diet in pregnancy - surely no doctor would say otherwise?

So in some people's lingo, yes, you should 'go on a diet' in pregnancy - if going on a diet means eating a balanced and healthy selection of foods.

YANBU, I was going to post something similar here and we have been moaning about it on one of the Pregnancy threads this morning.

My particular problem is not so much with the ideas behind the guidelines but with the reporting of them. I understand that it's good to encourage people to be healthy and to point out the risks of obesity to pg women. (Though arguably most people know these anyway.) My gripe is with the general scaremongering typified by the bloke NICE sent on to the Today programme this morning, who practially foamed at the mouth (I imagine) as he warned that over-eating in pregnancy can cause diabetes (not just gestational, IIRC), birth complications and fetal death.

I was not overweight before conceiving but I have definitely put on more weight than I should at 26 weeks. The chances that this has harmed my baby are absolutely minimal. I don't need to be shouted at by a grumpy man that all I need is an extra 'two slices of toast and a milky drink' in the third trimester. I eat a lot because I'm hungry, and I don't exercise as much as I used to because I'm too tired to go running. If this sounds defensive, it's because stupid guidelines and regulations make me feel defensive - and that's my problem with them. The NHS should encourage us to feel good and healthy about our pregnancies, not like potential harmers of our much-wanted babies if we deviate from the ideal.

Headbanger I think you have it spot on. This is all part of the typical attitude to pg women, i.e.: 'follow the guidelines to the letter and you deserve a healthy baby - deviate by drinking a small glass of wine, or not eating a healthy enough diet, and you are putting your baby at risk!' Well they can fuck right off. IMHO.

I dont think you are being unreasonable. I had to book in at a new hospital today (it was the 8 week booking in appointment even though I am actually 39 weeks pregnant). The midwife insisted on weighing me and comaparing my height and weight on ehr bmi chart which (I asked) is the same one they use when your not pregnant.She then proceeded to tell me that my bmi was quite high and give me advice on healthy eating. Now I may be wrong but Iw as size 14 before pregnancy (so not exactly thin) but SURELY being 9 months pregnant might raise my bmi a little. Had the most depressing appointment ever (had a rant in pregnancy board) and it was just the icing on the came to be told to take gentle exercise and not over indulge.

Fernie - where I work we have to reweigh all women at 36 weeks and calculate their BMI. Using normal BMI charts, then anyone with a BMI of over 30, or it maybe 35 should be on a CTG throughout labour.

It drives me wild. Its one hospital policy I don't really follow. Obviously if a woman had a BMI of 50 at booking I would recommend it more than for a woman who had a BMI of 28 at booking. I tell the women its hospital policy but its up to them, funnily enough most decline it.

Howcan they use the same bmi chart for preg & non preg? I nearly always put on loads of weight whilst preg 30kilos+. It was what I needed to do. For one preg I only gained 12kilos but did no different to the other pregs. A lot of the kilos where water as I lost 10 kilos in the days after giving birth

fernie you are 39 weeks and got a ticking off like a naughty child caught eating biscuits just before dinner?!?!?!?!?!