NICE - Guidelines on weight and pregnancy

[notyummy]

here

Interested in people's thoughts on this.

Most threads I see on here about this are posted by very over weight/obese ladies concerned about the impact on their pregnancy - or FURIOUS that people want to weigh them to work out how much risk they may be running.

A lot of the replies run along the lines of 'There, there, everything will be all right. They are all a bunch of body facists. I had an easy pregnancy and birth and I weight XX stone. Don't let them weigh you.'

And so on and so forth.

Should we be getting a bit tougher on this? (I am not sure how, btw - just opening a debate.) After all, it's not just the woman hereslef at risk - its a heightened risk to the baby. Plus the additional costs to the NHs as a result of more CSs/higher infection rates/more complications for babies.

Interested in other perspectives.

I don't think there's anything wrong in saying that if you're planning a pregnancy then you should aim to be in good nick before you conceive, a healthy weight, tanked up on the folic acid, given up on fags and booze etc., to give yourself and your baby a good chance of avoiding health issues pre/during/post pregnancy. I don't think there's anything wrong with monitoring body-weight during pregancy either... we're quite happy to submit to blood-tests and have our BP taken. Body weight just happens to be a very sensitive issue. I was overweight when I got pregnant (unplanned), was never monitored & had various medical problems, probably as a result. I'd do it differently if I had my time over.

I don't think it's necessary to 'get tougher' as such, except where a patient is asking for IVF on the NHS. NICE is set up to keep a lid on costs. The current cut-off for treatment is BMI 30 and maybe in future the limit could be lower.

I am very overweight, I was in my last pregnancy and they mentioned it at booking appointment, but nothing after that. I am now pregnant again and slightly heavier than last time.

I really wanted to be a lot lighter than last time, however due to an underlying health condition I couldn't exercise as I was constantly in pain and depressed (I am not one that stops eating when depressed, just the opposite!). It was more important from the doctors point of view to get me on an even keel than to try tackling my weight when I was so down.

I really want the MWs to weigh me at every appointment to monitor my weight as I don't want to gain any, or as little as possible. I have managed to lose nearly a stone in 3 months so that's a start. It is hard to say it should be a part of checkups in pregnancy as there are people who have suffered eating disorders to whom it would be detrimental. I think if you request it, they should weigh you every time.

I don't think it should be used as a measure of the risk you are running - more as a part of trying to keep you as healthy as possible by not gaining masses of weight, especially if you are overweight already.

'Should we be getting a bit tougher on this? (I am not sure how, btw - just opening a debate.) After all, it's not just the woman hereslef at risk - its a heightened risk to the baby. Plus the additional costs to the NHs as a result of more CSs/higher infection rates/more complications for babies.'

That sort of comment is why people get so cross with the latest NICE diktats...because sooner or later (at least under the last Govt) legislation would be passed in a kneejerk reaction. What are you going to do - stop people having sex if their BMI is over 26? How do you even begin to police that?

I think it's the nanny state voice, and the intrusion into the pregnancy 'cocoon' that women don't like. It also doesn't allow for the differences in bodies - my BMI is 30, for the waist-hip ratio I am 0.76 so at a low risk of disease; and my Doctor says my cholesterol level is 1.9 overall, and one of the best she's ever seen. Given that I eat full fat cheese, butter and lots of chocolate, this amazes me. My diet is otherwise healthy.

My dh on the other hand, has low fat spread, brown bread, 5 a day, doesn't eat chocolate, doesn't take sugar in anything, yet has Type 2 diabetes and is on statins and blood pressure tablets. Go figure.

No 'we' shouldn't be getting a bit tougher on this. Enough said.

What ahould be done then? NICE is attempting to make the point that women would be better off being a healthier weight before they get pregnant, and then there would be better outcomes for them and their baby. Obviously, there is a much wider issue around the whole society getting fatter, and a lot more people getting more obesity related diseases - some of those are pregant women.

I can't believe that we are just supposed to sit back and watch people carry on getting wider. For a start it is a huge drain on the NHS, and as a nation we are skint.

Obviously there are no easy answers, and 'getting tough' may be a poorly chosen phrase, however just allowing more and more people to become overweight (and statistically they are MUCH more likely to have overweight children) surely can't be the answer?

People claim they don't exercise because they are too busy - but seems hard to be constantly busy but not taking exercise (not counting those in sedentary desk jobs).

Doing housework,cooking meals etc gives you exercise. Teachers and nurses are on their feet all day, nowadays checkout staff work pretty fast so are getting exercise too. Let alone posties who work at a trot these days.

How come everyone is so fat.

If it's the non-workers then what is stopping them from walking out the front door. Walk for 30 mins then turn round and come back. Do it every day. In a month or two you'd be pretty fit.

Ok that's hard with small children but not impossible. Also exercise is one of the best things to help with depression as it causes the release of endorpins.

Problem is once you are seriously obese it needs a real life change to deal with it. Not just cutting back on chips. That probably deters people.

It's just common sense really. Obesity = health risk, which is increased during pregnancy.I don't think we should keep on pussyfooting around this issue to avoid upsetting people.
I was weighed throughout all my pregnancies [1988-2000], it was common procedure and I don't think anyone got upset over it. I did regulate my own diet [not starve myself], I didn't want [a] to give birth to massive babies or [b] to have lots of weight to lose afterwards either.
Having said that, I am now overweight; my own fault and my own responsibility to deal with it.
I don't think the NHS can turn a blind eye to it in all honesty. Individuals do have to take a certain amount of responsibility as regards their own health. We have reached this stage re smoking and it does have to be adressed re overeating [and alcoholism and drug use].

Although it seems to be socially acceptable to get all huffy about someone who's smoking and pregnant, drinking wine and pregnant, eating various banned foodstuffs and pregnant.... it's only a matter of time before 'fat and pregnant' (if that's not tautology) becomes the new socially unacceptable taboo.

Josie - I agree!

I am overweight - a size 18 when for my frame I should be a lot smaller, but I am not a drain on the NHS. I see the doc maybe once every six months for a blood test as being pregnant triggered ITP (an auto immune disease), but that and my back (disc damage from my 20s) are all I go for.

'We' have to sit back and let people do with their bodies what they will. If I choose to eat chocolate for breakfast, lunch and dinner, then that is my concern, not yours. You either go down the totalitarian route of rationing and dictating what people eat by controlling the food supply; or you let the populace get on with it.

I also have to say I resent all the focus on body type. I know a lass who is anorexic because she is so concerned about her body image - I'd rather people can be who they are without defining themselves by their size - it's the brains and the personality that count.

The discussion seems to be about obesity in pregnancy and not in general.

Society has developed the tendency to point at people smoking in pregnancy and say "how can you do that ?!?" Doctors in particular will advise against it and in my experience offer local help to quit.

Being overweight and pregnant also carries risks.

So will society start to do with overweight people as they do with pregnant smokers? If it's OK to do it with smokers, which most would say it is, shouldn't it be OK for overweight people?

More generally....

"I am overweight - a size 18 when for my frame I should be a lot smaller, but I am not a drain on the NHS."

As with smoking the problems being overweight generally build up over time. So while you may not be a "drain" on the NHS now in the future it's more likely that you will be when compared to someone who's not overweight.

And again it's seen as OK for society to "crack" down on smoking and try to restrict it and tax it.

And I say all of this as someone who is more than fond of the pies and really could do with loosing a fair bit of weight.

Smoking is a choice - weight sometimes isn't. One of the treatments for my auto immune disease for instance is steroids for the rest of my life. Bearing in mind that I got ITP when I was 29 and pregnant, and am now 44, if I'd had the steroids I'd be huge, as weight gain is a side effect of that medication. If you have to have medication that adds weight - are you to be penalised for that?

Cigarettes are highly taxed, so that influences behaviour (supposedly). I don't see that one can tax food in the same way - what would you have - an over 25 BMI checkout at Tesco?

I accept that weight sometimes isnt a chouce; but I refuse to believe that the majority of people who are overweight have an underlying illness contributing to it.

The reasons they are overweight may be complex, but the very simplistic reason for most (not all!) is that they eat too much and do little exercise.

Now, from a public health perspective it is probably the biggest challenge this counrty faces. Even in the US, which has a very 'hands off' tradition (otherwise known as 'sink or swim poor people') in public health care, is recognising that they need to do something. If I care nothing for whatever everyone around me is eating/drinking/smoking etc then in the longer term I will probably care about the fact that I have no pension due to all the money being spent on the NHS, and cannot access any healthcare because people with obesity issues are completely overstretching our medical services. That is why I DO think we should care how other people behave (over certain issues).

Smoking, seatbelts in cars etc. We have a traditional in influencing peoples behaviour for the better and having less people die as a result. I fail to see how this is different.

What I don't know is how we do it!

I'm not asking you to believe that all overweight people have an underlying illness, but some will. What people choose to eat is their business, not yours. You could equally argue that by getting people to live longer by being healthier you are over-stretching the NHS as there will be more people to treat as they haven't died off. The biggest challenge the NHS faces is that there are too many people in the UK, and the immigration levels puts a strain on the services.

I am not bothered about living as long as I can, but enjoying the ride whilst I'm here. That means chocolate, cheese, wine, decent beer, olive oil, pasta, cherries, plums, crisps, cheese straws, tzatziki, coffee, clotted cream, meat, bacon sarnies. You are a long time dead without these things.

Flipping heck scary - are you a DM devotee?!

I would prefer that people live to the end of their natural life (whenever that maybe) without needing to visit the doctors constantly because of chronic conditions caused by obesity.

The NHS would not function at the moment WITHOUT the evil immigrants. Have a look at the stats about the countries of origin of NHS staff at the moment.

No one is saying that people should not being allowed to have a treat. I am not some size 6 stick insect; I eat cake - I just exercise as well! The fact is that in the 1950s we all ate more calories than do now - but we exercised more. If people's lifestyles have changed to mean that they no longer burn those calories off, then we (as a nation) will get fatter. Now unless you are suggesting we dont treat people with chronic illness caused by obesity, then REGARDLESS of whether they die earlier or not, we still need to pay for their healthcare until they die. Because they are overweight and have made poor diet and exercise choices. There is a financial imperative in this, as well as a 'moral' one - not everyone would agree with both, but surely one or the other makes sense?

I believe there is more to look at than just weight in pregnancy - each individual should be assessed on thier circumstances- diet, excercise, etc. Being a helathy weight but never moving your body and only eating crap carries it's own risks. The NHS were so focussed on my weight I did some research myself and opted for a home birth with an independant midwife. Thank god as I had a lovely expereince. The only time I did go into hospital for a check the consultant tried to stop me leaving as either I or my baby "would bleed to death". Being overweight is my business and I'm sick of everyone banging on about weight!

Not only does being overweight mean that there is a risk to women during pregnancy, there is a risk to the babies as well, not only during gestation but, studies have suggested, for many years afterwards if mothers are overweight and eating unhealthily during pregnancy.

People seem to regard being overweight as a legitimate lifestyle choice - "It's my body, I don't see why I should have to lose weight" - but if you are pregnant, it may have long-term consequences on your children. I wish people would just face up to it and one way of doing that is if someone presents at a GP's surgery saying "I can't get pregnant", doctors should have the balls to tell them their weight could be a factor. I've spoken to some on this issue and the consensus seems to be that they don't like to as it's a sensitive issue.

No - Daily Telegraph actually.

We have too many people in the UK. It is a relatively small geographical space, and the resources are over stretched now due to the volume of people using them; schools, roads, social services, social care, GPs, Dentists etc.

I am not bashing immigrants (I am one where I live in Europe), but the immigration level both EU and non EU has added to the infrastructure problems. I did not see that I had typed anywhere that immigrants were evil; you are extrapolating from the word immigration a position that I do not hold. If you consider that more people live in London than in the whole of Belgium, and that by 2050 the UK will have the biggest population in Europe, then you see what I mean. It is possible to discuss things at an abstract and objective level surely, without descending to accusations of reading the Daily Mail?

As someone whose job according to their profile is getting Local and Central Government to communicate, you must be aware of the strains put on infrastructure over the past decade for example. If it was being seen in Cornwall when I left 4 years ago, then it must be worse in other more populated areas of the UK.

As to weight - people's choices are theirs to make - like smoking, drinking and taking illegal substances. I would also argue that people who have conditions caused by their weight are paying for their own health care through taxes; just as I presume those with eating disorders such as bulimia and anorexia are doing as well. I don't see that there is a moral imperative to lose weight; or that there is one to demonise people about it either.

Off to UK at o'crack sparrow tomorrow, so no computer access for a fortnight.

I am an immigrant to the UK.

But just thought I'd add that I am not overweight and not a smoker

ilove, are you married yet?
How did it go?

No, not yet . October. Very very low key. In Cornwall and hopefully my mother and aunt will be coming over from California.

No I don't think we should demonise people scary. I think we should to understand the (very) complex reasons that people are overweight and seek to influence their behaviour so they are less likely to be. I understand it is a free society and people should be allowed to exercise freedom of choice. I DO worry though that the children of overweight people are FAR more likely to become overweight themselves - they are having their freedom of choice taken from them as they can only eat and behave as the adults around them guide them to do. Those adults are their role models and if they 'normalise' an unhealthy lifestyle then they will become the one of the 1 in 4 children that are overweight when starting school (stats are far worse for year 6.)

I do agree about the infrastructure btw.

Sorry, couldnt resist the DM comment, but realise it was childish....

I didn't realise the NHS has stopped weighing people in pregnancy. When I had our first 3 babies on te NHS in the 1980s you wree weighedand told if it were too much or too less. I don't think that's wrong. I was always done sensitively and indeed when I had my twins later I wanted to put on enough weight as twins do better if they are good weights.

Oooh, full report at appropriate time please!