This week we will look at the critical moments when interventions can prevent an individual from developing future obesityand/or eating disorders. One of these times is pregnancy. There is a general belief that weight gain after pregnancy is inevitable and that women always struggle to lose weight once they have given birth to their babies.
In addition to the above, many women report that they have gained additional weight after each pregnancy until they reach the obese level by the time they have three or more children.
There seems to be a great inevitability about all these processes which discourages women to try and lose weight sensibly before and after pregnancy or after they have finished breastfeeding. According to Kassier, research results confirm this feeling of helplessness.
In 2014 Yajnik pointed out that, “... an individual is born at conception and not at delivery” in a paper tracing the transmission of obesity and adiposity and related disorders from mothers to babies. He also says that “The best window of opportunity to prevent foetal programming of NCDs [Non-communicable Diseases] is in the periconceptional period.”
The “periconceptional period” is that period during which gamgetogenesis (formation of the male sperm cells and the female ovum or egg cell), fertilisation, implantation, embryogenesis (early development of the embryo) and placentation (formation of the placenta) occur.
If we can improve the nutrition and the health of young girls who fall pregnant this would make a highly positive contribution to preventing the tidal wave of NCDs sweeping the globe in general, and South Africa in particular.
In South Africa we have a difficult balancing act to achieve because so many of our young women do fall pregnant when they are either overweight or greatly undernourished. To complicate matters, a great many women are not aware of how important this pre-conception period is and how they need to prepare themselves for pregnancy by achieving a normal weight and eating a healthy, balanced diet.
For example, Kassier mentions that if obese women can achieve even a modest weight reduction of 4.5 kg before they fall pregnant, the risk of them developing gestational diabetes (diabetes of pregnancy) is reduced considerably. Weight loss before pregnancy can also reduce the risk of neural tube defects in the foetus.
If you are, therefore, contemplating pregnancy or are in a relationship which could lead to unplanned pregnancy, and you are overweight or obese, it is vital to try and lose some weight with the help of a balanced diet and regular exercise, before you conceive.
Do keep in mind, however, that taking over-the-counter (OTC) slimming pills and potions is not a wise move. This may endanger the foetus because such products all too often contain potentially harmful ingredients, even if their labels proclaim that the products are “safe, natural and herbal”.
During the 9 months of pregnancy, some weight gain is to be expected, but women who eat for two and gain massive amounts of weight, tend to find it difficult to shed this weight after their pregnancies and will struggle with an increased BMI (Body Mass Index) for years to come, if not for the rest of their lives.
Kassier recommended that pregnancies should be spaced by at least 18 months and that maternal weight loss should be encouraged during this period.
There are of course stumbling blocks that pregnant women encounter. They may change their behaviours during pregnancy (eat more, eat different foods, exercise less), and then allow such negative behaviours to continue throughout their lives. Studies have shown that one of the most effective ways of counteracting this long-term negative effect of pregnancy on maternal body weight is to provide women with dietary advice during their pregnancy.
Problems and solutions
The following factors complicate this provision of dietary advice to mothers:
Dieticians are thinly spread in South Africa, and many women do not have access to dietary consultants.
Suna Kassier helped to train nearly 580 nutrition advisors across KwaZulu-Natal, who now work at clinics to give sensible dietary advice available to women throughout this province. Hopefully this excellent system will be introduced in all the provinces of South Africa.
Generally speaking, pregnancy and lactationdiets are a veritable minefield of misinformation.
Responsible journalism when writing about maternity and maternal diets can help a great deal to dispel such myths and falsehoods. One advantage, is that the antenatal period is regarded as a highly “teachable moment” when women are open to receiving health promoting and disease preventing information.
South Africans, particularly women, are still great magazine readers, as demonstrated by the amazing variety of magazines in all languages available in book shops, supermarkets, and even filling stations. These magazines and our plethora of local radio stations are the ideal channel for providing all the women in South Africa with balanced, sensible information about pregnancy, food intake during pregnancy and lactation, control of weight before, during and after pregnancy, and the use of regular exercise throughout life to maintain weight and health.
Challenging all communicators
I would like to appeal to everyone working in the fields of health communication to take up the challenge to write science-based articles and radio messages relating to maternal weight and health.
- Kassier S (2015). Prevention of Obesity & Eating Disorders. Paper presented at the SASA Nutrition in NCD Prevention Roadshow, Pretoria, on 12 February 2015.
- Yajnik, CS (2014). Transmission of obesity-adiposity and related disorders from the mother to the baby. Annals of Nutrition & Metabolism. Vol 64(Suppl 1:8-17).