Obesity and Pregnancy: Time For Straight Talk
The New York Times just published an article on the tremendous risks to mom and baby from maternal obesity, Overweight and Pregnant, because the American College of Obstetrics and Gynecology (ACOG) Committee on Ethics just released Committee Opinion No. 600: Ethical Issues in the Care of the Obese Woman.
The prevalence of obesity in the United States is growing rapidly and many physicians feel that it is becoming an epidemic. While we debate about whether or not we can call obesity a medical condition, the reality is that excess weight and obesity is the cause of multiple medical issues and can worsen the course and outcome of many conditions, including pregnancy. The impact is so great that we can confidently say that the risk of dying during pregnancy, labor, delivery or postpartum (the period of time from 0 to 8 weeks after delivery) is significantly increased for mother and baby, if the mother is obese. Dying – that means – DEATH. Sounds serious doesn’t it? But there are numerous issues involved in dealing with obesity, not the least of which is the social stigma that surrounds being overweight and the natural tendency for physicians and patients to feel uncomfortable discussing it.
ACOG recommends that we classify obesity as a medical condition. They state that “Classifying obesity as a medical condition can serve to reduce bias toward obese patients and to change the approach toward the patient from one of blame to one of caring.” They recognize that we should not deny care to patients based upon bias but upon medicine and that sometimes, obesity can create risks that require a physician to decline treatment or to refer to another specialist if a physician cannot provide safe and effective care.
While I am not at all interested in the debate about whether or not obesity is a medical condition, I am very happy about the ACOG approach. If calling obesity a medical condition makes patients and physicians take this issue seriously, and removes the stigma from directly addressing this at every visit with every overweight patient, then that will go a long way towards solving these issues.
If you are overweight, it is time for us to talk – directly, without bias, and with compassion… but we need to talk! And as your physician, I need you to take me seriously but not take it personally. I am not trying to insult you, I am trying to help you become healthier and to have a healthier pregnancy and baby. Getting to a healthier weight will make a difference now and for the rest of your life. Work with me.