This issue of the Sax Institute peer-reviewed journal is focused on reframing the obesity narrative. It was published last week in the lead up to the International Congress on Obesity (ICO), which is in Melbourne from 18-22 October 2022.
Rising obesity rates are a global challenge, and preconception and pregnancy are high-risk periods for excess weight gain and the subsequent development of obesity.
CRE HiPP Chief Investigator Associate Professor Jacqueline Boyle led a paper identifying policies and healthcare to optimise planning and weight management during the preconception period.
“Around one in two women conceive a pregnancy with a BMI >25 kg/m2,” said Associate Professor Boyle.
According to the Australian Institute of Health and Welfare, “a BMI of 25 to 29.9 is defined as overweight … and a BMI of 30 or more is defined as obesity in pregnancy.”
Associate Professor Boyle’s research shows that reproductive aged women are gaining weight faster than previous generations.
“This contributes to increased health risks for themselves over their lifespan, as well as increased risks in pregnancy and for their future children,” she said.
Pregnancy risks include gestational diabetes, hypertension in pregnancy, macrosomia and caesarean section. Risks to children include childhood obesity and metabolic syndrome, as well as cardiovascular disease as they move into adulthood.
“A system of universal population programs and targeted interventions, both across the lifecourse and leading up to preconception to prevent weight gain are important,” said Dr Boyle.
“This requires public health policy, programs and services across a range of areas, but importantly includes through the education system.”
She emphasised that “A holistic approach to a healthy weight is required.
“This is because psychosocial wellbeing and connectedness impact our health behaviours and capacity to effect change. Broader influences can affect our ability to engage with positive health behaviours.
“For example socioeconomic status can shape our ability to afford healthy nutrition, and our lived environment can limit our capacity for physical activity, if there is a lack of public spaces or safe areas to exercise.
“It is also particularly important that we do not stigmatise individuals living in larger bodies.”
Associate Professor Boyle also said that further research in this area is required.
“There is currently limited evidence that weight loss prior to conception leads to improved pregnancy outcomes. Two large Australian studies led by Professor Jodie Dodd and Professor Adrienne Gordon are working to evaluate this.
“In addition there has not been a significant focus on the effect of paternal increased BMI on children. This also appears to have an impact, and future work needs to involve men,” she said.
In the second CRE HiPP-led paper in the special issue, Research Fellow Dr Briony Hill and Senior Research Fellow and senior author Dr Cheryce Harrison are among the authors who looked at optimising weight gain in pregnancy. This paper discusses the main challenges and solutions for maternal obesity prevention.
This continues more than a decade of their research into preventing excess gestational weight gain (GWG), which is experienced by more than 50% of women during pregnancy.
“Weight gain outside of recommendations is associated with increased risks for both mothers and their children, and is commonly linked to higher weight status in later life,” said Dr Hill.
“If we can help mitigate some of this risk, we hope that families can lead healthier lives. This has additional benefits, such as potentially reducing healthcare costs.”
According to Dr Hill, the key challenge for maternal obesity prevention is reducing blame on mothers.
“The current narrative is that women who enter pregnancy with a high BMI/larger body size, or gain weight above recommendations, are putting their children at risk and that it’s ‘all their fault’,” she said.
“We need to shift this to understand that optimising wellbeing for mothers during pregnancy is a shared responsibility across society.”
Dr Hill’s research shows that strategies to help women maintain a healthy weight during pregnancy must consider their competing psychological, social and environmental priorities and demands.
“It is much easier to make changes to improve your diet and physical activity behaviours in pregnancy when there are no competing issues such as mental health concerns, poverty, or housing instability.
“Strategies such as seeking instructions on how to perform the behaviours (for example how to cook nutritious meals), setting clear goals, tracking progress towards meeting goals and understanding the consequences of behaviour can help.
“While our understanding of how to promote healthy diet and physical activity behaviours in pregnancy is improving, we now need to focus on how we can safely and effectively implement such programs in real world settings to help people in real life.
“This must take into account all of the competing priorities and demands faced by these women,” she said.
CRE HiPP Director Professor Helen Skouteris and Associate Investigator Professor Louise Baur were among four Guest Editors for the special issue. They contributed to the editorial which calls for “Determined action and bold leadership … to enact significant change in obesity prevalence.”
The special issue was produced in partnership with Monash University’s Health and Social Care Unit (HSCU) and with support from VicHealth. It can be viewed at www.phrp.com.au. A workshop discussing the papers in the issue will be held at ICO.Back