Science & Sensibility readers may recall the Maternal Obesity from all Sides series* we did a few months ago. Last week, while walking my dog and catching up on a few news podcasts, I heard this story on NPR's Morning Edition - a segment that was a part of the news outlet's series on Obesity in America. The story discusses new research that looks at why it can be so difficult to lose and keep weight off from a hormonal and biological perspective. The gist of the research referenced in this news piece is that when we concertedly work to lose weight, our body produces less of the hormone leptin (a natural appetite suppressant) which prompts a starvation signal in our brain, telling the body to conserve energy by decreasing metabolism and, at the same time, feel more hungry - prompting increased caloric intake.

Additionally, the Morning Edition segment made the point that once a person has gained more weight than that which is healthy for his/her stature, it becomes harder and harder to lose and keep the weight off. As the reporter summarizes, 'lower metabolism lasts a lifetime.' (Despite this, some excellent points are later made in the segment which suggest that moderate exercise six days a week - such as brisk walking, swimming or cycling, can have positive effects on weight loss and maintenance.)

What does all this have to do with maternity care issues?

Well, in the Maternal Obesity from all Sides series, we discussed the growing correlations between maternal overweight and pregnancy and L&D outcomes: how women of size are more likely to experience gestational hypertension and diabetes; how they are more likely to be offered labor inductions and undergo cesarean deliveries as a result of those comorbidities - whether or not those procedures are actually evidence-based for the given situation(s). And we also discussed how addressing size and/or weight once a woman is pregnant is both unfruitful and unfair - because most of us recognize that pregnancy is not a time when a woman should be attempting to lose weight. Likewise, it is not a time when a woman should be shamed for a preexisting condition (as if shaming is ever acceptable).

But, in the spirit of preventative care, I felt the NPR piece was enlightening: while there are MANY opportunities to improve maternal outcomes through preconception/interconception care, as pointed out in the recent blog post by Christine Morton, and the more distant series by Walker Karraa, perhaps working to prevent obesity in the first place - rather than focusing on after-the-fact individual or public health weight loss programming - is a better approach. Because, according to the news segment linked to above, once extra weight has been acquired, losing and maintaining that weight loss is exceptionally more difficult.

A similar NPR story on All Things Considered aired just a few days earlier which covered this same topic and reviewed the findings of a study recently published in the New England Journal of Medicine. The study by Priya Sumithran et al. assessed the hormone and metabolism changes that accompanied significant weight loss in severely calorie-restricted study subjects. As described in the Morning Edition segment, Sumithran's study described significant weight loss maintenance difficulties that were hormonally based. In essence: maintaining weight loss is about hormones, not will power.

Women of childbearing age have enough maternity care-related challenges to face: escalating labor induction and cesarean delivery rates, racial disparities in access to care. We talk a lot on this blog site about the cascade of interventions, a concept that is also frequently referred to in Lamaze teachings. Perhaps it is time we should also be talking about a healthy cascade of prevention, with maternal obesity being a prime target. Ideally this cascade of prevention begins well before women of childbearing age find themselves contemplating pregnancy, or preparing for birth. But even as childbirth educators, we can play a part in this healthy cascade. When covering postpartum topics, we can talk with our expectant parents about the importance of interconception health: nutritious dietary choices and adequate exercise. We can couch these discussions as approaches to optimizing health in various ways with various downstream benefits: having adequate energy to play with one's child(ren), reducing a family's healthcare cost burden, and yes, laying the ground work for healthfully supporting a future pregnancy if and when that occurs.

As Dr. Miranda Waggoner stated in her interview with Dr. Morton, '...we do have to worry about viewing women as pregnancy vessels,' but I also think we need to begin looking at expectant women beyond just the here and now.

*The Maternal Obesity from All Sides series is also reviewed in the current Journal of Perinatal Education. If you don't already receive the JPE and would like to check it out, you can request a free copy of the journal here.

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