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Weighing the evidence

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57% of UK women are on a ‘diet’ all or most of the time, yet as a student midwife it is impossible to have escaped the assertion that we are in the grip of an obesity crisis, threatening the health and pregnancy outcomes of increasing numbers of women, says NT student editor for midwifery, Holly Morse. 

holly morse

The media narrative, framing the overweight as lazy and weak-willed, combined with the multi-million pound diet industry appears to offer the answer: simply eat less and do more.

So…if most of us are on a diet, most of the time, why are we getting heavier??

Writing a recent assignment on the care offered to women considered to have a high BMI I was challenged by the evidence that BMI itself (calculated by dividing weight by height squared to give a ‘body fat’ calculation) is unable to differentiate between muscle, fat and bone – so is a very poor indicator of risk.

Unfortunately, due to its simplicity, it continues to be used in isolation, with midwives allocating women to consultant or midwifery led care based on this calculation alone.

“Dieting is an approach that has been unable to demonstrate any long term success in reducing obesity”

Experts in the US argue that our obsession with weight rather than health is damaging public health and that more focus should be shifted to increasing activity levels rather than on dieting.

Calorie restriction, causing weight loss, reduces metabolism, a clever protective evolutionary mechanism useful in times of famine – causing long term weight gain.

The concept of ‘dieting’ as an obesity panacea, encouraging women to support, financially, ideologically and emotionally has been legitimised by guidelines incorporating midwife referrals to diet companies.

Dieting is an approach that has been unable to demonstrate any long term success in reducing obesity, with less than one fifth of those who lose weight through slimming programmes maintaining the loss for one year and two thirds regaining more weight than they lost.

In addition to lack of weight loss or health benefits there is evidence that physical and psychological harm is caused by repeated attempts to adhere to structured diet plans giving rise to obsessive thoughts of food, bingeing behaviours, depression, social withdrawal and isolation, feelings of failure and decreased perception of self-worth and value.

“The implications of directing post-natal women to these ‘diet’ plans are far from benign, potentially breaching the NMC Code”

In contrast, supporting lifestyle change via exercise programmes creates positive metabolic responses, enhancing satiety, improving wellbeing through endorphin production and supporting weight loss and/or maintenance.

So, the answer to sustainable weight reduction it seems is not to restrict calories but to increase activity and vary sources of nutrition!

Between 2012 and 2017 the diet industry in the UK grew in value from £19 billion to £2.2 billion. Framing obesity as caused by laziness and non-compliance, huge profits rely on continued referrals from midwives and other health professionals.

For pregnant and postnatal women, already managing the impact of the physical changes of pregnancy and birth and psychological, emotional, social and practical adjustment of becoming a mother, the implications of directing women to these companies and ‘diet’ plans are far from benign, potentially breaching the NMC Code by failing to act in the best interests of the woman and family and to the best available evidence.

The consequences of behavioural and cognitive preoccupation with weight, mental health impact of likely ‘failure’ to maintain weight loss, repeat weight cycling and metabolic adaptations may have a long lasting negative impact on parenting and family health and wellbeing, including passing these on, through epigenetic changes and learned behaviour, to the next generation.

Food for thought for us all, especially as future health professionals?

Meet the Student NT editors for 2018 here

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