My big fat reading list

I keep on accumulating things I am reading that I wanted to talk about. Well, it has turned into a link fest. So, here’s my linkaround for the week, mostly journal club style:

Maternal Obesity and Breast-feeding Practices Among White and Black Women (pdf) and abstract. I had many problems with this article. First of all, the associations seemed really inconclusive. I would have preferred this data looked at through another lens, not obesity, but, since it was published in Obesity, I guess that was the point. The only association in any of the groups with BMI and breastfeeding was in the very obese, and that was only in white women. How is this an examination of race and BMI, except to show there WASN’T much of an association. I am also dismayed but not surprised at the higher cesarean rate among overweight and obese women. And, considering those higher cesarean rates, why did the adjusted hazard ratio NOT adjust for mode of delivery, when cesarean section has (in some research, not all) been associated with less initiation and success in breastfeeding? They adjusted for: mothers’ age, education, marital status at birth or during the pregnancy, Medicaid status, and pregnancy complications; parity; and first trimester initiation of prenatal care, but not mode of delivery.

What the data (not the discussion) highlighted was the racial disparity, not much about obesity and breastfeeding, and doesn’t offer much in the way of offering solutions or explanations as to why black women have such poorer rates of breastfeeding initiation.

Also from Obesity, BMI and Mortality: Results From a National Longitudinal Study of Canadian Adults.

Although a clear risk of mortality is associated with obesity, the risk of mortality associated with overweight is equivocal. The objective of this study is to estimate the relationship between BMI and all-cause mortality in a nationally representative sample of Canadian adults. A sample of 11,326 respondents aged ≥25 in the 1994/1995 National Population Health Survey (Canada) was studied using Cox proportional hazards models. A significant increased risk of mortality over the 12 years of follow-up was observed for underweight (BMI <18.5; relative risk (RR) = 1.73, P 35; RR = 1.36, P <0.05). Overweight (BMI 25 to <30) was associated with a significantly decreased risk of death (RR = 0.83, P 0.05). Our results are similar to those from other recent studies, confirming that underweight and obesity class II+ are clear risk factors for mortality, and showing that when compared to the acceptable BMI category, overweight appears to be protective against mortality. Obesity class I was not associated with an increased risk of mortality.

Emphasis mine. As someone in the obesity class I, I am feeling a lot of harumphing about this right now. I am waiting to hear all the criticism of underweight people (not that I would or I want it) from the peanut gallery, and the admission that overweight and mild obesity isn’t going to kill us all with the fat. I want a big fat apology to Dr. Regina Benjamin. (Commenting note: Please notice I never said appropriate exercise or a healthy-for-you diet were bad. That is not the topic. The topic is whether overweight and obesity deserves the constant, relentless public shaming and association with lack of health that it does).

And, just to be balanced, CNN has some information on why being overweight may negatively affect your health: provider bias. Yes, I also agree that some diagnostic tests and techniques like a manual pelvic exam or Leopold’s maneuver can be more difficult with more tissue there. But, the misdiagnosing and over testing (and over sectioning) of overweight and obese women is due to provider bias as much as testing and maneuvering fail. (Hat tip to Shakesville for that last one).

6 Comments

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6 responses to “My big fat reading list

  1. Oh hello. I love you. That’s all.

  2. I’ve been really busy with a due date on a project, but now I think you’re going to make me have to do a reply turned post on my blog!

    The gist of it: They love to do these “fat women breastfeed less” studies and stories, but when do they examine WHY, other than to simply blame obesity? Where’s the meaningful information that helps with the problem instead of merely reporting it? (And frankly, exploiting it for sensationalism and the obesity hysteridemic.)

    And you’re right, very few of these studies control for cesarean delivery, which a fair amount of research shows can impact bfing initiation rates in particular, and also short-term bfing rates. And labor management too—that can torpedo bfing in some ways as well.

    This is a touchy subject for me. Breastfeeding with my first baby was almost completely torpedoed because of induction, lots of IV fluids, the resulting severe edema, cesarean, being separated from my baby for 8 hours, a truckload of formula and glucose water shoved at us, and pacifiers everywhere you turned. It’s actually a miracle we managed to preserve bfing at all. I had no problems bfing my later babies, but bfing almost failed with #1….and MOST of that had to do with labor management and neonatal interventions. You CANNOT tell me that doesn’t matter.

    I also keep waiting for them to have anything meaningful to say about PCOS and breastfeeding. Many “very obese” women have PCOS, and some research (and lots of anecdotal evidence) shows that PCOS often affects bfing supply. So how much of this reduced bfing rate is due to PCOS supply issues, and how much to other factors? Lisa Marasco, IBCLC, has done research on this, but she is one of the lone voices in the wilderness. After all these years, why isn’t more being done on the PCOS/bfing connection?

    Also, there are SO many of us fat moms who HAVE breastfed successfully. Why aren’t they studying the fat women who bf successfully long-term vs. the ones who don’t and see what the differences are? I bet that’d show some interesting differences.

    I just wish there was more MEANINGFUL research on this topic instead of just simplistic sensationalism. Ugh.

    I sense a rant coming on! Thanks for sparking it.

  3. YoungBlazer

    This study has been proven as bunk
    http://news.harvard.edu/gazette/story/2013/02/weight-and-mortality/
    hope this helps

    • MomTFH

      No, the article (which is not a peer reviewed study like the one I link to) says that some researchers (whose institution printed the article) disagreed with some of the methodology (methodology which was supported by the CDC), not that it was proven to be “bunk.”

      When the Journal of the Amerian Medical Association issues a retraction, which it won’t, I’m sure you’ll be the first to let me know.

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