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).