My opinion piece in today’s JEP looks at the health problems (immediate and in the future) of being obese when pregnant and at how much the States should intervene (or not) and why. I have to say, it’s easier to write 7,500 words on the subject than to keep it to 750:
We’ve heard a lot recently about health issues facing Islanders, but what if I were to tell you that the health of our children can be affected even before they are born and that we are sitting on a health time-bomb?
The danger lies in excess body fat, particularly the inflammation-causing stuff around your belly and organs. Obesity in women of reproductive age is increasing worldwide, including in Jersey. This very real problem needs tackling now both in terms of our population’s health and the concomitant costs to the Island purse.
(Obese men who want to become fathers also have more problems with their end of baby making, but that’s a story for another time.)
We don’t have enough studies looking at the prevalence of obesity just before pregnancy, so the next best thing is to look at data regarding women of reproductive age, and these offer some disturbing insights. Let’s look at some of the problems that can ensue.
Fertility is reduced and associated problems (such as type 2 diabetes and chronic hypertension) mean there is more risk of miscarriage, premature birth, stillbirth and congenital foetal malformations. We also see an increased risk of gestational diabetes and pre-eclampsia, both of which can be dangerous if not treated in time.
In addition, babies that reach full term are often larger, which can result in a difficult labour, post-partum haemorrhage, more risks with Caesarean operations, later weight and health problems for the child, and more complications in subsequent pregnancies.
If this is putting you off your afternoon cuppa, then I apologise – but not too effusively. This is a big problem facing Jersey and one the States need to be discussing as a matter of urgency. Finger-pointing will not help: people don’t choose to become obese. We need to identify who is more at risk and find out their circumstances.
We must also ask: how do we educate women who want to become pregnant of the dangers of carrying a child when obese; how do we help already pregnant obese women manage their weight and blood sugar levels during and after pregnancy; and how do we follow up with overweight babies and toddlers, many of whom are destined to become obese teenagers and adults?
As many of the problems start from early pregnancy, reducing obesity before conception is probably the best strategy to decrease the health burden associated with maternal obesity, but one thing I have noticed is health professionals’ reluctance to say to overweight would-be parents, ‘You are overweight and this will affect your health and that of your children’.
We can’t afford to not speak through fear of offending: surely it’s more offensive to let people carry on as they are and be more likely to face health dangers? We hear that some of our Islanders do not know how to prepare healthy meals. Do we offer classes? Do we make them mandatory for pregnant, obese women? The States must start debating what and how much intervention is wanted, needed, acceptable and affordable.
At the very least, we need screening for glucose intolerance, insulin resistance, pre-existing (but not yet diagnosed) diabetes and nutrient deficiencies for women planning on becoming pregnant and those in their first trimester.
While no single diet fits all, Jersey needs to stop recommending and even ditch the NHS’s EatUnwell Plate, which is based on a complete misunderstanding of human biochemistry and designed to promote fat deposition and diabetes, and come up with our own EatBetterThanTheUK recommendations.
We also need a policy of differential taxing for fresh foods and processed foods, but when I last enquired about that, I was told by the Minister, ‘Sorry: really difficult to do’: hmmm, that is not a good reason not to try.
What of exercise? The calories-in-calories-out theory has been thoroughly debunked, meaning you cannot ‘run off that cake’; on the other hand, exercise has many health benefits including increasing insulin sensitivity which helps control weight gains in the first place. Can’t exercise much? Even fidgeting and housework count!
What to do in the meantime? Go ‘natural’. Ditch soft drinks, sugar and packet food and avoid having more than one daily serving of wheat. Instead, eat real food: tuck into delicious, filling meals made from meats, organs, dairy, eggs, nuts, pulses and colourful, fresh produce – there’s so much loveliness out there to choose from.
And while you’re thinking about it, please contact your Deputies and ask what they are going to do to help our Island’s health.
Bouan appétit!