The name that UNC Health Care is giving its children’s clinic in North Carolina has been raising a lot of eyebrows. The facility is slated to be renamed the Krispy Kreme Challenge Children’s Specialty Clinic. But criticism from the medical community at the University of North Carolina and elsewhere is making the health care system rethink that choice.
Since the announcement last month, Barry Popkin, a nutrition professor at UNC-Chapel Hill, says he’s heard from a lot of colleagues wondering, “What the heck is going on at UNC?” The clinic in question is actually about 25 miles away, in Raleigh — home to North Carolina State University.
“For them to name it this way — to give advertisement to a very unhealthy food, high in added sugar and unhealthy fats and refined carbs with no nutritional value — was quite surprising to people around the nation,” Popkin says.This story is part of a partnership that includes WFAE, NPR and Kaiser Health News. It can be republished for free. (details)
The name seems particularly unfortunate, some critics say, because North Carolina ranks poorly in measures of childhood obesity.
For the Krispy Kreme company, the advertisement is both free and unintentional. Leslie Nelson, head of fundraising and communications at UNC Children’s Hospital, says the clinic — and the race — are in no way sponsored by the doughnut maker, which is based in Winston-Salem.
“The corporation is definitely not part of the name,” she says. “It’s named for a race! The name of the doughnut happens to be in the name of the race. But at the heart of it, it’s about the race and about these kids.”
The Krispy Kreme Challenge is an annual, 5-mile charity race that student volunteers at NC State University created about a decade ago, initially just for fun, and then to raise money for the hospital. The event, always held in February, has grown in size over the years, and now includes about 8,000 runners.
Chris Cooper, a junior in chemical engineering and economics at NC State, is the current executive director of logistics for the race, which does involve eating doughnuts.
“You run 2.5 miles, starting at the NC State Belltower,” Cooper explains, “and then the challengers eat a dozen doughnuts,” which they pick up mid-way, at stations set up in front of the local Krispy Kreme shop.
But most of the runners raise money without scarfing down fried sweets.
“The casual runners normally just pick their doughnuts up and keep running,” Cooper says. “And then you run 2.5 miles back to the Belltower.” The students got permission from the pastry company to use the Krispy Kreme name — but they pay for the doughnuts.
If all that pastry pounding and distance running sounds kind of sickening, well, Cooper says it can be.
“After Krispy Kreme, when people are running back, there is normally a fair amount of throw-up that happens,” he says. “We have a group of students whose job is to go around and clean up the streets.”
Gross, sure. But the race has raised nearly $1 million for UNC Children’s Hospital and clinics so far, and the student leaders have committed to raising another $1 million.
“Behind all of this is a group that’s committed to making a difference for our patients and families,” says Nelson.
UNC Health Care is now having conversations about whether to go through with the name change, Nelson says. An online petition to scrap it has gathered about 13,000 signatures so far.
Marion Nestle, a public health professor at New York University, and former adviser in nutrition policy for the federal government, says public fallout from awkward pairings of corporate brands with health causes has been increasing.
She points to Coca-Cola’s corporate partnership with the American Academy of Family Physicians as another high-profile example.
“There was a big demonstration in front of a California hospital a few years ago,” Nestle says, “in which physicians burned their membership cards to the academy in protest.”
Last summer, the physician’s group and the soft drink company announced they’re ending their deal.
Nestle says that’s certainly not apples to apples with what’s happening at the UNC clinic. But she does think putting Krispy Kreme in the clinic’s name — for whatever reason — sets a bad example for kids.
Race coordinator Chris Cooper says if UNC decides to back off the name change, he’s OK with that.
“I don’t think anyone in the organization was really excited about us having a name on the clinic,” he says. “I think a lot more of it was, ‘How are we going to use this name to help the children’s hospital even more?'”
But, if it isn’t helpful in drawing more people to the race and in raising more money for the good cause, Cooper says, then he has no attachment to the name.
Feeling a bit bloated and sluggish after Thanksgiving weekend? A major study just out in the journal JAMA Internal Medicine offers an added nudge to get back on the exercise wagon. How fit you are even in your 20s, the study finds, can dramatically affect your risk of heart disease and death well into middle age.
So dramatically, in fact, that every minute matters.
Imagine you’re doing a stress test on a treadmill. Every two minutes, the machine makes you go faster and at a steeper incline. The first few minutes are no sweat — you’re walking, then trotting, then jogging — but soon you start to suck air, and finally hit the point that you can bear no more. (Or you may reach the 18-minute maximum, if you’re superhuman.)
Say you did that test in your 20s. Now fast-forward 25 years. The study found that every extra minute you could last on the treadmill meant you were at a 15 percent lower risk of death over that quarter-century, and at a 12 percent lower risk of harmful effects of heart disease, including stroke and heart attack.
“That’s a lot,” I found myself saying in a phone interview with the study’s two lead authors, Dr. Ravi V. Shah, of Harvard Medical School and Beth Israel Deaconess Medical Center, and Dr. Venk Murthy of the University of Michigan.
“We were surprised too,” Dr. Shah said.
“Two, three, four, five minute differences are not uncommon,” Dr. Murthy said. “That adds up. That’s 15 percent per minute — it’s pretty substantial.”
Though, of course, it must be noted that the overall risk of heart disease and death are relatively low in such a young population. Among the 4,872 people in the study, 273 died, but 200 of those deaths had no relation to heart disease. And just 4 percent of the study’s subjects had a “cardiovascular event” like a heart attack.
Still, the results cast new light on just how much fitness matters for heart health — even in our 20s, when many of us can still get away with a sleepless all-nighter or an all-weekend TV binge.
This new research is the first large study to examine people in their 20s onward over such a long period, the lead authors say, and underscores the importance of starting good fitness habits early — not just in later years, when the health price of inactivity is already well known.
The study also found that the heart benefits of fitness held true independent of weight and other heart risk factors. That suggests, Dr. Shah said, that “being fit is important for everyone, not just for people who are trying to lose or maintain weight.”
The study — an epic endeavor that began back in the mid-1980s and was led by four universities, including Harvard and Johns Hopkins — also suggests that early trajectory matters. That is, typical as it may be, it is not a good idea to let your fitness decline in your 20s.
Nearly 2,500 of the subjects underwent a second treadmill test just seven years after the first. For every minute less that they could last compared with their first test, their risk of death in the coming years went up by 21 percent, and their risk of heart disease by 20 percent.
And one other, particularly fascinating finding: Fitness as reflected by treadmill performance did not seem to matter for an accepted measure of heart health, the accumulation of calcium deposits in the arteries that supply the heart.
Drs. Shah and Murthy explain in an email:
“Calcium score” is something that we measure on a CAT scan that reflects how much calcium is deposited in the arteries that supply the heart (the coronary arteries). A higher calcium score is taken to indicate a higher burden of coronary artery disease, and many studies have found that calcium score is associated with poorer cardiovascular health and outcomes.
One would expect that greater fitness would therefore be related to a lower calcium score or absence of calcium in the arteries. We found that fitness in early adulthood was not related to the presence or extent of coronary artery calcium 25 years later.
This doesn’t mean that exercise and being fit doesn’t reduce your risk of heart disease — in fact, we found that markers of heart muscle health were certainly improved with greater fitness. It does, however, suggest that the biological relationship between exercise and heart health is complex, and needs further study.
“The surprise in this study was that there was not a relationship of outcomes to coronary calcium scores,” said Dr. Ira Ockene of UMass Medical School, who co-wrote a commentary on the study. “So what’s that all about? Well, the authors didn’t really know. But they raised a number of possibilities. One possibility is that in young people, disease has a different mechanism than you might see in older people,” and the effects in arteries may progress at a different rate.
There’s a great deal we don’t understand about the biology that underpins the health benefits of exercise. But clearly, Dr. Ockene said, “We’re designed to be very physically active, and when we just sit, it’s not good.”
Safety note: If you’re a quantified-self health hacker and now want to use the study’s calculations to assess your own heart-disease risk, Drs. Shah and Murthy caution against trying a treadmill test protocol at home or at the gym.
“We absolutely do not think that’s a good idea,” Dr. Murthy said. “These protocols are designed to wear people out very, very quickly; they’re done under medical supervision. And what we really wouldn’t say is a good idea is for people to go home and do this without that level of experience, because not only can they have heart complications, but they can have falls and injure joints. These are done with a whole medical team observing and supervising.”
“That being said,” he added, “People who feel like they’re not currently exercising and don’t feel like they’re fit, absolutely it’s a good idea to start an exercise program. But if you’re not actively engaged in exercise and you’re not in shape, it’s also probably a good idea to see your doctor first.”
Readers? Reactions, thoughts, personal experiences?
By Dr. David Scales
As if the symptoms of PMS itself weren’t bad enough – the hot flashes, dizziness, cramping, trouble sleeping — now researchers have found a possible link to high blood pressure.
Currently, doctors are naturally aware of Premenstrual Syndrome, but are not thinking about it as a warning sign that a patient is at risk for developing health problems down the line. A new study by Dr. Elizabeth Bertone-Johnson, an epidemiologist at UMass, and her colleagues may soon change that.
They studied over 1,200 women – all part of a well-known and long-followed group called the Nurses’ Health Study – who developed at least moderate PMS. The researchers matched them to twice the number of women without PMS symptoms and looked for links to the diagnosis of high blood pressure.
Their analysis, published this week in the Journal of Epidemiology, found women with moderate-to-severe PMS had a 40% higher risk of developing high blood pressure over the next 20 years than the control group that experienced few PMS symptoms.
The researchers took into account factors we already know lead to hypertension, such as obesity, smoking, or a lack of exercise.
Still, the study had a number of limitations, so it will need to be repeated to make sure the link between PMS and high blood pressure holds up to scrutiny.
Dr. Bertone-Johnson and her colleagues are also looking into ways to prevent the symptoms of PMS. So far, they have found that high dietary intake of certain vitamins like thiamine, riboflavin or vitamin D as well as calcium can lower the risk of developing PMS. Another study by Bertone-Johnson’s group suggested increased iron and zinc intake may be protective.
These studies are preliminary, though, so I wouldn’t go out and load up on vitamins, iron and zinc –- but they do suggest that PMS may be treatable, and that treatment might help prevent some of its potentially harmful downstream consequences.
By Alison Bruzek
Warning: You may be tempted to use some of the following information to rationalize skipping your annual flu shot. But in fact, you’re out of luck. The message from public health authorities is absolutely clear: roll up your sleeve (or prepare your nasal passages) and get your flu vaccine.
“Just do it now, would be my advice,” said Dr. Larry Madoff, director of epidemiology and immunization at the Massachusetts Department of Public Health. “There’s always a benefit to getting the flu vaccine.”
Granted, you wouldn’t be entirely crazy for thinking otherwise, thanks to recent headlines like these:
From USA Today last winter: “Flu shots only 23% effective this season.”
From CBS News: “Flu vaccine might be less effective in statin users.”
And on the front page of The Boston Globe earlier this month: “Repeated flu shots may lose potency.” (The story came from STAT, the Globe’s new online sibling publication covering medicine and bioscience, which used the headline, “Getting a flu shot every year? More may not be better.”)
The STAT story reports in its third paragraph that public health officials “still believe an annual vaccination is better than skipping the vaccines altogether.” But its primary emphasis is on a “growing body of evidence” that with flu vaccines, “more may not always be better.”
As one mother wrote on Facebook, “[It’s] very upsetting for someone like me, who has had their kids vaccinated every year.”
The message is confusing, even for someone well aware of the recommendation from public health authorities that everyone over six months old should get a flu vaccine unless there’s a medical reason to avoid it. Flu is no joke: It kills thousands, and probably tens of thousands, of Americans a year, the CDC says.
So what to do if you’re still worried?
To begin with, listen to the author of the study, Dr. Edward Belongia, an epidemiologist at the Marshfield Clinic Research Foundation. The STAT story notes he still strongly encourages everyone to get their flu vaccine.
As Dr. Belongia told me about his study: “At this point there really aren’t any implications for the general public.” Rather, it’s a jumping-off point for future research. Furthermore, the study was presented as a poster in October at an infectious diseases conference; it hasn’t yet been through the rigorous peer review required for publication in a scientific journal.
The study itself is intriguing — it concluded that children who had gotten a flu shot in two previous years, for a specific strain of the flu, were more likely to contract that flu than kids who had just been vaccinated for the first time.
But Dr. Madoff at the Massachusetts Department of Public Health said the idea that vaccines may bring diminishing returns isn’t new. In fact, it’s been around since the 1990s. And the bottom line, he said, is that “the return may diminish but there’s always a benefit to getting vaccinated.”
Or as a spokesperson for the CDC said, “This is an interesting new finding and CDC will be looking into it further. For now, the CDC recommendation for vaccination remains unchanged.”
The CDC recommends a flu vaccine every year because the body’s immune response prompted by vaccination declines over time, and flu viruses change from year to year. So “if you have been vaccinated recently, there’s still clearly a benefit to getting a flu vaccine this year and every year,” Dr. Madoff said. It’s true, he said, that “the additional benefit you gain isn’t as great if you’ve been vaccinated previously, but there’s still clearly a benefit.”
One of Dr. Madoff’s potential explanations for why flu vaccines could have a diminishing effect is that antibodies to the flu you already have may bind to portions of the new flu vaccine and make them less active. Or it could be that if you’re already immune to one strain of the flu and get another vaccine, instead of creating new antibodies for the new strain of flu, the vaccine instead boosts the antibodies for the older strain.
But “these are theories,” he said, “and I don’t think we really fully understand what’s accounting for this phenomenon.”
There’s reason to hope the question will someday be moot, though. Research is under way on a “universal” flu vaccine that would work for all strains and so there would no longer be a need for annual shots.
For now, if your head is still spinning from the back and forth, the best answer is to follow the CDC’s guidelines for the flu vaccine and let the scientists debate until they come to a consensus. Until they do, the guidelines won’t change.
Still not persuaded? Dr. Madoff has some good flu news for this year: The flu vaccine cocktail is better than ever. Last year, the flu vaccine strains that were chosen ended up being a poor match for the strains that were circulating. This year, he says, the match is much closer.
Wade Roush, a longtime technology journalist and outreach officer for the Program in Science, Technology, and Society at MIT, said he cringed a little when he saw the STAT headline, out of concern that it could reinforce the views of people who are already suspicious of vaccines.
“We know that thanks to the media ruckus over the measles vaccine, and the fraudulent idea that it might cause autism, there are still clusters of parents who don’t get their kids vaccinated,” he said. So when reporting on vaccines, a frame that doesn’t feed into the myths about vaccines is especially crucial.
“The risk of contracting influenza and getting sick or dying if you don’t get vaccinated is the same as it ever was, and you can still lower that risk drastically by getting vaccinated,” Roush said. That’s the context a story on any vaccine especially needs.
And if you’re finally convinced, there’s still time. The flu vaccine takes a few weeks to have an effect, Dr. Madoff said, but the peak of the season isn’t until January/February. And consider: In Massachusetts, the Department of Public Health now ensures that all flu vaccines for children under the age of 18 are free.
- Further reading from NPR’s Shots blog: Worried about the flu shot? Let’s separate fact from fiction
Like millions of Americans, I spent yesterday baking and eating all sorts of food which is traditional to Thanksgiving. I have always loved the cranberry sauce and mashed potatoes, I enjoy the pumpkin pie with lots of whipped cream, but for me the pièce de résistance is the turkey. However, if Congress had heeded Benjamin Franklin, we would probably not be eating turkey at Thanksgiving.
The story begins in July 1776 when the second Continental Congress appointed a committee composed of John Adams, Thomas Jefferson and Benjamin Franklin to design an official seal for our new nation. Although the committee submitted a design by August of that year which included 13 shields each with a state name, the eye of Providence, and the motto “E Pluribus Unum,” Congress did not approve this seal. Rather they appointed subsequent committees in 1780 and 1782 to design a seal. There were a vast variety of proposed symbols including various goddesses, Roman soldiers and Indian warriors. The final design was assembled by Charles Thomson, secretary of Congress, from pieces put forth by all three committees. It was Thomson who inserted a native American bald eagle into the design, replacing the proposed imperial eagle suggested by the 1782 committee. Thomson thought that the U.S. seal should include something uniquely American and saw the bald eagle as a symbol of freedom, liberty and independence.
Franklin, however, thought otherwise. In a letter to his daughter in January 1776, he characterized the bald eagle as a bird of “bad, moral character” and “a rank coward.” He also argued that the turkey was
…a true original Native of America. Eagles have been found in all Countries, but the Turkey was peculiar to ours, the first of the Species seen in Europe being brought to France by the Jesuits from Canada, and serv’d up at the Wedding Table of Charles the ninth. He is besides, tho’ a little vain and silly, a Bird of Courage, and would not hesitate to attack a Grenadier of the British Guards who should presume to invade his Farm Yard with a red Coat on.
However, Franklin in his encomium on the turkey, hit on an important point – the turkey makes for good eating. Fit for a king in fact! Had the turkey been chosen as the national symbol, it is very unlikely we eat turkey on any occasion. I, for one, am glad that we still honor the native turkey on Thanksgiving, rejoicing in its flavor. And even if the bald eagle has a bad character, he still looks magnificent perching in a tree, or posing on our seal.
By Nell Lake
After her stroke, a 95-year-old woman in New York State found that she could no longer taste her food. She was also unable to feel hunger, so she didn’t know when she was supposed to eat. As a result, the woman began losing weight, grew weak and wasn’t getting the nutrients she needed.
Enter Meals on Wheels, a national home-delivered meals program established by the 1965 Older Americans Act. The woman (who asked that her name not be used) began receiving meals at her home five days a week. This, she says, helped her remember to eat regularly. Her weight improved, and so did her general health.
Malnutrition like hers is surprisingly common. Six percent of the elderly who live at home in the United States and in other developed countries are malnourished, according to a 2010 study in the Journal of the American Geriatric Society. The rate of elder malnutrition doubles among those in nursing homes — 14% according to the same study.
And rates skyrocket among elderly populations in rehabilitation facilities and hospitals: Various measures show an astonishing one third to one half of seniors are malnourished upon being admitted to the hospital.
“Malnutrition is a serious and under-recognized problem among older adults,” says Nancy Wellman, a nutritionist and instructor at Tuft University’s Friedman School of Nutrition Science and Policy.
It’s not a new problem. But growth in the elderly population, and concerns about healthcare costs, have helped renew efforts by nutritionists and other advocates to establish screenings for malnutrition in medical settings, and to improve interventions that can prevent or reverse the issue.
Most basically, malnutrition means not getting enough nutrients for optimal health. In older adults, the causes are complex, experts say. Illness, disability, social isolation, poverty — often a combination of these — can all contribute to malnutrition. An older person may become malnourished because she has trouble chewing or swallowing. The medications she takes may suppress appetite. She may be unable to get to a grocery store. She may live alone, be depressed, or simply be uninterested in eating.
It’s important to know, says Connie Bales, a dietician and faculty member at Duke University Medical Center, that obese and overweight seniors can be malnourished, too. Eating too many calories doesn’t necessarily mean you’re getting the right nutrients for maintaining muscle and bone. “One can be quite malnourished, yet not be skinny,” Bales says.
Whatever the cause, malnutrition leads to further trouble. It increases older adults’ risk of illness, frailty and infection. Malnourished people visit the doctor and are admitted to the hospital more often, have longer hospital stays and recover from surgery more slowly.
The association between malnutrition and hospitalization goes both ways, say Wellman and other experts: The sick are more likely to become malnourished, and the malnourished are more likely to get sick.
Thus, says elder advocate Robert Blancato, speaking at a recent panel on the topic, improving nutrition among older people is important not just to their well-being and quality of life, but to containing health care costs. The malnourished generate bills $2,000 to $10,000 higher per hospital stay than others do, according to a study in the Journal of the American Dietetic Association.
Another study published in the journal Clinical Nutrition found a threefold increase in medical costs among the malnourished. (Hospital stays can also cause or worsen elder malnourishment: Older patients often don’t eat well in the hospital, and doctors may prohibit them from eating or drinking in preparation for medical procedures.)
Not surprisingly, financial hardship is a central cause of elder malnutrition. According to a 2014 report from the AARP Foundation, nearly 9 million older people in the U.S. can’t afford nutritious food. About one quarter of low-income adults 65 and older say they’ve reduced the size of their meals or have skipped meals because they didn’t have enough money.
Jeffrey Bubar might have been among them — his fixed income places him barely above the federal poverty line. Yet he’s well fed.
Earlier this week, Bubar, 76, dug happily into a plateful of sloppy Joe, baked potato and vegetables. He chatted with four other elderly men, also regulars at a Congregate meals program in Northampton, Massachusetts — one of hundreds of such programs across the country. (Another provision of the Older Americans Act.)
Bubar — who has no family, lives alone and has no car — walks to the program every weekday. The meals provide him with both companionship and nourishment — sources of health and well-being that would otherwise likely elude him. “I like being with people,” he says.
His fixed income places him barely above the federal poverty line. Without the meals, food would make a much bigger “dent” in his budget, he says; and the program’s nourishment “helps keep my health up.” It’s a nutritional and social anchor in his otherwise isolated life.
But many eligible seniors don’t receive such benefits. The AARP report, for example, found that of those elders eligible for the Supplemental Nutrition Assistance Program (SNAP), only 13 percent receive the benefit. It’s an important gap to address, says Lura Barber, director of Hunger Initiatives for the National Council on Aging, and there are many reasons for it. One is that “there’s a huge stigma attached to [food benefits],” she says. Older people worry, for example, that by receiving help they’ll take benefits away from children who need it. But “seniors are also less likely than other age groups to know about the program, about how to apply, and [to know] that they might be eligible.”
Following hospital stays, these programs could also help patients recover from illness or surgery. And yet very few hospital patients receive information about nutrition benefits. A recent survey by the Gerontological Society of America found that only 6 percent of hospitalized elderly received information about SNAP. Only 3 percent of hospitalized older people received information about group meals programs such as the one Bubar benefits from. And only 3 percent learned about the availability of delivered meals to home-bound seniors.
Good Nutrition, Better Outcomes
Such lack of information is another problem worth addressing, Barber says. “There’s a huge gap in how we’re providing vulnerable older adults with help as they move from a healthcare setting” back to their homes. Even those simply “going to a doctor for a regular visit are not learning about [nutrition] programs.”
Rose Ann DiMaria-Ghalili, a nurse and researcher with Drexel University’s College of Nursing, says better nutrition can improve hospital outcomes and reduce hospital readmissions. “We know,” she says, “that weight loss increases the risk of 30-day readmission,” she says. “And that failure to thrive and weight loss are frequent reasons for readmission in surgical patients.”
Nancy Wellman says, “If you can’t eat well, you’re going to end up in a nursing home, or you’re going to end up back in the hospital.”
Given mounting evidence that better nutrition in both older patients and seniors living at home is a cost-effective way to improve health outcomes—not to mention quality of life—Wellman and others call for several manageable fixes:
“We should be thinking about nutrition as one of the key aspects of healthy aging, of maintaining our independence, maintaining our quality of life, staying out of nursing homes, and staying out of hospitals,” Wellman says. She and other advocates urge individuals, community programs, medical professionals, and policymakers to learn about and prioritize nutrition as an important and relatively inexpensive way of improving health.
Nutrition Screenings And Interventions
Including nutritional status and nutrition interventions in patients’ plan of care would promote better outcomes, says DiMaria-Ghalili. And Wellman says, “We need to establish systematic screenings and intervention models” for patients entering and leaving the hospital. Connie Bales of Duke Medical Center argues that doctors and nurses could usefully view patients’ nutritional status as a vital sign, as they do blood pressure or temperature: “We know what [a patient’s] pulse rate is, what their respiration rate is,” Bales says. “What about their nutritional status?”
Access To Benefits
Barber would like to see nurses routinely asking elderly patients whether they’re receiving nutrition benefits, and referring them to meals programs and SNAP where appropriate. Nurses or other staff, she says, could also help older patients fill out applications for benefits before patients leave the hospital.
Finally, Wellman offers basic advice to older adults: “Bring home more fruits, more vegetables, some low-fat dairy…or full-fat milk if you’re underweight. Bring home prepared or prepackaged food, because it’s more likely that you’ll eat it.” If foods aren’t appealing, try adding more spices to enhance taste. If you’re overweight but ill, she says, it’s often better to prioritize eating well over losing weight. And if possible, seek out company: “People eat better when they’re with other people,” Wellman says.
On Monday, Bubar was looking forward to joining his friends at the Congregate program for the Thanksgiving meal. He’d already checked out the menu: “It’ll be turkey and whipped potatoes and butternut squash,” he said. He expected that the program’s cook would make the pies right there in the kitchen, so Bubar was eagerly anticipating house-made pumpkin pie with whipped cream.
Nell Lake is the author of “The Caregivers: A Support Group’s Stories of Slow Loss, Courage, and Love.” This article was written with support from the Journalists in Aging Fellowships, a program of New America Media and the Gerontological Society of America, sponsored by the Silver Century Foundation.
Yes, they’ve told us this before: If you’re pregnant, you needn’t refrain from exercise. But now, the influential (and fairly conservative) professional group of U.S. obstetricians and gynecologists is saying it even more forcefully: If you’re pregnant and facing no complications, you really should exercise — it’s the ideal time to improve your health, including your weight.
In an updated committee opinion, the group, the American College of Obstetricians and Gynecologists (ACOG), says: “Women with uncomplicated pregnancies should be encouraged to engage in physical activities before, during, and after pregnancy.”
The list of recommended activities includes: walking, swimming, stationary cycling, low-impact aerobics, yoga (modified and not hot), pilates (also modified), running, jogging, racket sports and strength training, and all with the usual caveats to check with your doctor first.
Importantly, the opinion says: “Some patients, obstetrician–gynecologists, and other obstetric care providers are concerned that regular physical activity during pregnancy may cause miscarriage, poor fetal growth, musculoskeletal injury, or premature delivery. For uncomplicated pregnancies, these concerns have not been substantiated…”
Here are the full set of ACOG’s updated recommendations:
• Physical activity in pregnancy has minimal risks and has been shown to benefit most women, although some modification to exercise routines may be necessary because of normal anatomic and physiologic changes and fetal requirements.
• A thorough clinical evaluation should be conducted before recommending an exercise program to ensure that a patient does not have a medical reason to avoid exercise.
• Women with uncomplicated pregnancies should be encouraged to engage in aerobic and strength-conditioning exercises before, during, and after pregnancy.
• Obstetrician–gynecologists and other obstetric care providers should carefully evaluate women with medical or obstetric complications before making recommendations on physical activity participation during pregnancy. Although frequently prescribed, bed rest is only rarely indicated and, in most cases, allowing ambulation should be considered.
• Regular physical activity during pregnancy improves or maintains physical fitness, helps with weight management, reduces the risk of gestational diabetes in obese women, and enhances psychologic well-being.
• Additional research is needed to study the effects of exercise on pregnancy-specific outcomes, and to clarify the most effective behavioral counseling methods and the optimal intensity and frequency of exercise. Similar work is needed to create an improved evidence base concerning the effects of occupational physical activity on maternal–fetal health.
Raul Artal, M.D., the main author of the new committee opinion, said that unlike in previous eras, pregnancy today “should not be looked at as a state of confinement.” He said in an interview that only a mere “16 percent of pregnant women engage in physical activity” and noted that the obesity rate among women of reproductive age is alarming. (Based on 2011–2012 data, the prevalence of obesity in women ages 20-39 in the U.S. is 31.8 percent and it’s 58.5 percent when the overweight and obese categories are combined, according to the ACOG report.)
Obviously, problems with obesity in pregnancy aren’t new, and ACOG has already issued recommendations on the issue, so why the update now?
“I strongly believe that pregnancy is an ideal time to initiate an exercise program,” said Artal, professor and chair emeritus of the department of obstetrics, gynecology and women’s health at St. Louis University. “Women have easy access to medical care in pregnancy more than any other time during their lives. They have more medical supervision than any other time in their lives. When else does a women have eight, 10 medical visits a year?”
He said this update is essentially more emphatic than earlier recommendations.
“Now we are more definitive in our advice,” Artal said, noting that the benefits of exercise for pregnant women include maintaining physical fitness, improving longevity, helping with weight management and preventing diabetes in women who are overweight or obese. Also, he said: “It helps them with preventing hypertension and other sedentary lifestyle co-morbidities.”
ACOG also put out a new practice bulletin on obesity in pregnancy, which it calls “the most common health care problem in women of reproductive age.”
Obesity, ACOG notes, can lead to a range of problems, including:
…an increased risk of miscarriage, premature birth, stillbirth and having a baby with a birth defect. Obese pregnant women are at an increased risk of cardiac problems, sleep apnea, gestational diabetes, preeclampsia and venous thromboembolism, or blood clotting in the veins. The cesarean delivery rate is also higher for obese women, and cesareans pose greater dangers for obese women than for normal-weight women because of increased risks associated with anesthesia, excessive blood loss, blood clots and infection at the incision site. Moreover, the negative impacts on the fetus are long-term: obesity in pregnancy may cause the newborn to have a medically complicated life, because the fetus is directly impacted by maternal obesity.
However, the ACOG bulletin says: “Obese women who have even small weight reductions before pregnancy may have improved pregnancy outcomes.”
Based on guidelines issues by the Institute of Medicine, ACOG recommends the ideal weight gain for overweight pregnant women ranges from 15-25 pounds, and the range for obese pregnant women is from 11-20 pounds.
Of note, the group al so says that motivational interviewing (which we’ve reported on here) has been successful “to promote weight loss, dietary modification, and exercise.”