Such a big problem

August 11, 2014

            In 1985 Georgians were among the most overweight individuals in the country.  By 2005, the incidence of obesity had more than doubled. By 2005, 28% of all adults in Georgia and 26-28% of adults in Rabun County were obese. 

            Obesity is particularly problematic for women, increasing by 50 to 400% a woman’s risk for gestational diabetes, hypertension in pregnancy, pre-eclampsia, preterm delivery and delivery by C-section. These are all serious problems that can decrease the likelihood of a healthy newborn baby.

            When a C-section is necessary, obesity increases by 30 to 150% the risk of increased blood loss, wound infection, uterine infection (endometritis) and blood clots.

            The American College of Obstetrics and Gynecology has some recommendations regarding the issue of obesity and pregnancy:

1.         Both diet and exercise are appropriate in pregnancy

2.         Dietary interventions are better.

3.         Women need a structured plan for losing weight

4.         Referral to a nutritionist may help

5.         Doctors, nurses, women and women’s husbands and families should talk about the issues related to obesity and pregnancy.

            One of the ways pregnancy leads to excessive weight gain is the phrase: “pregnant women are eating for two.”  While there is some truth in this statement, this reality should NOT be an excuse for gorging.  A pregnant woman only needs to be taking in 200 to 300 extra calories in the second and third trimesters of pregnancy. A medium sized apple is 90 calories.  2 tablespoons of peanut butter is 180 calories.

            There is another serious problem caused by obesity. Public health officials are now faced with a growing epidemic of liver disease that is tightly linked to obesity.

            In the past two decades, the prevalence of the disease, known as nonalcoholic fatty liver, has more than doubled in teenagers, adolescents and adults. Diagnostic testing surveys have found that it occurs in about 10 percent of children and in at least 20 percent of adults in the United States, eclipsing the rate of any other chronic liver condition.

            There are no drugs approved to treat the disease. It has become a leading cause of liver transplants around the country.

            Doctors say that the disease, which causes the liver to swell with fat, is particularly striking because it is nearly identical to the liver damage that is seen in heavy drinkers. But in this case the damage is done not by alcohol, but by poor diet and excess weight.

            A 13-year-old in Hiawassee, Ga., learned he had the disease two years ago after developing crippling abdominal pain. “It’s like you’re being stabbed in your stomach with a knife,” he told a New York Times reporter.

            “A lot of times when I see a patient with fatty liver,” said Dr. Malik at the University of Pittsburgh “the first thing out of their mouth is, ‘Well, is there a pill for this?’ And there’s not. There just isn’t. You have to make lifestyle changes, and that’s a much more difficult pill for people to swallow.”

Robert A. Hatcher M.D., M.P.H.

Emeritus Professor of Gynecology and Obstetrics

Emory University School of Medicine

Atlanta, Georgia