ACOG Joins National Obesity Care Week 2016: Take 5 to Change the Way We Care

Today, more than a third of the adult population, 36.5 percent, is affected by obesity. The number of adults who are affected by severe obesity continues to rise. It’s time for a change in obesity care. With senocw-supporter-web-visual-copyvere obesity on the rise, our nation, led by the health care community, must attack this disease from multiple angles and unite to overhaul the treatment of obesity. ACOG recognizes the important role that obstetrician-gynecologists play. Ob-gyns often meet their patients at a young age, when obesity is less likely to be an issue. Therefore, we are in an ideal position to help educate women and provide counsel on the importance of a healthy lifestyle and fighting obesity.

The 2nd Annual National Obesity Care Week (NOCW), October 30 through November 5, seeks to ignite a national movement to ensure anyone affected by obesity receives respectful and comprehensive care. ACOG is proud to join the Campaign, which was founded by The Obesity Society, the Obesity Action Coalition, Strategies to Overcome and Prevent Obesity Alliance and the American Society for Metabolic and Bariatric Surgery.

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Yes, “The Times, They Are A-changin”… but so are we!!

“The Times They Are A-changin”…  That’s how I began my presidential inaugural address last year, and guess what? They are still changing!  This theme underscored virtually everything we did this past year. Let me very briefly review where we are…

We began the year with a major legislative victory in that the SGR was repealed, and in its place is a more complicated program affecting physician payment, MACRA.  I am finishing my year by appointing a work group of experts to better understand the new law and help translate it for our members. Stay tuned on that front.

Numerous issues arose during the year, ranging from over-the-counter contraception, home births, Planned Parenthood, TRAP laws, midwifery, Zika and many more. We have such an amazing staff in Practice and Communications…we were able to issue timely and meaningful statements about all of these issues and keep informed debate going on the national level about these and other important topics.

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“For our patients, our specialty and our organization…”

When I assumed the presidency in May, I promised to work on behalf of our patients, our doctors and ACOG. Not quite halfway through a very busy year, I wanted to give you a progress report on my activities.

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Enjoying Summer While Fighting Obesity

Ah, summertime is here again and you know what that means. Warmer weather and longer days: the perfect time to remind our patients (and ourselves) to enjoy the outdoors and get active in the fresh air. Walking, riding bikes, and swimming are all ways to work out while making the most out of the season.

This is not about getting back into a swim suit, but about fighting obesity. Just last month in my inaugural address, I challenged ACOG members to join me in the fight against obesity. Why? Because, in our country alone obesity claims 300,000 lives a year. The health hazards of being obese are quite well known: diabetes, heart disease, high blood pressure and stroke. Obese women are also at a higher risk for numerous types of cancer, including esophageal, pancreatic, colorectal, postmenopausal breast, endometrial, ovarian and renal.

Approximately 36% of adult women in the United States are affected by obesity, and that number has been on the rise. Therefore, physicians have been faced with the challenges inherent in caring for these patients. As ob-gyns, we are, for many patients, the only physician a woman sees on a regular basis. Moreover, we have highly trusted relationships with our patients due to the sensitive nature of our specialty. Ob-gyns are in an ideal position to help educate women and provide counsel on the importance of a healthy lifestyle and fighting obesity.

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For the Times They Are A-Changin’

Come gather ’round people…  

…If your time to you’s worth savin’  

Then you better start swimmin’ or you’ll sink like a stone  

For the times they are a-changin’ ~Bob Dylan

I began my ACOG Presidency this past Wednesday by reciting some of Bob Dylan’s famous verse from the 1960’s. It rings true today, especially in medicine and our specialty as obstetrician-gynecologists.

As the times change I thank our now past-president, Dr. John Jennings, for his leadership and friendship during this past year. With the counsel of his past president, Dr. Jeanne Conry, John tackled some of the very difficult issues facing our practices and our workforce. I will continue his fine work and advance it on behalf of our patients, our specialty and our organization, ACOG.

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No Sushi during Pregnancy…and Other Hard-to-Swallow Rules

I love sushi—living in California this is no surprise. Lucky for me my office is across the street from one of the best local sushi restaurants in town. It’s a favorite destination for me, my staff, and my patients. I recommend it to everyone—EXCEPT my pregnant patients. Why? Because I am inherently cautious.

We know raw fish is more likely to contain parasites or bacteria than cooked fish is. Sushi-related infections are rare, but this doesn’t erase my concern about the risk of adverse outcomes, mercury exposure, and the potential complications of treating an infection should one occur. As an ob-gyn, this is my job. It’s my business to consider potential problems, make my patients aware of them, and advise them to avoid unnecessary risks. If you really want to have some sushi, it’s a good idea to eat only cooked or vegetable sushi.

My goal is not to worry or alarm my patients, but to make suggestions based on solid, high-quality research. I use evidence to guide my recommendations, support my practice, and help my patients make healthy decisions for themselves and their fetuses. That’s why a recent essay by an economist and mom, who asserts that many common pregnancy recommendations are not fully supported by evidence, caught my attention.

Ob-gyns understand there’s often conflicting data and that the changes we suggest during pregnancy can sometimes be overwhelming: nine months can seem like an eternity when you have to give up your favorite things. Sometimes we even look back and realize our advice missed the mark. I remember a time when bed rest was prescribed for many patients with preterm labor, which we now realize accomplished little. But as doctors, we’re continuously learning. Advising patients to avoid things that we KNOW can cause harm is a good practice. Why take the risk of drinking alcohol when you know it could cause a problem? Given the risks, most patients don’t want to use their own child as a test subject.

In other areas, the evidence is very clear. For example, obesity and its impact on pregnancy, the fetus, and a woman’s long term health. Research has shown that excess weight gain increases the risk of maternal and neonatal complications. Obese women have a higher risk of having children born with birth defects. Excess pregnancy weight also increases the risk of maternal obesity eight to 10 years after delivery, especially if women do not lose their pregnancy weight within six months. I would argue that we have not focused enough on weight gain. Ob-gyns could go even further to support women on appropriate weight gain and exercise during pregnancy and healthy weight loss and exercise after delivery.

Certainly it is up to women to make their own decisions during their pregnancy. It’s also important for ob-gyns to remember not to lecture patients, but to partner with them to help them achieve the healthiest pregnancy possible. We must stay tuned in to the recommendations put forth by ACOG and the dedicated practicing physicians who spend countless hours reviewing the latest literature and developing guidance and best practices for ob-gyn care. And it’s also OK to listen to that precautionary voice in the back of your head. Evidence first, but better safe than sorry.

Listen to Dr. Conry’s NPR interview: The Facts Behind Pregnancy Rules

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A Healthy Weight for Pregnancy

It’s no secret that the US has a weight problem. Roughly two-thirds of us could stand to lose a few (or more) pounds. Today, more than half of all pregnant women in the US are overweight or obese. Maintaining a healthy weight is always important to overall health, but it becomes an even more important vital sign when a woman is pregnant or planning a pregnancy.

Carrying too much weight can throw a wrench in a woman’s reproductive works. Not only can it interfere with getting pregnant, but it can also make pregnancy more difficult once achieved. Overweight and obese women are at increased risk of a number of complications during and after pregnancy, such as high blood pressure, preeclampsia, gestational diabetes, and cesarean delivery. They are at a higher risk of problems related to cesarean delivery—including complications with anesthesia, excessive blood loss, blood clots, and infection. Overweight and obese women also have increased odds of miscarriage, stillbirth, premature birth, or having a baby with a birth defect.

So what’s a woman struggling with weight to do if she wants to achieve the best pregnancy outcome? Losing weight before becoming pregnant is ideal, but that doesn’t always happen. According to new ACOG recommendations on weight gain and obesity during pregnancy, some overweight and obese women may be cleared to gain less weight than typically recommended to reduce risk factors. Gaining less weight during pregnancy may also help with losing extra pounds post-delivery.

If you’re considering getting pregnant in 2013 and are currently outside of a healthy BMI range, it’s not too late to make a New Year’s resolution to lose weight. There are many resources and articles focused on eating right and getting fit at this time of year, so investigate and develop your plan of attack. If you’re already pregnant, be sure to ask your doctor about a healthy amount of weight gain and an exercise plan to help you stay active.

Reach Your Fitness Goals with Health Apps

Nearly half of people in the US make a New Year’s resolution each year. We often vow to lose weight and be more healthy—both noble and important aims to strive for. But if you’ve ever made a resolution, you probably won’t be surprised to find that by the end of January, many people have abandoned their newly set goals.

If you think that expensive trainers or diet plans are the only thing that will help you stick to your resolution, you may want to explore your smartphone first. There are apps aimed at keeping you honest and focused—or at least get you moving in the right direction. Many fitness apps are available to help you track your calories, log daily activity levels, and tailor your routine to get results.

Food tracking apps allow you to keep a detailed log of what you’re eating, often helping you spot patterns in your eating that are sabotaging weight loss (eg, that daily mid-morning doughnut or the twice-weekly buffalo wings at happy hour that regularly push you over your recommended calorie goals). Calorie trackers give you a recommendation for the number of daily calories you need in order to reach your weight goals alongside the actual number of calories you take in on a given day. Some food tracker apps have extensive databases of foods, which make logging calories easier and faster than ever.

To help you maintain your exercise goals, give fitness trackers a try. With these apps, you can log your routes, pace, miles, and different types of workouts. Many allow you to share your activities and progress on social media sites such as Facebook and Twitter, allowing you to engage your support network (friends and family) for encouragement and accountability.

Not sure which app to try? Check out the Huffington Post’s list of the best fitness apps. You can also see what ACOG Fellows have recommended on our Facebook page. Or if you have a food or fitness tracking app that you love, please share it with us in the comments section. We’d love to hear what you’re using and what’s working for you.

Here’s to a healthy and active 2013!

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Over the River and Through the Woods = A Good Winter Workout

It’s the time of year when schedules are full of holiday parties and meals, and opportunities for food-and-alcohol-centered merriment abound. It’s also the time when the average adult packs on a sneaky, often unnoticed, pound or two that has a high chance of lingering on your waistline long after the calendar changes over. This is one of the many reasons why it’s so important to make time for fitness.

You may already know the benefits of regular physical activity such as a reduced risk of heart disease, stroke, some cancers, type II diabetes, osteoporosis, high blood pressure, and high cholesterol. It can also improve your ability to perform daily tasks, keep you mentally sharp, and help you avoid injuries. Winter fitness is especially beneficial because it helps with health concerns specific to cold weather:

It boosts immunity. During cold and flu season, exercise can help you dodge the seasonal sniffles. Regular activity appears to boost the immune system, making it easier for your body to handle wintertime germs. Flu vaccination and frequent hand-washing also help keep you healthy.

It staves off holiday spread. Weight gain during the holidays can contribute to the 20–30 pounds that most Americans gain during adulthood. Exercise can help you balance the number of calories that you eat with the number of calories you burn, so you can enjoy some treats without the negative consequences.

It improves your mood. The shorter days of fall and winter cause some women to experience seasonal affective disorder, a condition marked by symptoms such as tiredness, irritability, cravings for complex carbohydrates (such as bread and pasta), and depression. For others, a hard day at work or holiday visits with family and friends can be very stressful. Exercise is one of the best natural antidepressants around and can help relieve stress and anxiety, improve your mood, lower levels of stress hormones, and boost levels of feel-good hormones.

ACOG recommends at least 30 minutes of moderate-intensity exercise (eg, brisk walking or bicycling) on most days of the week to lower your risk of chronic disease, 60 minutes on most days of the week to maintain weight, and at least 60 to 90 minutes a day to lose weight. If you can’t get a full workout in every day, try going for a walk after meals, raking leaves, vacuuming, or taking the stairs. Or winterize your workout with cold weather activities such as ice skating, snow shoveling, or skiing. Any physical activity helps, so fight your inner couch potato this winter and get moving.

Guest Blog: Taking on the Obesity Epidemic

Eva Chalas, MD

Most women in the US struggle and are frustrated with weight control. Obesity rates are at an all-time high not just for adults, but now also for children. The clear nationwide progression in weight gain despite accompanying growth in the weight-loss industry underscores the need for physicians to get more actively involved. It is absolutely vital that we equip ourselves with the tools and knowledge to effectively reach patients who are overweight or obese.

A body mass index (BMI) of 25 to 29.9 is considered overweight, while a BMI of 30 or higher is considered obese. The health hazards of high BMI are well known and include diabetes, heart disease, high blood pressure, and stroke. Less known is the fact that obese women are also at a far greater risk for numerous types of cancer, including esophageal, pancreatic, colorectal, postmenopausal breast, endometrial, ovarian, and renal.

It is estimated that more than 60% of adults are now overweight and obese. Unfortunately, there are indications the situation could get even worse. A new report from the Robert Wood Johnson Foundation and Trust for America’s Health reveals that based on current trends, most Americans could be obese within the next two decades.

The cost to society in dollars must also be considered. The Centers for Disease Control and Prevention reports that in 2008 alone, medical costs associated with obesity were estimated at $147 billion; the medical costs for people who are obese were $1,429 higher than those of normal weight. All of this is sobering news—but news that must be considered as we work together to help our obese patients find success through a healthier lifestyle.

Women rely on us for guidance, and ob-gyns are in an ideal position to help educate and direct women toward a healthier lifestyle. I am happy to be working with ACOG colleagues from across the country on a soon-to-be-launched initiative addressing women and obesity. Our goal is to provide ACOG members with educational and clinical information on the impact of obesity in our field, along with useful tools to share with patients so we can address this national epidemic.

Eva Chalas, MD, FACOG, FACS, is chair of ACOG District II (New York). She is director of clinical cancer services, vice-chair, Department of Obstetrics and Gynecology and chief in the Division of Gynecologic Oncology at Winthrop-University Hospital. Additionally, Dr. Chalas serves as a professor at Stony Brook University School of Medicine.