Weight monitoring during pregnancy could help save lives

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Hazel Flight, Edge Hill University

There are times in a person’s life when specific events can have long-term implications on their future health. Pregnancy is one of those times – when major and dramatic changes occur within a woman’s body composition in a short period of time.

A key element of a healthy pregnancy is appropriate weight gain. Maternal obesity is thought to be one of the most common factors in high-risk pregnancies. It can cause short and long-term health risks to both mother and child, an increased birth weight and problems with delivery.

It is thought that 20% of pregnant women in the UK are obese, and due to the current obesogenic environment it is likely that this proportion will increase.

Obesity in pregnancy can cause infants to be predisposed to develop childhood obesity, metabolic syndrome and diabetes. For the mother there is also the risk of pre-eclampsia, miscarriage and gestational diabetes.

To combat this, there have been calls for women’s weight to be monitored throughout the course of their pregnancy. This is something which has not been carried out consistently in the UK since the 1990s (when there was a lack of clinical evidence to suggest it was worthwhile).

But we know now that body composition measurements can help predict maternal health and pregnancy outcomes. This monitoring throughout pregnancy may also have an influence on the birth weight of the baby, which in turn is a key determinant of short and long-term health conditions.

Midwives have a unique opportunity to provide advice regarding appropriate nutrition to the women in their care, and health promotion and education are considered among the most important activities they perform. However studies in the UK, Sweden and Australia conclude that many struggle to provide this advice.

One reason for this is that midwives do not have clear guidelines regarding what weight a woman should gain throughout her pregnancy. The National Institute of Health and Care Excellence (NICE) are currently considering a target of 16kg for women of a normal weight and 9kg for those who are obese.

Eating for how many?

It is important to remember that weight gain during pregnancy is not the sole issue with regard to the future health of the baby. If a baby has low weight gain following birth the risk of chronic disease later in life is increased and the child can also be undernourished and suffer stunted growth.

And while the focus is often on obesity and excessive weight gain, there are also serious issues at the other end of the spectrum. Women who do not gain enough weight and are not consuming enough calories are more at risk of giving birth preterm to children with a low birth weight. Babies born under 2.5kg are less likely to survive, and those that do also have an increased risk of long-term health conditions.

The current dietary reference value for a pregnant woman is an extra 200 Kcal per day in the third trimester only. This is all that should be required in order to maintain the healthy development of the foetus.

Counting 200 calories. Shutterstock

The myth that pregnant women are “eating for two” encourages them to feel they can eat whatever they want. The right information about how much and what they should eat during pregnancy is still not reaching many women – potentially putting their health, and that of their unborn babies, at risk.

So who should be providing this information? The weight loss organisation Slimming World has been commended for supporting women to eat healthily and monitor weight increase in pregnancy.

But there also needs to be advice provided to how to increase weight for those who are underweight. Alongside information regarding adequate and appropriate nutritional intake, there is a need for specialist support and education within this area. This could be a valuable role for a nutritionist as part of the care provided to women during their pregnancy.

Management of a healthy weight and subsequent weight gain in pregnancy is becoming increasingly difficult to maintain within modern society. The current advice from NICE is that weight and height are measured at the pregnant woman’s first appointment – but not regularly throughout the pregnancy.

Yet pregnancy is a time when women often have an increased nutritional awareness and the motivation to do what is right for themselves and their baby. Regular weight monitoring would be an effective way of helping them achieve this – while they are hungry for information on how to be as healthy as they can be.The Conversation

Hazel Flight, Programme Lead Nutrition and Health, Edge Hill University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Crime and nourishment – the link between food and offending behaviour

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Hazel Flight, Edge Hill University; John Marsden, Edge Hill University, and Sean Creaney, Edge Hill University

It is well known that eating a balanced diet is of vital importance for maintaining good health and well-being. It is also one of the great social pleasures of life. Yet, far too many young people in prisons are consuming a poor diet, lacking in nutrition.

Alarmingly, research suggests over half of food items available for purchase in some prisons in the UK and the US are “high in fat or sugar”. It has also been suggested that in the US, prison food has been described as “scant, joyless, and unsavoury”. But it doesn’t have to be like this. Sant’angelo dei lombardi in Italy is said to have one of the best fed prisons in the world, where prisoners work to produce organic fruit and vegetables and leave healthier than when admitted.

Poor nutrition can impact on concentration and learning and may result in episodes of violent or aggressive behaviour. In prison, a bad diet can also contribute to increased rates of poor mental and physical health compared with the general population.

To tackle this problem, a new UK government strategy aims to provide young people with healthy eating advice on arrival in prison. Inmates up to the age of 21 will be provided with nutritional guidance so they can make “informed choices” about their diets.




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Poor diet, aggression and impulsivity

The amount and nutritional value of food available in prisons and the dietary choices prisoners make has a significant influence on the quality of a prisoner’s life. Consuming highly processed and sugary foods can lead to sudden peaks and troughs in the amount of glucose in a person’s blood. This can cause fatigue, irritability, dizziness, insomnia and is even a risk factor for depression – particularly in men. It has been shown that a diet of whole foods can offer protection against depression.

Deficiencies in vitamins and minerals can lead to a number of issues. For example, low levels of iron, magnesium and zinc can lead to increased anxiety, low mood and poor concentration, leading to attention deficits and sleep disturbance. Omega 3 is required to improve cognitive functioning.

Recent government policies have recognised the problem of additives and the high sugar content of food, with the introduction of the sugar tax and moves to address the use of colourings, which have been found to have a negative effect on behaviour and hyperactivity. A recent example of the UK government’s willingness to intervene in the purchasing decisions of young people is the outlawing of energy drink sales to under-16s.

The types of problems associated with a poor diet, such as aggression, attention deficits and hyperactivity can make impulsive behaviour more likely. Studies have shown that “high levels of impulsivity are connected with high and stable levels of offending”.

Addressing the problem

Lucy Vincent – a freelance journalist with a background in both food and fashion – has started a campaign to address the need for better food in UK prisons. She believes that decent nutrition has the power to positively impact self-esteem, health, learning and development. Young people in prison are likely to have struggled with these issues and providing a better diet is an important step in improving their emotional health and well-being.

But there are obvious difficulties in improving the diets of young offenders. For example, Public Health England suggests that providing a balanced diet costs £5.99 per person, per day. Yet some prisons have food budgets as low as £1.87 per person, per day. There are obvious economies of scale to take into account, but providing a balanced diet for young offenders would still be a costly exercise – at a time when other parts of the prison service are starved of funds.

With experienced prison officers leaving the service and their remaining colleagues protesting over unacceptable levels of violence, improving the diet of young people in prison will be difficult to achieve.

But if the UK is to come close to breaking the cycle of reoffending, it needs to meet the basic needs of young people in prison and respect the basic human right of adequate nutrition. Government advice for young inmates is one thing, but those in prison need to have healthy food to choose from if they are to have any hope of staying healthy in jail.The Conversation

Hazel Flight, Programme Lead Nutrition and Health, Edge Hill University; John Marsden, Senior Lecturer in Counselling and Psychotherapy, Edge Hill University, and Sean Creaney, Lecturer in Psychosocial Analysis of Offending Behaviour, Edge Hill University

This article is republished from The Conversation under a Creative Commons license. Read the original article.