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Trends in global obesity.

According to the World Health Organization (WHO) (2013), the prevalence of obesity continues to rise across the world. Overweight and obesity are identified as abnormal, and excessive fat accumulation which can have negative health consequences (WHO, 2013). Healthy weight range can be determined by considering an individual's body mass index (BMI). The WHO defines a BMI of 25 or greater as constituting being overweight and a BMI of 30 or greater as constituting obesity. In 2008, more than 30% of individuals over the age of 20 were overweight. According to the World Health Organization (2013), more than a billion people, 200 million men and 300 million women respectively, were classified as obese. In 2011, more than 40 million children around the world, 5 years old or younger, were classified as overweight. Despite the increasing prevalence of obesity, it is entirely preventable (WHO, 2013).

Considerations for Childbirth Educators

Childbirth educators need to be aware of the implications that being overweight or obese have on pregnancy and childbirth. Because overweight and obesity have become increasingly prevalent, more women of childbearing age and pregnant women are within these classifications. Overweight and obese women experience a greater probability of complications during pregnancy, delivery, and post-partum. These complications include high blood pressure, preeclampsia, gestational diabetes, increased necessity for Cesarean section at delivery, and inability to lose weight after childbirth (American Congress of Obstetricians and Gynecologists [ACOG], (2013). It helps to understand how a woman's pre-pregnancy weight will inadvertently affect her health during pregnancy. Overweight and obese body habitus negatively affects fetal development. According to ACOG (2013), fetuses of overweight or obese pregnant women are more likely to be born prematurely, stillborn, or with congenital birth defects. Babies born to overweight or obese women are more likely to have a higher birth weight, which can result in birthing complications. They are at greater risk for meeting the guidelines for childhood obesity (ACOG, 2013). It is helpful for childbirth educators to be aware of the pregnancy and post-partum consequences to fetal development and how weight will affect the physical health of children during pregnancy and after birth.

A woman's pre-pregnancy weight will affect her health during pregnancy

One final consideration for childbirth educators includes understanding how weight gain during pregnancy is affected by being overweight or obese. A woman's weight before pregnancy will determine how much weight is healthy for her to gain during pregnancy. According to the Institute of Medicine ([IOM], 2009), the increase in prevalence of overweight and obese has facilitated the necessity of updating guidelines for weight gain during pregnancy. Overweight and obese women should gain between 15 to 25 lbs and into 20 pounds respectively. Underweight and women of normal weight should gain between 28 to 40 pounds and 25 to 35 pounds respectively (IOM, 2009). Women who are overweight or obese are not required to gain as much weight during pregnancy as women who are underweight and of normal weight. Furthermore, during the second and third trimesters, overweight and obese women should gain weight at a decreased rate when compared to underweight and normal weight women (IOM, 2009).

Current Trends in Obesity

Food insecurity has been surpassed by overweight and obesity as a global concern (Popkin, B. & WHO, 2013). A correlation was previously found between overweight and obese prevalence and more developed countries. Recent trends now show that overweight and obesity as a health concern are not confined to countries that are more developed. Therefore, overweight and obesity are a public health concern for all countries and are of greater concern than lack of food at this time.

Data for the year of 2009-2010 demonstrate that more than 35% of adults in the United States were classified as obese (United States Department of Health and Human Services (USDHHS), 2012). This means that more than 78 million U.S. adults as well as more than 12 million children were obese. Data shows that fewer women were becoming obese when compared to men. Obesity was more prevalent in older women as opposed to younger women. However, no such differences were noted in age among men (USDHHS, 2012). According to the Centers for Disease Control and Prevention (CDCP) (2013), every state in the United States has an obesity rate of at least 20%. However, certain geographical regions of the U.S. have shown higher prevalence of obesity including the Midwest and the South. Geographical regions with significantly lower prevalence of obesity include the West and the Northeast (CDCP, 2013). The three states with the highest prevalence of obesity include Louisiana, Mississippi, and Arkansas. The three states with the lowest prevalence of obesity include Colorado, District of Columbia, and New York (CDCP, 2013).

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Data from 2012 demonstrate that the prevalence of overweight and obesity continue to increase in Canada. More than 25% of Canadian women and more than 40% of Canadian men reported height and weight information that classified them as being overweight. Eighteen percent of Canadians over the age of 18 self-reported height and weight information that classified them as obese (Government of Canada (GOC), 2013). While rates for overweight and obesity were higher in men than in women; total rates when including both overweight and obesity demonstrate that more than 5.5 million women and 7.5 million men in Canada are carrying excess weight on their person (GOC, 2013). A closer look at geographic regions demonstrates higher prevalence of obesity in certain provinces and territories including Newfoundland and Labrador, Nova Scotia, and Prince Edward Island. Lower prevalence of obesity was demonstrated in British Columbia and Quebec (GOC, 2013).

Australia has also seen an increase in the prevalence of overweight and obesity for more than 20 years. According to the National Health and Medical Research Council (NHMC) (2014), in 2011-2012, close to 60% of Australian adults were categorized as overweight or obese. Further data from the NHMC (2014) notes that more than 25% of those adults were considered obese. Data from 2007 demonstrated that approximately a quarter of children between the ages of two and 16 were classified as overweight or obese (NHMC, 2014). Six percent of those children were categorized as obese (NHMRC, 2014). Obesity is more prevalent in those in rural areas as well as within disadvantaged socioeconomic groups. Other groups that also have higher prevalence of overweight and obesity include those born overseas as well as aboriginal and Torres Strait Islander peoples (NHMRC, 2014).

The National Health Service (NHS) (2013) released findings that demonstrated an increase in obesity rates over the past decade in England. Not only did the percentage of English adults that had healthy BMIs decrease, there was also an increase of obesity rates over the last 8 years to 24% for men and 26% for women (NHS, 2013). In 2011, it was noted that both obese women and men were found to have been suffering from negative health consequences such as high blood pressure. Furthermore, obesity-related hospitalizations totaled more than 11,500, ten times as many as occurred in 2011-2012 (NHS, 2013).

According to the International Association for the Study of Obesity (IASO, 2012), trends show increasing prevalence of obesity across the globe. Regions of the world including the Americas region, European region, Eastern Mediterranean, South East Asia and Pacific Region, and the African region are comprised of countries that have increasing prevalence of obesity. While it can be difficult to obtain data that accurately represents obesity statistics, in recent years many countries have begun to collect data that pertains to obesity (IASO, 2012). Brazil and India are examples of countries that have monitored height and weight information in order to collect relevant data as far back as 1975. However, some countries may focus more on collection of data from men or women selectively. For example, when the data available for men and women was compared, more countries were collecting obesity related data on women than on men. Examples include Egypt; which began data collection in the 1990s (IASO, 2012). The variations in available data demonstrate that while data is available, there are countries that are not adequately or accurately represented in obesity statistics because only one gender is represented in available data. This could lead to an underreporting of overweight and obesity.

There is much to gain from considering available data to discern current trends in global obesity. IASO (2012) considered global prevalence of obesity by considering height and weight of women and men. IASO identified five countries in each region that had the highest prevalence of obesity among women and among men singularly. For women in the Americas they include Mexico, Barbados, the U.S., Paraguay, and Panama. All of these countries had obesity rates of more than 30% (IASO, 2012). Egypt, Palestine, Saudi Arabia, Kuwait, and Qatar in the Eastern Mediterranean region all had obesity rates of more than 40%. In the European region Greece, England, Scotland, Israel, and England all had obesity prevalence of more than 25%. Algeria, Mauritius, South Africa, Seychelles, and Lesotho had the highest obesity prevalence in Africa with 20% obesity rates or higher. Nauru, Samoa, Niue, French Polynesia, and Tonga were noted to have the highest prevalence of obesity in South East Asia and the Pacific region (IASO, 2012).

Prevalence of obesity in men facilitated the inclusion of several countries not identified as in the top five countries for highest rates of obesity in women. In the Americas, these countries include Venezuela and Canada. In the Eastern Mediterranean, Bahrain was included. In the European region, Cyprus and Ireland were included (IASO, 2012). In Africa, Cameroon was added. In South East Asia and the Pacific region, Cook Island was added.

Further changes in obesity rates were noted between women and men globally. They include lower obesity prevalence rates for men overall compared to women. Examples include Africa and South East Asia and the Pacific region. In African women, prevalence of obesity was noted to be 20% or more. For men this number was significantly less varying from 6.5% on the low end to 14.7 on the high end (IASO, 2012). However, even the highest obesity prevalence rate for men in Africa was significantly less than the rates for women in Africa. Women in Tonga (South East Asia and Pacific region) had the highest prevalence of obesity compared to women in other regions as well as men globally with 70% prevalence rate. Lower prevalence of obesity was noted for men in the Eastern Mediterranean in countries Kuwait, Saudi Arabia, Qatar, and Palestine. However, in the European region, in both Greece and England obesity was more prevalent in men (IASO, 2012). In women, the lowest rates of obesity were in the African region of Mauritius with 20%. In men, the lowest rates of obesity were in Cameroon with 6.5% obesity rates.

Possible Contributors to Obesity

There are a number of possible contributors contributing to the obesity epidemic on a global scale. These contributors include changes in lifestyles such as growing reliance on automobiles and less traveling on foot, or more sedentary lifestyles that center on engaging in indoor activities such as television and utilizing technology such as the internet. There has been an increase in highly processed foods that are not nutritious. Even though these foods are not nutritious, they are frequently marketed to individuals in advertising campaigns and they are consumed by many (NHS, 2013). Other possible contributors include cultural perceptions of attractiveness and eating behavior within families. Families may have certain patterns of food choice based upon food resources and rules that ultimately affect the choices that families make when making food choices (Delormier, Frohlich, & Potvin, 2009). While other contributors to obesity such as overeating, lack of proper physical activity, and genetics may play a part in the development of obesity, chemicals in our environment may also play a role. Exposure to synthetic chemicals has been occurring with greater frequency since chemicals have become more prominently utilized. Many chemicals that are being utilized have the ability to negatively affect the body's ability to control weight (Baillie-Hamilton, 2002). Therefore, it is necessary for future research in global trends in obesity to consider that there may be several contributing factors to the obesity epidemic that are acting synergistically to bring about and exacerbate obesity.

Conclusion

Monitoring overweight and obesity provides data that can be utilized to better understand patterns of obesity. Collecting data pertaining to overweight and obesity which is specific to geographic regions can provide additional insight into local overweight and obese trends. Identification of trends specific to locales can assist those developing intervention targeted to meet the needs. Perceptions of body image and beauty should also be considered on a cultural scale in an effort to understand how these perceptions may affect obesity rates. Food availability and consumption patterns are considered globally in an effort to understand how foods consumed may play a role in the development of obesity; especially if foods are highly processed and contain little nutritional value (Delormier, Frohlich, & Potvin, 2009).

Childbirth educators should continue to provide pregnant women with comprehensive information that can improve their health during pregnancy. Some specific interventions include information regarding appropriate weight gain during pregnancy. Women who are within normal weight parameters before pregnancy should gain between 25 and 30 pounds while women who are underweight should gain more weight; between 28 and 40 pounds during pregnancy (United States Department of Health and Human Services Office of Women's Health (USDHHSOWH), 20m). Women who are overweight should gain between 15 and 25 pounds during pregnancy while women who are obese should gain a minimal 11 to 20 pounds during pregnancy (USDHH SOWH, 2010).

Childbirth educators should continue to encourage pregnant women to eat a variety of healthy foods necessary to ensure that they receive adequate amounts of vitamins and minerals necessary for a healthy pregnancy. Special focus should be placed upon taking a prenatal vitamin and the specific nutrients pregnant women need for maintaining a healthy pregnancy including adequate levels of folic acid, iron, and calcium (USDHHSSOWH, 2010).

Additional education needs to be provided to diabetic women who want to become or are pregnant. According to the American Diabetes Association (ADA) (2013), diabetic women can foster a healthy pregnancy by maintaining proper glycemic levels before becoming pregnant and throughout pregnancy. Certain medications used to control blood glucose in type 2 diabetes patients may be unsafe for use during pregnancy (ADA, 2013). Childbirth educators can play a vital role in ensuring that diabetic women understand how diabetes will affect their pregnancy and diabetic women discuss relevant issues regarding diabetes with appropriate healthcare professionals.

Childbirth educators encourage healthy pregnant women to remain active during pregnancy. Women who exercise regularly before pregnancy will be able to maintain much of their exercise regimen with certain modifications to ensure safety (American Pregnancy Association APA, 2013).

Pregnancy is a part of any woman's healthy lifespan, and much can be done to change outcomes. The global trends for obesity have a direct influence on current pregnancies and the health of the next generation of children. Preventing obesity is the responsibility of all who work in the health care field.

References

American Congress of Obstetricians and Gynecologists. (2013). Committee opinion: Obesity in pregnancy. Retrieved January 8, 2014, from http://www. acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Obstetric_Practice/Obesity_in_Pregnancy

American Diabetes Association. (2013). Prenatal care for women with diabetes. Retrieved February 27, 2014, from http://www.diabetes.org/living-withdiabetes/complications/pregnancy/prenatal-care.html

American Pregnancy Association. (2013). Pregnancy exercise guidelines. Retrieved February 27, 2014 from http://americanpregnancy.org/pregnancyhealth/exerciseguidelines.html

Baillie-Hamilton, P.F. (2002). Chemical toxins: A hypothesis to explain the global obesity epidemic. The Journal of Alternative and Complementary Medicine, 8(2), 185-192.

Center for Disease Control and Prevention. (2013). Adult obesity facts. Retrieved from http://www.cdc.gov/obesity/data/adult.html

Delormier, T., Frohlich, K.L., Potvin, L. (2009). Food and eating as social practice-understanding eating patterns as social phenomena and implications for public health. Sociology of Health & Illness, 31(2), 215-228. doi: 10.nn/j.1467-9566.2008.01128.x

Government of Canada. (2013). Overweight and obese adults (self-reported), 2012. Retrieved from http://www.statcan.gc.ca/pub/82-625-x/201300i/ article/11840-eng.htm

Institute of Medicine. (2009). Weight gain during pregnancy: Reexamining the guidelines. Retrieved on from http://www.iom.edu/Reports/2009/weightGain-during-pregnancy-Reexamining-the-Guidelines.aspx

International Association for the Study of Obesity. (2012). Trends in % obesity in adult males living in selected emerging countries. Retrieved from http:// www.iaso.org/site_media/library/resource_images/Emerging_countries.pdf

International Association for the Study of Obesity. (2012). Global prevalence of obesity in adult males. Retrieved February 23, 2014, from http://www.iaso. org/site_media/library/resource_images/Global_Obesity_Top_5_in_each_ region.pdf

National Health and Medical Research Council. (2014). Obesity and Overweight. Retrieved from http://www.nhmrc.gov.au/your-health/obesity-andoverweight

National Health Services. (2013). Latest obesity stats for England are alarming. Retrieved i/07/2014 from http://www.nhs.uk/news/2013/02February/ Pages/Latest-obesity-stats-for-England-are-alarming-reading.aspx

Popkin, B.M. (2010). Recent dynamics suggest selected countries catching up to US obesity. American Journal of Clinical Nutrition, 91, 284s-2848s.

U.S. Department of Health and Human Services. (2012). Prevalence of obesity in the United States, 2009-2010. Retrieved on from http://www.cdc.gov/nchs/ data/databriefs/db82.pdf

U.S. Department of Health and Human Services Office on Women's Health. (2010). Staying healthy and safe. Retrieved on February 27, 2014, from http://americanpregnancy.org/pregnancyhealth/exerciseguidelines.html

World Health Organization. (2013). Obesity and overweight. Retrieved February 23, 2014, from http://www.who.int/mediacentre/factsheets/fs311/en/#

Jennifer Doyle has a Bachelors degree in Social Work from Northeastern State University, a Master's degree in Social Work from the University of Oklahoma, and is currently pursuing a PhD in Health Psychology. She resides in Oklahoma.

Jennifer Doyle, BSW MSW
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Author:Doyle, Jennifer
Publication:International Journal of Childbirth Education
Geographic Code:1USA
Date:Apr 1, 2014
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