Fighting Child Obesity Starts in the Womb

In January, 2011, Endocrinetoday.com reported a change in the definition of gestational diabetes in attempt to stem the increase of diabetes and obesity in future generations. While more pregnant women will be diagnosed with GDM, these women should have access to more nutrition support.

Americans eat too much refined sugar and starch. Excessive refined carbohydrate consumption has led to a tripling of child obesity. Today 17 percent of American children are considered obese, with rates climbing all over the world. This global phenomenon starts in the womb.

Research shows that the risk of child obesity passes from one generation to the next. The metabolic "stew" of pregnancy (hormones, glucose and other nutrients) that nurtures the fetus also programs it. The metabolic environment of grandmother's womb sets the stage for mother, which in turn sets the stage for the daughter and her baby. Every pregnant woman has the opportunity to impact the health of future generations.

Not Everyone Is Vulnerable

Some people are more vulnerable to the influence of excessive sugar and refined starch in their diets than others. Greater insulin resistance makes processing sugar and refined starches more difficult for some. This insulin resistance increases their risk of becoming obese.

The hormones that regulate pregnancy exaggerate insulin resistance. Women who exhibit the greatest insulin resistance get diagnosed with hyperglycemia (elevated blood sugar) or outright gestational diabetes.

Gestational Diabetes And Glucose Intolerance: The Seeds Of Childhood Obesity

As some research suggests, insulin resistance may have been an advantage in times of scarcity. But in affluent countries with abundant food supplies, insulin resistance leads to a much higher risk of obesity. Pregnant women are heavier, have higher blood glucose levels, and grow bigger babies. They are more glucose intolerant. Glucose intolerance is another way of saying "insulin resistant" (except in type 1 diabetes).

When someone is glucose intolerant, they secrete excessive insulin when they eat too much, especially too much sugar or refined starches. This insulin drives the body to store energy as fat. The body doesn't use it for fuel. An hour after a meal, this person may feel a desire to eat and crave more carbohydrates.

Today we realize that any woman who experiences glucose intolerance -- even without gestational diabetes -- can grow a baby at risk of becoming obese. In our melting pot society, many of us have genetic traits that helped our ancestors survive scarcity.

Depending on the country, about 2 to 10 percent of women develop gestational diabetes (GDM) -- a glucose intolerance during pregnancy. Taking into account new diagnostic levels, the percentage of women diagnosed with gestational diabetes is expected to be around 17 percent.

An early sign of glucose intolerance is very fast weight gain during the first trimester. Excessive weight gain any time during pregnancy increases risks for both mommy and baby.

Not All Fat Is Problem

We want healthy babies with healthy fat stores. Fat stores help newborns survive before a mother's milk comes in which usually occurs three to four days after birth. Fat fuels the very rapid growth of an infant's first year.

The real issue isn't weight, but body composition. Even babies with a "normal" birth weight can grow too much fat in their organs and tissues. Excessive fat stores are the problem. Trained pediatricians and pediatric nurses assess babies to determine if a baby has excessive fat stores. Too much fat means that the baby is not metabolizing energy effectively.

How To Grow Healthy Babies

We can't change genetic heritage, but we can decrease glucose intolerance and increase insulin sensitivity. The goal is for both the pregnant woman and her growing baby to use glucose and fat more effectively for fuel.

Physical movement increases acute insulin sensitivity by at least 40 percent. Moving daily with purpose is more beneficial than one or two longer sessions a week at the gym. The benefit of physical movement is acute. It happens right away, but it also deteriorates over time. 60 hours after exercise, there is no more benefit for insulin resistance. Try to be active most days of the week.

The food we eat is important. It is too easy to eat excessive amounts of refined sugar and starch that drive insulin secretion. The body works better with whole foods -- fruit, vegetables, lean meats and dairy. They are more expensive, but disease costs even more. The goal is to eat a balance of whole foods including enough protein and healthy fat. And then stop when you are satisfied, and before you feel "full."

Stress drives cortisol secretion and the liver dumps sugar into the bloodstream as our body gears up for "fight or flight." But you aren't going to fight and you only wish you could flee.

You are stuck on the freeway or overwhelmed at work. Doesn't matter. The body is ready for action that doesn't happen. In times of stress extra glucose is picked up by fat cells and stored as fat.

Anything that reduces stress is helpful: Exercise, meditation, enough sleep, and eating well are all good strategies. Develop reasonable expectations about what you can and can't do. Over-scheduling, trying to do too much, compensating with too much caffeine (and many other substances) can make glucose tolerance worse.

All Of Us Need To Support The Effort

It is estimated that one out of every three babies born today will develop diabetes if nothing is done. We need to decrease the risk of child obesity and metabolic illness in this country today.

When we encourage everyone to eat better, exercise more regularly, and manage stress effectively, there will be less risk of gestational diabetes in the first place, and fewer fatty babies as well. The challenge is in front of all of us, not just women of child bearing age.

 

Follow Bonnie Modugno, M.S., R.D. on Twitter: www.twitter.com/morethanfoodinc

Comments

[DrP]

07:56 AM on 02/20/2011

I am so impressed that this columnist "gets it" about glucose intolerance and insulin-resistance. This is the key to reversing the obesity epidemic. Because of a family history of "Type II Diabetes," I spent 20 years believing that the answer to avoiding the fate that befell my grandfather and father was to avoid fat because, the med. profession told us, "eating fat makes us fat and being fat gives us diabetes." During those 20 years, my health deteriorated and I raised a morbidly obese daughter and ADHD son. In 1999, I was blessed to have a book that explained carbohydrate intolerance "fall off the shelf" when I was browsing in a bookstore. The book had a list of the symptoms of insulin-resistance, and I had them all. I changed my diet that year, and will never go back. My kids were slowly to accept that the way I was eating was right for them, but now, 11 years later, they both limit their carb consumption and are in excellent health.
The only arguments I have with this column are: the recommendation to eat low-fat meat and dairy- fat is the best nutrient class for the insulin-resistant (my diet is about 60-70% fat and I burn ketones); the other is promoting fruit consumption - fruit is too high in sugar and the same nutrients can come from non-starchy veggies with no effect on insulin; all grains, even "whole" should be avoided.

[morethanfoodinc]

08:52 PM on 02/22/2011

Bravo, you have figured out an approach to food that works for you. I have two comments.

First, I find people experience insulin resistance at varying levels of intensity, and it can shift over time. Not everyone needs to restrict carbohydrates to the level that you find effective. You must be extremely insulin resistant. Many of my clients do well with 30-45% of their calories from carbohydrates, including some grains and fresh fruit. In addition, some people find that they can handle more or different types of carbohydrates depending on their life circumstances.

The second is re: lean meats and dairy. If our animals were fed their natural diet I would not be so concerned about fat content. At this time, CAFOs feed animals soy, grain and stale bakery products. This feed changes the nutritional profile of the animal fat.

In the end, there is no one right way to eat for all people. Finding the balance of carbohydrate, protein and fat that works for you is the key.

[JHKH]

01:29 AM on 02/19/2011

In my last pregnancy I was borderline GD. I am vegetarian, and had been for close to 20 years prior to that. The major component of my plant based diet was (and continues to be) the basic food -- not canned, not prepared frozen meals, not fast food. I was active -- playing tennis until 7 months in. And only stopping then because of pre-term labor. I gained about 20 pounds with each of my three pregnancies, and all three babies were average weight at birth. So, gestational diabetes is not necessarily the key -- it's the diet that some pregnant women eat. Low in nutrition, high in empty calories. A bad diet that they will likely carry over to be the diet that baby is fed as it grows up. My children are not obese, never were, and likely won't be in the future. They were fed the same diet as I ate while pregnant and continue to eat to this day.

[morethanfoodinc]

10:02 AM on 02/19/2011

You are testimony to the influence of diet on the incidence of GDM and the potential for diet to decrease risk of child obesity. A vegetarian diet can work very well, but that is not the only solution. Mixed diets are also very effective. For some, animal protein provides a sense of satiety (feeling satisfied after a meal). It helps people avoid eating excessive refined sugars and starches, which can still happen on a vegetarian diet.

[DrP]

08:01 AM on 02/20/2011

A vegetarian diet can have to many carbs for those with severe insulin-resistance. It is hard to be vegetarian without relying on legumes for protein and non-meat/dairy sources of fat are difficult to find in enough quantity to make the diet ketogenic. Since we can't burn glucose, burning ketones is the alternative. I absolutely thrive on my high-fat, ketogenic diet. I limit carbs to 20 grams a day in the form of non-starchy vegetables only. I am 58 with a major family history of glucose intolerance/insulin resistance. I cycle thousands of miles a year and jog regularly on this ketogenic diet. My son has managed his ADHD and my daughter lost half her body weight with carb restriction as well. My brother reversed what he though was chronic fatigue syndrome which he suffered terribly when he was vegan- a very bad choice for those of us with insulin-resistance, which is probably at least 2/3 of the population.

[jeff albin]

11:02 PM on 02/18/2011

A lot of eating behavior starts in the schools!

http://loudfartnoremorse.blogspot.com/2011/02/does-your-school-have-eating-disorder.html

[morethanfoodinc]

09:10 AM on 02/19/2011

I agree that food choices can change dramatically once a child begins to access food away from the home. The opportunity for indulgent eating is everywhere: birthday parties, social events, school fundraisers. But that is true in the larger community as well.

As a society we celebrate food--especially refined sugar and starch-- as a reward, recreation, entertainment, pacifier, self soother, and a treat. Even when we aren't hungry. Highly adulterated and processed food is everywhere. I wonder what others are doing to cultivate a healthier food environment in your home, school or other community.

[Mary Poe]

09:33 PM on 02/18/2011

I think that there should also be a movement to make sure that women who want to have a baby are healthy before they carry a baby. I made sure that I was at the ideal weight for my height before I had both babies. I never imagined how physically demanding it is to carry a baby during the past few weeks of the last trimester.

[morethanfoodinc]

11:10 AM on 02/18/2011

I appreciate the sentiment. This news is not fun. Young women and pregnant women definitely carry the burden here. It is the current state of our food supply coupled with a culture of indulgence that makes this burden so onerous.

My ultimate message is that everyone needs to address the quality of their diet. If not, even those "lucky" people who get away with eating whatever they want are going to be burdened trying to live in a society that cannot support itself. It will not be pretty when 1/3 of the population gets diabetes during childhood. They'll need dialysis, go blind, and suffer neuropathies just like long term diabetics in their 50's and 60's do today --but they will be in their 30's. The "lucky" ones will be left to do all the work.

[Susan B. Dopart, M.S., R.D.]

10:59 AM on 02/18/2011

Thank you Bonnie for this informative and educational article - women have so much power over the future health of their children and I thank you for laying out the research.

Susan B. Dopart, M.S., R.D.
www.susandopart.com

[clearthinker2008]

09:56 AM on 02/18/2011

"Fighting Child Obesity Starts In The Womb"

Ugh

[alahnar]

02:09 PM on 02/18/2011

Please elaborate. I thought she did an excellent job of laying out why that's true.