Bonnie Modugno, MS, RD - Child Obesity Starts in the Womb
Child Obesity Starts in the Womb
In January, 2011, Endocrinetoday.com reported a change in the definition of gestational diabetes mellitus (GDM) 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% 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”.
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.
Historically 2-10% of women develop gestational diabetes —a glucose intolerance during pregnancy. The new diagnostic limits are estimated to increase incidence to 17%.
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 A PROBLEM
We want healthy babies with healthy fat stores. Fat stores help newborns survive before a mother’s milk comes in which usually occurs 3-4 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 up to 40%. Moving daily with purpose is more beneficial than 1 or 2 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. 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.