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New Guidelines for Obesity Screening: Good plan, but missing underlying social issues

All physicians should screen all adults for obesity. So say new guidelines published
this week by he US Preventive Services Task Force. The guidelines recommend
measuring each persons height and weight to calculate their body mass index or
BMI. Everyone with BMI of 30+ should be referred to counseling and behavior
change support programs.

It’s a good plan. Screening for obesity and managing weight is particularly
important during pregnancy.  Extra weight contributes to complications and is
rarely lost after birth. Fat bodies produce fat babies building obesity and its
attending health risks into the next generation. Weighing is the only prenatal
care procedure shown to affect outcomes.

If your doctor does not discuss weight, that does not mean it doesn’t matter.

Although weight management has long been part of a minimum quality prenatal
care service, providers infrequently weigh mothers. They say weight is a touchy
subject and they don’t want to embarrass or alienate patients, so they don’t
talk about it. Others say they do not know how to calculate BMI.  (Calculate it
yourself with this handy gadget from the Beginnings Guides resources collection.)

The guidelines emphasize traditional approaches that frame weight management
as a battle involving diet diaries, calorie counting, exercising and tracking activity
levels. An approach unlikely to be engaging or popular.  One of the authors said,
“We also need to help people understand why they’re not eating more healthfully
or being more active, and help them address those issues.”  He is right, partly.

What’s missing from the guidelines is recognition of the links between obesity
and sexual abuse. Research demonstrates that obesity is not just about an
individual’s lousy eating habits or laziness. It is shockingly often about a history
of abuse, experienced or witnessed, called ACES - Adverse Childhood Experiences.
Fat is protective. 

Counseling and support services will need to do more than “get people to eat right”;
they will have to recognize and address underlying social issues, starting with
sexual abuse.  

References:

Virginia A. Moyer, on behalf of the U.S. Preventive Services Task Force. Screening for and Management
of Obesity in Adults: U.S. Preventive Services Task Force Recommendation Statement. Annals of Internal
Medicine. 2012 Jun 26. Available free online at
http://annals.org/article.aspx?articleid=1200996

U. S. Department of Health & Human Services, Public Health Service (1989) Caring for our future: The
content of prenatal care. A report of the Public Health Service Expert Panel on the Content of Prenatal
Care. NIH Publication No. 90-3182 Washington, DC: National Institutes of Health.

Kogan, M.D., Alexander, G.R., Kotelchuck, M., Nagey, D.A. (1994). Relation of the content of prenatal
care to the risk of low birth weight. Journal of the American Medical Association, 271(17), 1340-1345.

The Adverse Childhood Experiences Study http://www.acestudy.org/

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