Regaining Weight Bad For The Health.

Recent research has shown that even after dieting and losing weight, the body tends to try its best to regain the lost fat stores. Holiday times tend to be tough for those trying to stay trim, and New Year resolutions often don't stick.

Perhaps an article published in the American Journal of Clinical Nutrition will provide some extra incentive. The study shows that older women who lose weight tend to gain it back again as fat not muscle.

Barbara Nicklas, Ph.D., a gerontologist at the J. Paul Sticht Center on Aging and Rehabilitation at Wake Forest Baptist and principal investigator for the study put it rather frankly : 

"The body composition of some of the women was worse than before their weight loss ... When older women lose weight, they also lose lean mass. Most women will gain a lot of the weight back, but the majority of the weight regained is fat."

Dr. Nicklas and her colleagues evaluated 78 postmenopausal women with an average age of 58. The women were chosen with a criteria of having lost around twelve percent of their body weightas part of a study from a dieting program. Their change in body mass composition was recorded at the end of the weight loss program, comparing muscle with fat components. It was then measured again six and 12 months later. During the year of study the women did not follow any further weight loss program. 

The aim of gathering the data was to establish whether women who regained weight did so in accordance with their original body mass ratios. At the end of the study, 53 of 78 (68 percent) of the women at the six-month follow-up and 52 of 68 (76 percent) the women at the 12-month follow-up had regained some of their lost weight. Eleven women (16 percent) weighed more at the 12-month follow-up than they did at baseline, and 16 (24 percent) women continued losing weight after the intervention.

Of those who regained weight, three quarters gained more than four pounds in the following six months and this number increased to nearly 85% at the twelve month mark. The so called "regainers" were then used to evaluate the type of body mass that constituted their weight gain.

Unfortunately for dieters everywhere, it appears that fat was regained far faster than muscle. At the beginning of the study it was assessed that the weight loss consisted of one third muscle (33%) and two thirds fat (67%), whereas the weight regain showed 81 percent fat and only 19 percent muscle.

As Dr. Nicklas points out : 

"Most people will regain their weight after they lose it ... Young people tend to regain weight in the proportion that they lost it. But the older women in our study did not appear to be regaining the muscle that they lost during initial weight loss in the same way."

Post menopausal women already have it tough with hormonal changes and loss of bone density already known to occur, so losing muscle mass, and worse still, replacing it with fat, is probably the last thing they should be doing. It puts the issue of dieting at this age into a certain perspective and might even make those who need to lose weight for health reasons, more likely to consider surgical options with more reliable outcomes. As Dr. Nicklas puts it : 

"There are certainly a lot of health benefits to weight loss, if you can keep the weight off ... For older women who lose weight, however, it is particularly important that they keep the weight off and continue to eat protein and stay physically active so that, if the weight does come back, it will be regained as muscle instead of fat."

The researchers cautioned that their study involved only sedentary abdominally obese, postmenopausal women, and the findings may differ in men or in younger populations - obviously future studies are needed to look at other sectors of the population. None the less, it's an interesting and useful study that will help doctors and patients alike to choose weight loss options more wisely. The researchers concluded that : 

"Many health complications associated with overweight and obesity are improved with weight loss ... However, negative consequences (such as loss of muscle mass and bone density) are also associated with weight loss and are detrimental for older adults, which results in a reluctance to recommend intentional weight loss in this population...Because lean mass loss in older adults may be associated with the development of adverse health events and disability, it is important to examine whether the benefits of weight loss outweigh the risks in this population."

What Is a Hangover? What Causes a Hangover?

A hangover is a collection of signs and symptoms linked to a recent bout of heavy drinking. The sufferer typically has aheadache, feels sick, dizzy, sleepy, confused and thirsty. Hangovers can occur at any time of day, but are usually more common the morning after a night of heavy drinking. As well as physical symptoms, the person may also experience elevated levels of anxiety, regret, shame, embarrassment, as well asdepression.

The severity of a hangover is closely linked to how much alcohol was consumed, and whether the sufferer had enough sleep. The less sleep the worse the hangover. It is impossible really to say how much alcohol can be safely consumed to avoid a hangover - it depends on the individual, his/her circumstances that day, how tired they were before their drinking started, whether they were already dehydrated before the drinking began, whether they drank plenty of water during their drinking session, how much sleep they got afterwards, etc.

In the vast majority of cases, hangovers go away after about 24 hours. Responsible drinking can help avoid hangovers - this is covered further down the page.

What are the signs and symptoms of a hangover?

A symptom is something the sufferer or patient feels and describes, such as feeling thirsty or a headache, while a sign is something everybody, including the doctor or nurse can detect, such as bloodshot eyes, or a rash.

The signs and symptoms of a hangover generally start to occur when the drinker's blood alcohol drops considerably - typically, the morning after a night of high alcohol consumption, and may include:

• Accelerated heartbeat
• Anxiety
• Bloodshot eyes
• Body and muscle aches
• Diarrhea
• Dizziness
• Halitosis (bad breath)
• Headache
• Hypersalivation
• Flatulence
• Lethargy, tiredness, fatigue, listlessness
• Nausea
• Photophobia (sensitivity to light)
• Problems focusing or concentrating
• Sensitivity to loud sounds
• Depression (dysphoria)
• Irritability
• Moodiness
• Sleepiness, or a feeling of sleep deprivation
• Stomachache
• Thirst
• Trembling or shakiness, erratic motor functions
• Vomiting
If the individual has the following more severe signs and symptoms, he/she may have alcohol poisoning - this is a medical emergency (get medical help as soon as possible)

• Breathing loses its regular rhythm
• Breathing slows down to less than eight inhalations per minute
• Confusion or stupor. The patient is in a daze
• Fits (seizures)
• Hypothermia - body temperature drops
• The patient passes out (loses consciousness)
• The skin becomes pale, or takes on a blue tinge
• Vomiting continues and does not abate

What are the causes of a hangover?

A hangover is the consequence of having consumed too much alcohol - an accumulation of several factors:
• Urination - alcohol makes people urinate more, which raises the chances of dehydrationoccurring. Dehydration can give the individual that sensation of thirst and lightheadedness.
• Immune system response - there may be an inflammatory response by the immune system to alcohol, which may affect appetite, concentration and memory.
• Stomach irritation - alcohol consumption raises the production of stomach acids; it also slows down the rate at which the stomach empties itself - this combination can lead to nausea, vomiting or stomachache.
• Drop in blood sugar - some people's blood sugar levels can fall steeply when they consume alcohol, resulting in shakiness, moodiness, tiredness, general weakness, and even seizures in some cases.
• Dilation of blood vessels - alcohol consumption can cause the blood vessels to dilate, which can cause headaches.
• Sleep quality - although sleeping when drunk is common, the quality of that sleep may be poor. The individual may wake up tired and still sleepy.
• Congeners - these are substances that are produced during fermentation and are responsible for most of the taste and aroma in distilled drinks (whisky, gin, etc). They are known to contribute to symptoms of a hangover. Examples of congeners include esters and aldehydes.

What are the possible treatments for a hangover?

According to the National Health Service (NHS), UK, there is no "treatment" for a hangover - the best way to avoid one is either not to drink, or to drink sensibly and within the recommended limits.

UK health authorities say that men should not consume over 3 to 4 units and women 2 to 3 units of alcohol per day.

You should not drink more than you know your body can handle.

A hangover has to run its course, and that can be best done with rest, drinking plenty of water, perhaps some painkillers and simply waiting.

Do not go for a "hair of the dog" - an alcoholic drink to get rid of a hangover. This is a myth, and will likely just prolong your hangover symptoms. The following tips may help:
• Drink - sip water throughout the day. Water is the best fluid.
• Eating - go for bland foods, such as crackers or bread, which may raise blood sugar and are easy on the stomach. Fructose-containing foods may help metabolize (break down and get rid of) the alcohol more rapidly.
• Pain - some people may take a painkiller. Be aware that certain painkillers, such as acetaminophen (Tylenol, paracetamol) attack the liver, while aspirin may not be ideal for a very delicate stomach. If you are not sure what to choose, ask a qualified pharmacist or health care professional.
• Rest - if you can manage to get back to sleep, you will probably recover a little bit faster. Make sure you have some water next to your bed.

Green Tea May Lower "Bad" Cholesterol, New Analysis

A new analysis of published studies finds that consuming green tea, either as a beverage or in capsule form, is linked to significant but modest reductions in total and LDL or "bad" cholesterol, but the researchers found no link with HDL or "good" cholesterol and triglycerides. Dr Olivia J. Phung, of the College of Pharmacy at Western University of Health Sciences in Pomona, California, and colleagues, write about their findings in the November issue of the Journal of the American Dietetic Association.

Green tea contains catechins, polyphenolic compounds that are known to exert numerous protective effects, particularly on the cardiovascular system. 

However, Phung and colleagues note that although randomized controlled trials have examined the effect of green tea catechins on blood fats or lipids, including cholesterol, these have been small and shown conflicting results. 

So they decided to pool and analyze the evidence so far from all the studies they could find that examined the relationship between consumption of green tea catechins and changes in levels of total, low-density lipoprotein (LDL), high-density lipoprotein (HDL) cholesterol, and triglycerides.

They searched all the recognized databases up to March 2010 and found 20 randomized controlled trials, covering a total of 1,415 participants, that reported changes in at least one of these levels.

When they pooled and analyzed the data from these trials, they found that:

• Green tea catechins, at doses ranging from 145 to 3,000 mg per day (including consumption as green tea beverage and extract in capsules) taken for 3 to 24 weeks, led to statistically significant reductions in total and LDL ("bad") cholesterol compared to controls who did not consume any.
• Green tea catechins did not alter HDL ("good") cholesterol or triglyceride levels.

The results showed that the beverage form of green tea was more consistently effective than capsules, though the overall benefits were quite small, Phung told Reuters news agency in an email where she urged patients already taking cholesterol-lowering medication not to switch to green tea, either as capsules or as a beverage.

Smoking Marijuana Not Bad For The Lungs

Journal of the American Medical Association put a dent in the arguments against Marijuana smoking today, with release of a new report showing casual pot smokers might even have stronger lungs than non smokers. 

Researchers say that there is good evidence that occasional marijuana use can cause an increase in lung airflow rates and lung volume. Volume is measured as the total amount of air a person can blow out after taking the deepest breath they can.

The study, which was carried out by The University of California, San Francisco, and The University of Alabama at Birmingham, spans over more than two decades and involves more than 5000 men and women, in four American cities : Birmingham, Chicago, Oakland, Calif., and Minneapolis. 

One of the study's co-authors, Stefan Kertesz commented : 

"At levels of marijuana exposure commonly seen in Americans, occasional marijuana use was associated with increases in lung air flow rates and increases in lung capacity ... With marijuana use increasing and large numbers of people who have been and continue to be exposed, knowing whether it causes lasting damage to lung function is important for public-health messaging and medical use of marijuana." 

He continues that even at daily usage levels of one joint per day over seven years, people were not seeming to have any degradation of lung capacity or function.

The authors factored in for people who smoked tobacco and those that lived in more polluted areas with lesser air quality. The harm from cigarettes showed up clearly while those smoking a joint a day and not smoking tobacco did not show the degradation. Even one joint per week for twenty years did not appear to have significant effect.

Its not known exactly why tobacco appears to be so much more harmful than marijuana, especially considering the contents of the smoke are similar. It is known that THC, one of the main active cannabis oils in the herb, has anti inflammatory properties that may help to soothe the lungs. A part of the increased capacity was put down to the way pot smokers usually take deep breaths when they smoke, but one joint per day is hardly giving your lungs great exercise.

Obviously more research is needed, and it would be interesting to see results of lung tests in communities such as Jamaica and the Himalayas where smoking pot is endemic and done in larger daily volumes. 

No Safe Level Of Alcohol During Pregnancy!!!

The authors of a study published online on Tuesday that was designed to overcome the difficulties of obtaining accurate and reliable data in Fetal Alcohol Syndrome research, say their findings reinforce the warning that there is no safe level of alcohol consumption during pregnancy.

The lead author of the study is Haruna Sawada Feldman, a post-doctoral student in the University of California, San Diego pediatrics department, where senior author Christina Chambers, is a professor. The study is published in the journal Alcoholism: Clinical and Experimental Research. 

Fetal Alcohol Syndrome (FAS) is a spectrum of growth, mental and physical abnormalities that can occur in babies whose mothers drink alcohol during pregnancy.

Physical features of serious FAS include smooth philtrum (no groove between nose and upper lip), thin vermillion border (thin upper lip), short palpebral fissures (abnormally small-set eyes), microcephaly (small head circumference), and growth deficiencies in weight and height.

Feldman said in a statement that they designed the study to overcome two key problems in Fetal Alcohol Syndrome research.

One is that FAS research often relies on what the mothers say about their alcohol consumption. Sourcing data in this way raises questions about inaccuracy due to recall bias and social stigma.

Feldman says they overcame this by collecting data during pregnancy when women were unaware of their pregnancy outcome.

"The data were also collected by trained counseling specialists who had built a rapport with the woman and guaranteed confidentiality while collecting sensitive information," said Feldman.

An added bonus of getting the data in this way was that it included specific details about the stage of pregnancy, dose and pattern of alcohol consumption.

The other difficulty with FAS research is spotting the symptoms in newborns. This requires a careful examination of specific physical features:

"These alcohol-related features are often subtle, and a non-expert examiner may miss or misclassify features, and/or can be biased by subjectivity, especially if he/she suspects or knows about prenatal alcohol exposure (PAE)," said Feldman. 

To overcome this second challenge, the study used an expert in dysmorphology, someone trained to look for physical abnormalities, including very subtle ones. 

And the expert was exposure blinded, that is they did not know which of the babies they were examining were suspected of having FAS, and further potential bias was reduced because the exams were done in the context of a larger piece of research that was looking at over 70 different variables, of which effects of alcohol was only one.

The data for the study came from 992 women and their single babies in California gathered between 1978 and 2005. It included patterns of drinking and timing of alcohol exposure in relation to selected FAS features.

Patterns of drinking were assessed in terms of drinks per day, number of binge episodes and maximum number of drinks.

Timing of exposure was evaluated for zero to six weeks after conception, six to 12 weeks after conception, and during the first, second, and third trimesters.

The results showed that:

• Higher prenatal alcohol exposure in every alcohol consumption pattern was significantly linked to an increased risk of the baby being born with reduced birth weight or length, having a smooth philtrum, thin vermillion border or microcephaly.
• The most significant links were during the second half of the first trimester.
• During this period of gestation, for every increase of one alcoholic drink in the average daily consumption, there was a 25% increase in risk for smooth philtrum, 22% increase in risk for thin vermillion border, 12% for microcephaly, 16% for reduced birth weight, and 18% for reduced birth length.

The authors note that the links "were linear, and there was no evidence of a threshold."

"Women should continue to be advised to abstain from alcohol consumption from conception throughout pregnancy," they add.

Feldman said the fact they found no links during the first half of the first trimester between alcohol consumption and FAS signs should not be taken to mean it is safe to drink alcohol during this stage of pregnancy.

Their study only took into account live births and so did not include women who may have miscarried or had stillbirths.

"It is important to know that alcohol-exposed infants who would have exhibited alcohol-related minor malformations might also be more likely to be lost to miscarriage following exposure during the first six-week window," warned Feldman.

"Clinicians should continue to follow the recommendations to encourage women who are planning a pregnancy or have the potential to become pregnant to avoid alcohol, and to advise women who become pregnant to stop alcohol consumption," said Feldman. 

"These new findings can also help clinicians quantify the importance of discontinuing alcohol as early as possible." 

In Cardiovascular Disease, Is It The Alcohol Or Polyphenols In Red Wine That Benefits Patients?

Observational epidemiologic studies relating wine and alcohol to health all suffer from the fact that they, of necessity, compare people who prefer certain beverages, but not the beverages themselves. While there have been many intervention trials in animals, randomized trials in humans are less common. Randomized crossover trials, in which each subject receives all interventions in sequence, can be especially important as they tend to avoid baseline differences among subjects and can detect effects of different interventions with smaller numbers of subjects. 

This study by Chiva-Blanch G et al, just published in the American Journal of Clinical Nutrition, included 67 male volunteers in Spain who were considered to be at "high-risk" of cardiovascular disease on the basis of increased BMI, smoking, diabetes,hypertension, or other risk factors. About one half of the individuals were taking ACE inhibitors, statins, aspirin, and/or oral hypoglycemic drugs, so the results of this study may be especially relevant for patients in the real world. 

The subjects agreed to not consume any alcohol for a baseline period, then for three one-month periods consumed 30 g/day of alcohol as red wine or as gin, or an equivalent amount of phenolics from dealcoholized red wine. The polyphenol contents of the RW and the DRW interventions were the same. A very high degree of compliance of the subjects with the assigned interventions is evidenced by results of counting numbers of empty bottles of the intervention beverage returned, dietary records, urinary metabolites, etc. Further, there is good evidence that there were no important changes between periods in diet or exercise habits. The effects of each intervention on a large number of adhesion molecules and chemokines that affect inflammation and relate to the development of vascular disease were evaluated. 

The key results of the study were that both ethanol and nonalcoholic compounds in red wine have potentially protective effects that may reduce the risk of vascular disease. Specifically, the authors conclude that "the phenolic content of red wine may modulate leukocyte adhesion molecules, whereas both ethanol and polyphenols of red wine may modulate soluble inflammatory mediators in patients at high risk of cardiovascular disease." 

Specific comments on the study: Most reviewers considered this to be a well-done, comprehensive study. As one reviewer commented: "This is an excellent paper. The results strongly indicate an effect of wine polyphenols on inflammation (in broad and modern terms) and this is just what we expect from the biochemistry and nutritional effects of fruits and vegetables. The effect of ethanol, on the other hand, likely fits a hormetic mechanism, where low doses regularly supplied are protective while high doses in a single shot are worsening the progression of disease." Another reviewer added: "We need more information on separating the effects of beer, wine, and various types of spirits. Some spirits like brandy and whisky can have useful antioxidant effects, so distinguishing effects among different types of beverages may be informative." 

Another Forum reviewer commented: "This is a very interesting paper that goes a way towards answering the question whether it is the alcohol or polyphenols in red wine that confer the health benefits. The trial was well conducted and controlled, with very detailed analyses. It would have been interesting to analyse any changes in conventional risk factors after the interventions. It would also have been interesting in the study to determine the effects on vascular function by, for example, brachial artery activity (flow mediated dilatation)." 

Given that the effects of both alcohol and polyphenols on physiologic factors (e.g., platelet function, fibrinolysis) are transient, generally lasting for no more than 24 hours, it was appropriate that the subjects in this study were instructed to consume the intervention substance (RW, gin, DRW) on a daily basis. When drinking is moderate, there is no evidence that having "alcohol-free days" is beneficial to health. Indeed, most epidemiologic studies show better health effects from daily consumption rather than from drinking on a few days per week. 

Concerns about the present study: One Forum reviewer stated: "This appears to be a carefully designed and well executed study, but I have four concerns: (1) The study has been undertaken in high-risk individuals, more than half of whom are hypertensive, a quarter dyslipidaemic, and a quarter diabetic. It is not described what happened to the conventional risk factors during the interventions. (For example, any improvement in inflammatory markers may have come at the cost of higher blood pressure with the alcohol interventions.) (2) Was there any weight change that could have confounded any of the outcomes? (3) Both polyphenol and alcohol biomarkers were measured - did the change in these biomarkers correlate with the changes in any of the inflammatory markers; i.e., any suggestion of a dose response relationship? (4) Even though at least 30 outcome variables were assessed, the authors do not describe any correction for multiple comparisons." 

Another Forum reviewer: "This is a well conducted study, and adds to our understanding of the potential cardiovascular benefits of alcohol and the non-alcoholic compounds of alcoholic beverages. However, in this study more than one-half of the high-risk subjects consumed drugs with known anti-inflammatory effects, which could be a confounding factor. The anti-inflammatory effects of these pharmaceuticals may be responsible for the beneficial results, and may not be related to the RW, DRW and gin interventions." However, others think that this concern is unlikely to be important since this was a crossover study, and there were no changes in lifestyle or medication use between the intervention periods. 

The key results of the study were that both ethanol and nonalcoholic compounds in red wine have potentially protective effects that may reduce the risk of vascular disease. Specifically, the authors conclude that "the phenolic content of red wine may modulate leukocyte adhesion molecules, whereas both ethanol and polyphenols of red wine may modulate soluble inflammatory mediators in patients at high risk of cardiovascular disease." Thus, this study provides important new mechanistic evidence that the reduced risk of cardiovascular disease among red wine drinkers observed in most epidemiologic studies may result from a combination of both the alcohol and the polyphenols in the wine. 

#Schizophrenia Diagnosis Associated With Progressive Brain Changes.

Adolescents diagnosed with schizophreniaand other psychoses appear to show greater decreases in gray matter volume and increases in cerebrospinal fluid in the frontal lobe compared to healthy adolescents without a diagnosis of psychosis, according to a report in the January issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

"Progressive loss of brain gray matter (GM) has been reported in childhood-onset schizophrenia; however, it is uncertain whether these changes are shared by pediatric patients with different psychoses," the authors write as background information in the study.

Celso Arango, M.D., Ph.D., of the Hospital General Universitario Gregorio Marañón, Madrid, Spain, and colleagues, examined the progression of brain changes in first-episode early-onset psychosis and the relationship to diagnosis and prognosis at two-year follow-up among patients at six child and adolescent psychiatric units in Spain. The authors performed magnetic resonance imaging (MRI) of the brain for 61 patients (25 diagnosed with schizophrenia, 16 withbipolar disorder and 20 with other psychoses) and 70 healthy control participants. MRI scans were conducted at study baseline and after two years of follow-up.

Compared with control patients, those diagnosed with schizophrenia showed greater gray matter volume loss in the frontal lobe during the two-year follow-up. Patients with schizophrenia also showed cerebrospinal fluid increase in the left frontal lobe. Additionally, changes for total brain gray matter and left parietal gray matter were significantly different in patients with schizophrenia compared with patients in the control group.

Among patients with schizophrenia, progressive brain volume changes in certain areas were related to markers of poorer prognosis, such as more weeks of hospitalization during follow-up and less improvement in negative symptoms. Greater left frontal gray matter volume loss was related to more weeks of hospitalization whereas severity of negative symptoms correlated with cerebrospinal fluid increase in patients with schizophrenia.

The authors did not find any significant changes in patients with bipolar disorder compared to control patients, and longitudinal brain changes in the control group were consistent with the expected pattern described for healthy adolescents.

"In conclusion, we found progression of gray matter volume loss after a two-year follow-up in patients who ended up with a diagnosis of schizophrenia but not bipolar disease compared with healthy controls," the authors write. "Some of these pathophysiologic processes seem to be markers of poorer prognosis. To develop therapeutic strategies to counteract these pathologic progressive brain changes, future studies should focus on their neurobiological underpinnings." 

Truths and myths about pregnancy & obesity.

Vitamins, weight gain, preterm birth and more

Ironically, despite excessive caloric intake, many obese women are deficient in vitamins vital to a healthy pregnancy. This and other startling statistics abound when obesityand pregnancy collide. Together, they present a unique set of challenges that women and their doctors must tackle in order to achieve the best possible outcome for mom and baby.

In the December issue of the journal Seminars in Perinatology, maternal fetal medicine expert Loralei L. Thornburg, M.D., reviews many of the pregnancy-related changes and obstacles obese women may face before giving birth. The following myths and truths highlight some expected and some surprising issues to take into account before, during and after pregnancy.

"I treat obese patients all the time, and while everything may not go exactly as they'd planned, they can have healthy pregnancies," said Thornburg, who specializes in the care of high-risk pregnancies and conducts research on obesity and pregnancy. "While you can have a successful pregnancy at any size, women need to understand the challenges that their weight will create and be a partner in their own care; they need to talk with their doctors about the best way to optimize their health and the health of their baby."

Myth or Truth?

Many obese women are vitamin deficient.

True

Forty percent are deficient in iron, 24 percent in folic acid and 4 percent in B12. This is a concern because certain vitamins, like folic acid, are very important before conception, lowering the risk of cardiac problems and spinal defects in newborns. Other vitamins, such as calcium and iron, are needed throughout pregnancy to help babies grow.

Thornburg says vitamin deficiency has to do with the quality of the diet, not the quantity. Obese women tend to stray away from fortified cereals, fruits and vegetables, and eat more processed foods that are high in calories but low in nutritional value.

"Just like everybody else, women considering pregnancy or currently pregnant should get a healthy mix of fruits and vegetables, lean proteins and good qualitycarbohydrates. Unfortunately, these are not the foods people lean towards when they overeat," noted Thornburg. "Women also need to be sure they are taking vitamins containing folic acid before and during pregnancy."

Obese patients need to gain at least 15 pounds during pregnancy.

Myth

In 2009, the Institute of Medicine revised its recommendations for gestational weight gain for obese women from "at least 15 pounds" to "11-20 pounds." According to past research, obese women with excessive weight gain during pregnancy have a very high risk of complications, including indicated preterm birth, cesarean delivery, failed labor induction, large-for-gestational-age infants and infants with low blood sugar.

If a woman starts her pregnancy overweight or obese, not gaining a lot of weight can actually improve the likelihood of a healthy pregnancy, Thornburg points out. Talking with your doctor about appropriate weight gain for your pregnancy is key, she says.

The risk of spontaneous preterm birth is higher in obese than non-obese women.

Myth

Obese women have a greater likelihood of indicated preterm birth - early delivery for a medical reason, such as maternal diabetes or high blood pressure. But, paradoxically, the risk of spontaneous preterm birth - when a woman goes into labor for an unknown reason - is actually 20 percent lower in obese than non-obese women. There is no established explanation for why this is the case, but Thornburg says current thinking suggests that this is probably related to hormone changes in obese women that may decrease the risk of spontaneous preterm birth.

Breastfeeding Questions and Answers.

Do Small Breasts Mean Breastfeeding Problems?

No! Breast size is not related to the ability to produce milk for a baby. Breast size is determined by the amount of fatty tissue in the breast, not by the amount of milk. Most women, with all sizes of breasts, can make enough milk for their babies.

Will Breastfeeding Keep Me From Getting Pregnant?

When you breastfeed, your ovaries can stop releasing eggs, making it harder for you to get pregnant. Your periods can also stop. But, there are no guarantees that you will not get pregnant while you are nursing. The only way to make sure pregnancy does not occur is to use a method of birth control. If you want to use a birth control pill while breastfeeding, the safest type is the "mini-pill." However, talk with your doctor or nurse about what birth control method is best for you to use while breastfeeding.

Will Breastfeeding Tie Me to My Home?

Not at all! Breastfeeding can be convenient no matter where you are because you don't have to bring along feeding equipment like bottles, water, or formula. Your baby is all you need. Even if you want to breastfeed in private, you usually can find a woman's lounge or fitting room. If you want to go out without your baby, you can pump your milk beforehand, and leave it for someone else to give your baby while you are gone.

Breastfeeding is a unique experience for each woman and her baby, and each woman has to find her own routine, setting, and positions that work best. Today, many mothers return to jobs outside of their homes after their babies are born, and the breastfeeding routine that they've set up while on maternity leave has to change. Many women continue to breastfeed successfully though, with the help of a breast pump. Whether you choose to stay at home to care for your baby, or choose to return to a job outside your home, here are some tips about breastfeeding and pumping to make breastfeeding easier and safe for you and your baby.

Does Breastfeeding Hurt?

Breastfeeding does not hurt. There may be some tenderness at first, but it should gradually go away as the days go by. Your breasts and nipples are designed to deliver milk to your baby. When your baby is breastfeeding effectively, it should be calming and comfortable for both of you. If breastfeeding becomes painful for you, seek help from someone who is knowledgeable aboutbreastfeeding. 

To minimize soreness, your baby's mouth should be wide open, with as much of the areola (the darker area around the nipple) as far back into his or her mouth as possible. The baby should never nurse on the nipple only. If it hurts, take the baby off of your breast and try again. The baby may not be latched on right. Break your baby's suction to your breast by gently placing your finger in the corner of his/her mouth, and re-position your baby.

Should I Use Baby Pacifiers?

Most breastfeeding counselors recommend avoiding bottle nipples or pacifiers for about the first month because they may interfere with your baby's ability to learn to breastfeed. After you and your baby have learned to breastfeed well, you can make your own decision about whether or not to offer a pacifier.

Can I Breastfeed Discreetly?

You can breastfeed discreetly in public by wearing clothes that allow easy access to your breasts, such as button down shirts. By draping a receiving blanket over your baby and your breast, most people won't even realize that you are breastfeeding. It's helpful to nurse the baby before he/she becomes fussy so that you can get into a comfortable position to nurse. You also can purchase a nursing cover or baby sling for added discretion. Many stores have women's lounges or dressing rooms, if you want to slip into one of those to breastfeed.

Benefits for Mom & Baby during breastfeeding.

Here are just some of the many good reasons why you should breastfeed your baby:

• Breast milk is the most complete form of nutrition for infants. Breast milk has just the right amount of fat, sugar, water, and protein that is needed for a baby's growth and development. Most babies find it easier to digest breast milk than they do formula.
• There are health risks to your baby if you do not breastfeed. Breast milk has agents (calledantibodies) in it to help protect infants from bacteria and viruses. Babies who are not exclusively breastfed for 6 months are more likely to develop a wide range of infections diseases including ear infections, diarrhea, and respiratory illnesses. They are sick more often and have more doctor's visits. Infants who are not breastfed have a 21% higher postneonatal infant mortality rate in the U.S.
• Breastfed babies score higher on IQ tests in childhood, especially babies who were born prematurely.
• Nursing uses up extra calories, making it easier to lose the pounds of pregnancy. It also helps the uterus to get back to its original size and lessens any bleeding you might have after giving birth.
• Breastfeeding lowers the risk of breast and ovarian cancers and possibly the risk of hip fractures and osteoporosis after menopause.
  
  
  • Breastfeeding can help you bond with your baby. Physical contact is important to newborns and can help them feel more secure, warm and comforted.
  There are many benefits to breastfeeding. Even if you are able to do it for only a short time, your baby's immune system can benefit from breast milk. Here are many other benefits of breast milk for a mother, her baby, and others:
  

  Benefits for Baby:

  • Breast milk is the most complete form of nutrition for infants. A mother's milk has just the right amount of fat, sugar, water, and protein that is needed for a baby's growth and development. Most babies find it easier to digest breast milk than they do formula.
  • As a result, breastfed infants grow exactly the way they should. They tend to gain less unnecessary weight and to be leaner. This may result in being less overweight later in life.
  • Premature babies do better when breastfed compared to premature babies who are fed formula.
  • Breastfed babies score slightly higher on IQ tests, especially babies who were born pre-maturely.

  Benefits for Mom:

  • Nursing uses up extra calories, making it easier to lose the pounds of pregnancy. It also helps the uterus to get back to its original size and lessens any bleeding a woman may have after giving birth.
  • Breastfeeding, especially exclusive breastfeeding (no supplementing with formula), delays the return of normal ovulation and menstrual cycles. (However, you should still talk with your doctor or nurse about birth control choices.)
  • Breastfeeding lowers the risk of breast and ovarian cancers, and possibly the risk of hip fractures and osteoporosis after menopause.
  • Breastfeeding makes your life easier. It saves time and money. You do not have to purchase, measure, and mix formula. There are no bottles to warm in the middle of the night!
  • A mother can give her baby immediate satisfaction by providing her breast milk when her baby is hungry.
  • Breastfeeding requires a mother to take some quiet relaxed time for herself and her baby.
  • Breastfeeding can help a mother to bond with her baby. Physical contact is important to newborns and can help them feel more secure, warm and comforted.
  • Breastfeeding mothers may have increased self-confidence and feelings of closeness and bonding with their infants.
    
    
    

    Benefits for Society:

    • Breastfeeding saves on health care costs. Total medical care costs for the nation are lower for fully breastfed infants than never-breastfed infants since breastfed infants typically need fewer sick care visits, prescriptions, and hospitalizations.
    • Breastfeeding contributes to a more productive workforce. Breastfeeding mothers miss less work, as their infants are sick less often. Employer medical costs also are lower and employee productivity is higher.
    • Breastfeeding is better for our environment because there is less trash and plastic waste compared to that produced by formula cans and bottle supplies.

    Health Risks of Not Breastfeeding:

    • Breast milk has agents (called antibodies) in it to help protect infants from bacteria and viruses. Recent studies show that babies who are not exclusively breastfed for 6 months are more likely to develop a wide range of infectious diseases including ear infections, diarrhea, respiratory illnesses and have more hospitalizations. Also, infants who are not breastfed have a 21% higher postneonatal infant mortality rate in the U.S.
    • Some studies suggest that infants who are not breastfed have higher rates of sudden infant death syndrome (SIDS) in the first year of life, and higher rates of type 1 and type 2 diabetes,lymphoma, leukemia, Hodgkin's disease, overweight and obesity, high cholesterol and asthma. More research in these areas is needed (American Academy of Pediatrics, 2005).
    • Babies who are not breastfed are sick more often and have more doctor's visits.
    • Also, when you breastfeed, there are no bottles and nipples to sterilize. Unlike human milk straight from the breast, infant formula has a chance of being contaminated.

    Breastfeeding - How Long?

    Babies should be fed with breast milk only - no formula - for the first six months of life. The longer a mom and baby breastfeeds, the greater the benefits are for both mom and baby. Ideally, babies should receive breast milk through the first year of life, or for as long as both you and your baby wish.  Solid foods can be added to your baby's diet, while you continue to breastfeed, when your baby is six months old. For at least the first six months, breastfed babies don't need supplements of water, juice, or other fluids. These can interfere with your milk supply if they are introduced during this time. One of the best things that only you can do is to breastfeed your baby for as long as possible.
    
    
    
    

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