You can be overweight and still be healthy. You can eat a diet where 80% of your nutrition comes from nutrient dense whole foods and the rest may be processed or ultra processed foods and you will probably still be in pretty good health. Especially if you are adding regular intense exercise and moderating stress and have good sleep hygiene. You can also live this way and have small tweaks in one of these factors and begin to develop health issues. But what often happens is that the slightly overweight person tips over into obesity range and inevitably, the health risks begin to accumulate with no real warning signs. At some point, the accumulation of fat stores throws things out of balance and creates a state of inflammation. This is not an overnight process and so it often goes overlooked for way too long. I am all for being comfortable with how you look but I am more interested in all of us as a society moving towards preventative medicine and using signals like obesity to look for red flags elsewhere is important.
Our medical system is not terribly good at monitoring health markers for impending issues. Our general blood panels that we are given (once a year if lucky) are not built for prevention. The ranges for nutrient, hormone, lipids and inflammatory markers (if they even include them) are much too broad to signal an upcoming problem and so we can often tip the scales for way too long before getting a red flag. Strangely enough our medical system is also hypertuned to call out obesity as a health risk once things have gone too far. We get told “Just lose some weight” like it is the easiest thing to accomplish now that your hormones have down-regulated, your immune system is inflamed and your lipid stores are designed ot maintain themselves. So trust me, I write this article knowing full well that losing weight is difficult and sometimes much more complex than calorie math. I also write this because more and more data is arising on the health impacts of maternal obesity on the baby.
What the data shows
This data is important because about 50% of women of childbearing age are overweight or obese. If we are seeing a trickle down issue it will be very important to implement better health advice for those looking to conceive. The rates of gestational diabetes, hypertension and preeclampsia are all elevated with obesity and can all have an impact on fetus weight and health. There is an association between maternal obesity and stillbirths, neonatal deaths, neonatal intensive care admission and congenital abnormalities. The term obesity is both specific and vague. We can define what the parameters are for individuals who are average weight, overweight or obese. But using the term within correlational terms for disease or health risk is tricky. This is mostly because the mechanisms associated with lipid deposits and downstream health problems are not fully understood. But some of them are and we are beginning to get a better grasp on why obesity is so highly associated with many health problems.
Some of the mechanisms
Fetal development is impacted by genetics and environment and there are a multitude of interactions between these two factors. For instance, the size of the baby is driven primarily from genetics passed on from the male but these mainly come into play post delivery. While in the womb, the size of the baby is regulated mostly by the size of the mother and the amount of calories she consumes. Good quality calories are important but energy overload can tax the system regardless of what kind of nutrients are attached to it. So minimizing any extras is especially important if you are already overweight. There can be complications with delivery for babies with high birth weight. It can affect the comfort of the mom by increasing the risk of nerve pinching, inhibiting the effectiveness of pain killers and reducing push capacity. Developmental issues can arise as well, some of which may follow them for their entire adult life.
While some genetic factors, such as those related to insulin growth factor and insulin receptors are weakly related to childhood obesity and other developmental issues they do not explain much of the risk. Childhood obesity is more strongly correlated to maternal obesity than it is to paternal obesity. It is also associated with excessive weight gain during pregnancy, especially if maternal weight was not excessively high beforehand. There appears to be a strong role in intrauterine conditions with regards to risk of obesity, type 2 diabetes and metabolic disease later in life.
Obesity is connected with an increase in insulin, androgens and leptin. This shift in the hormonal balance is a big part of the problem. For instance, one study has shown that excess weight is linked to higher levels of serum leptin. Maternal hyperleptinemia can lead to leptin resistance in the placenta and changes in placental function. Inflammatory factors like cytokines and adipokines can also shift out of homeostasis with excessive weight. Adiponectin can decrease with obesity and affect the signalling pathways for glucose to be taken up by muscle tissue. It also helps with placental nutrient transfer during pregnancy. The end result is that low adiponectin levels are positively correlated with high birth weights.
There is a natural increase in blood levels of lipids and triglycerides during pregnancy. The body naturally makes fat tissue increasingly insulin resistant as pregnancy continues. Though triglycerides do not pass through the placenta, a complex interplay of extra high triglyceride levels trigger metabolite storage in fat cells in the fetus. Oxidized fat tissue in the fetus may interfere with gene expression and epigenetic changes in the offspring. Studies done on these mechanisms include placental, rat and human research. So while we are slowly identifying how obesity is linked to health outcomes for children of obese mothers we need to be careful with making any strong conclusions. Random control studies are happening and some meta analases are available with the research that has been done.
One such meta-analysis has revealed that as maternal weight increases, the risk of certain congenital anomalies also increase. These include; neural tube defects, spina bifida, cardiovascular issues, cleft palate, limb reduction and a few others. It is noteworthy that a couple congenital disorders were shown to be reduced with obesity, including gastrochisis.
Some of the other long term effects on offspring include permanent changes to the hypothalamus, pancreatic islet cells and adipose tissue. These are all interconnected systems that help regulate hunger, satiety and weight management among other things. A longitudinal study with 8400 children showed that babies born to obese mothers were twice as likely to be obese by 2 years of age. Those who remained obese into ages 3-5 were about 6x more likely to be obese in adulthood.
Again, obesity is a vague term. For most of us it is a simple adjective that reports someones outward appearance. But for those of us who spend our time in the weeds of health journals, it is very clear that after a certain threshold, obesity is also a signifier of serious metabolic decline, cardiovascular disease risk and hormonal imbalance. According to the Alzheimers society, midlife obesity is correlated with a 30% increased risk of developing Alzheimers later in life. Other forms of dementia are also linked to mid life visceral body fat levels. This is a disease that begins in our 30s and 40s and is just one more thing we want to try and prevent by making sure our children develop soundly and with good health habits. This may begin in the womb.
Gaining weight through pregnancy
Gestational weigh gain (GWG) seems to be less of an issue than pre pregnancy weight. On average GWG tends to be higher for women of lower pre pregnancy weight and some small randomized control trials have shown the ability to mitigate GWG using lifestyle changes, like exercise and nutrition protocols (obviously). Some studies have shown that some pre-conception weight loss can reduce a lot of the risks associated with maternal obesity. The threshold of weight loss and reduced risk has not been identified but it does appear that even being in the process of lowering metabolic issues while conceiving and while pregnant may reduce the risks to both mother and infant. The studies have not caught up yet but I can’t see how this wouldn’t be the case.
In the last 16 years I have had several moms-to-be lose weight overall during their pregnancies. It was never the goal but as long as you are loading up with nutrient dense foods and not underfeeding yourself, you can train pretty hard and begin to reset your metabolic problems. Building muscle is probably the best thing you can do in the short term to change how your body metabolizes and stores glucose. There is nothing stopping you from building muscle while pregnant. It won’t be fast and it won’t be much, but if you are starting from “zero” it can happen. If you are new to training then I highly recommend you find a trainer who is familiar with prenatal fitness. The old rule of thumb was to not push hard and not do anything new, just stick to movements that you had done before. But this is BS. As long as you have a well adapted and slowly evolving program designed from a thorough evaluation, you can still train moderately hard /intensely within reason. But knowing which movements are unnecessary or potentially detrimental through each trimester is definitely important.
What you eat is absolutely important but calorie overload during pregnancy is slightly different than at other times. Getting the few extra calories you need from glucose, fructose, or too much saturated fat if you are already in an already inflamed state might not be a good idea. You only need about 300 extra calories per day. This could be a nutrient dense smoothie between breakfast and lunch, it’s as little as that. And while GWG isn’t as important as where you are at prior to conception, it can still effect the intrauterine environment so quality and quantity do matter.
You can do a lot of good to your metabolic health in 3-6 months. If you are beginning to try and get pregnant, now is the perfect time to make some changes. Most of the benefit begins before you start to see the needle move on the scale.
If you are looking for some guidance. Contact us for a 1 on 1 consultation. We can help develop programs for nutrition and exercise that move the needle without taxing the body unnecessarily through pregnancy. We also offer in person and online training.
Joey
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