Bariatric surgery may improve pregnancy outcomes - mostly

Many women opt for bariatric surgery in order to increase chances of maintaining a healthy pregnancy.  A recent study suggests that weight loss surgery can help a woman do just that, but there are risks.

Personally, my full term post bariatric surgery pregnancy was different than my pre-WLS pregnancies.  I was at a more normal bodyweight at the time of my daughter's gestation, and I did not seem to suffer the ill effects of obesity on pregnancy like I had with my prior children.  I had no high blood pressure, no high blood sugar, nor did I land on bedrest - which I had with previous babies.    My post RNY pregnancy offered me anemia and rampant hypoglycemia.  I was not well. 

She was born healthy, but small, in comparison to my earlier babies.  I noted a lack of body fat at birth.  This is several weeks old.

Baby
My post bariatric surgery baby - my smallest birthweight baby.

 

New York Times

While the study found some risks for women who had surgery, including more babies born too small and a greater likelihood of stillbirths, experts said that overall the results were better.

The findings have implications for an increasing number of women and children, especially in the United States, where nearly a third of women who become pregnant are obese. Obese women have more problems in pregnancy, including gestational diabetes, pre-eclampsia, and stillbirth. Their babies are more likely to be premature, overweight or underweight at birth, have certain birth defects, and develop childhood obesity.

The study, published Wednesday in The New England Journal of Medicine, sought to find out if surgery could safely mitigate some of those effects. Swedish researchers, led by Kari Johansson, a nutritionist at the Karolinska Institute, evaluated records of 2,832 obese women who gave birth between 2006 and 2011, comparing women who had bariatric surgery before becoming pregnant with women who did not.

They found that women who had had surgery were about 30 percent as likely to develop gestational diabetes, which can lead to pre-eclampsia, low blood sugar, birth defects and miscarriage. They were about 40 percent as likely to have overly large babies, whose challenges can include lung and blood problems.

The outcomes were worse in some categories. Women who had surgery were twice as likely to have babies who were small for their gestational age, suggesting the need for better nutrition for pregnant women with surgically-reduced stomachs. And more of their babies were stillborn or died within a month after birth, although the number of such deaths in each group was very small and might have been due to chance, experts and the authors said. There was no significant difference in rates of premature births or babies with birth defects.

The study via NEJM -

BACKGROUND

Maternal obesity is associated with increased risks of gestational diabetes, large-for-gestational-age infants, preterm birth, congenital malformations, and stillbirth. The risks of these outcomes among women who have undergone bariatric surgery are unclear.

METHODS

We identified 627,693 singleton pregnancies in the Swedish Medical Birth Register from 2006 through 2011, of which 670 occurred in women who had previously undergone bariatric surgery and for whom presurgery weight was documented. For each pregnancy after bariatric surgery, up to five control pregnancies were matched for the mother’s presurgery body-mass index (BMI; we used early-pregnancy BMI in the controls), age, parity, smoking history, educational level, and delivery year. We assessed the risks of gestational diabetes, large-for-gestational-age and small-for-gestational-age infants, preterm birth, stillbirth, neonatal death, and major congenital malformations.

RESULTS

Pregnancies after bariatric surgery, as compared with matched control pregnancies, were associated with lower risks of gestational diabetes (1.9% vs. 6.8%; odds ratio, 0.25; 95% confidence interval [CI], 0.13 to 0.47; P<0.001) and large-for-gestational-age infants (8.6% vs. 22.4%; odds ratio, 0.33; 95% CI, 0.24 to 0.44; P<0.001). In contrast, they were associated with a higher risk of small-for-gestational-age infants (15.6% vs. 7.6%; odds ratio, 2.20; 95% CI, 1.64 to 2.95; P<0.001) and shorter gestation (273.0 vs. 277.5 days; mean difference −4.5 days; 95% CI, −2.9 to −6.0; P<0.001), although the risk of preterm birth was not significantly different (10.0% vs. 7.5%; odds ratio, 1.28; 95% CI, 0.92 to 1.78; P=0.15). The risk of stillbirth or neonatal death was 1.7% versus 0.7% (odds ratio, 2.39; 95% CI, 0.98 to 5.85; P=0.06). There was no significant between-group difference in the frequency of congenital malformations.

CONCLUSIONS

Bariatric surgery was associated with reduced risks of gestational diabetes and excessive fetal growth, shorter gestation, an increased risk of small-for-gestational-age infants, and possibly increased mortality. (Funded by the Swedish Research Council and others.)

PS.  Post RNY baby is eight years and four months old now.  She's fine.

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Honey Boo Boo Weight Intervention

Sometimes there are no words, yet there are so. many. words.  It's hard to choose them.

Why is this a story? Why is it relevant?

Regardless of your feelings of Mama June's "parenting" for what it is -- or isn't -- (or why it is vastly different than yours or what you grew up with) this child is quite typical of an American Child.

Maybe she's an American Child times twenty plus some considering her life has been under a media microscope since she was very small, and she has been brought up to act for the cameras.  What we see of this kid is so many of the things in our own children that are enhanced because cameras-in-her-face-act-more-goofy-we're-getting-paid for this.

And I know it makes you uncomfortable.  (I know it does.  That is why you watch it, or that is why you must comment about NOT watching because "That Poor Girl, Bless Her Heart!"  Shut up.)

Don't pretend she isn't realistic -- kids with overweight and obesity are quite the norm.  Even those with somewhat healthy, active lifestyles. 

I used to get comments about my youngest ... "She's just like Honey Boo-Boo."  I never really knew if those who said it meant that she was overweight, or hyperactive.  Because all of my kids are diagnosed overweight or obese

But I am not Mama June.

We do not eat like the Mama June household.    But, that said, overweight still occurs.  

I'd ask you to ask my youngest what her favorite food is.

It's gluten free organic vegan burritos.  Thank-you.  They are expensive, so if you'd like to send a case? PLEASE DO.  I think they're on my Amazon Wish List.  LMAO. 

But why is it that her childhood obesity is a "problem" for us and requires an intervention a la The Doctors?  Because the public consumed her lifestyle and promoted it by reality television?  This child's weight is not our business.  

A lot of it is probably our fault for promoting and exploiting it.  

Stop pushing reality television.  


Nutritional Deficiencies and seizure activity

I've often wondered about this as a post WLS epileptic.  Is there more I could DO to control my symptoms?  I know there are quite a few of you out there - with or without deficiencies occurring along with your seizure disorders after WLS.  

From Epilepsy.com -

Continue reading "Nutritional Deficiencies and seizure activity" »


Permitters and Restrictors.

 

Trader Joe's Greens, Beans and Grains Review

Greens-beans-grains

I live in the forest food desert where food delivery would be nice by drone.  (No, really.  Seven feet of snow. SEND. FOOD.  SEND. RATIONS.  SEND TOILET PAPER.  Don't think I am not serious.)

Someone should create a quasi-healthy-food-drop service to my area and I would even accept Trader Joe's because I am between two of their locations and not within driving distance (I don't drive, still, brain still not participating in life skills training here) and haven't stepped foot inside one but once this past year or even two.  I am so out of touch with what is On Store Shelves, guys.  If you have something to tell me about, tell me, I mean that - I see nothing.

And that was last week.  I cleared out a shelf of $100 worth frozen vegetarian products. 

Because that is the way I eat now (yeah, we haven't spoken much on the blog have we?  Because... I don't know...) so when I find something I like and likes me back in the bowel I BUY THEM ALL AT ONCE.  I took a risk on this product "Trader Joe's Greens Beans And Grains" and assumed it would like me back 'cause WHY NOT?!  I have been forcing myself to eat The Greens! The Beans and The Grains! in any form I find for a while now because I spent years being afraid to do so -- and I think my gut became afraid to digest!  (Short story, it took a while to acclimate to real foods, but it works.  Most of the time.)

This product.  I didn't read the label closely.  I just saw GREENS and grabbed it because I thought "Yummy, I love greens and it's prolly vegetarian and it's gotta be good," and the calorie count was low.

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But, it's not what I thought it was.  I was thinking a smoky-greeny concoction - it isn't at all - and I think they probably should have named it WHAT IT ACTUALLY IS!  

Peanut (...inspired, like?) Stew!  Maybe they didn't because people might not have bought it?  I honestly probably would not have bought it if I saw peanuts AT ALL.  Good move, TJ's.

"If you're familiar with West African cuisine, you might find our Greens, Beans and Grains similar to a traditional peanut soup or stew; albeit with a Trader Joe's influenced interpretation. In place of the collard greens typical in an African version, we've chosen kale as the Green to accompany our beans and grains. Kale is the primary reason this entrée delivers so generously on vitamin A, vitamin C, iron, calcium, protein, and dietary fiber.

But just because kale/greens are named first, don't assume that's the only standout here.  On the contrary, garbanzo beans play a pivotal role, filling in where West African cooks may utilize peanuts. They add fiber, protein, and iron, as well as super taste and texture. (We haven't left the peanuts out entirely, though, so peanut lovers rejoice!) As for the Grain portion of the show, we went with whole wheat couscous, a traditional ingredient in West African & North African cooking. All together, Greens, Beans and Grains is simmered in a vegetable stock with tomatoes, seasoned with garlic, onion, cilantro, cumin, coriander, caraway, cayenne, lemon juice, and salt - it's the spices that really play up the African connection and give the dish its memorable flavors.

We developed Greens, Beans and Grains with our supplier, and it's only available at your neighborhood Trader Joe's. We're selling each nine ounce package - an excellent single meal size - for $2.99, every day. You'll find it in our freezers."

I have eaten it twice now.  

It is not an attractive meal.  It's what my youngest calls bum-bums, and this?  Is bums in sauce.  

02-feb-09a

The first time, I microwaved it for the allotted time and ate the two sides separately and it was just too spicy.  I actually walked away from it.  I was dipping the couscous into the chickpeas and left some of the sauce behind.  

This morning, I cooked it a little less, and plated the entire concoction together.  I liked it much more this way.  I added a spoonful of Greek Yogurt on the side to kill the heat because I am a wuss, and I really enjoyed it.  I found that the couscous mixed with the peanut sauce was super moist and totally filling. 

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That said, I am still a gastric bypass post op, although at my stage (nearly 11 years) I can eat the entire portion, I would NOT eat this product as an early-stage post op, make sure you are cleared for legumes, nuts, greens and pasta.  It's full of ALL OF THEM. And damn it, I AM EATING THEM.  :P

But, I liked it enough.  BECAUSE VEGETABLES.

  • Via - Trader Joes
  • Price - $2.99
  • Pros - Greens! Beans! Grains! Vegetarian, Under 300 calories.
  • Cons - Ugly as sin.
  • Rating - Pouchworthy when you can digest it. 

 


Weight Loss RX = FIBER

Fiber-Weight-Loss

PCRM - 

Adopting a vegetarian diet causes weight loss, even in the absence of exercise or calorie counting, according to a new meta-analysis published as an online advance in the Journal of the Academy of Nutrition and Dietetics on Thursday, Jan. 22, 2015.

The mega-review analyzed 15 studies, conducted with 755 participants in Finland, Norway, Poland, Spain, Sweden, and the United States. The studies varied in length, from as short as four weeks to as long as two years, with an average weight loss of 10 pounds over a 44-week period.

“The take-home message is that a plant-based diet can help you lose weight without counting calories and without ramping up your exercise routine,” saysNeal Barnard, M.D., lead author of the study, president of the Physicians Committee, and an adjunct associate professor of medicine at the George Washington University School of Medicine and Health Sciences. “We hope health care providers will take note and prescribe this approach to patients looking to manage their weight and health.”

One of the secrets behind losing weight on a plant-based diet is to fill up with fiber. The Physicians Committee recommends consuming close to 40 grams of fiber a day, which is easy to do when you move vegetables, fruits, whole grains, and legumes to the center of your plate.

More than 1.4 billion adults worldwide are overweight and at increased risk for type 2 diabetes, heart disease, osteoarthritis, and certain forms of cancer.

“If you’re overweight, losing just 5 to 10 percent of your body weight can slash the risk of both type 2 diabetes and cardiovascular disease,” says Susan Levin, M.S., R.D., C.S.S.D., a study author and director of nutrition education for the Physicians Committee. “As the weight comes off, you’ll start to see blood pressure, blood sugar, triglycerides, and cholesterol fall right along with it.”

 


This Girl Can.

I saw this video floating around a couple of weeks ago but did not click it. I just did - and glad I did. I enjoyed it, aside from the use of one phrase I don't particularly ... like?

It's inspiring for those who struggle with exercise and body image. (Because, yes.)