Obesity in pregnancy

Epidemiological studies show the incidence of obesity in pregnancy to be increasing, and the management of the morbidly obese woman on labour ward can be a challenge for anaesthetists. The chapter defines obesity, body mass index, classification, and prevalence, and reviews the physiological effects of obesity on the respiratory, cardiovascular, gastrointestinal, renal, endocrine, and haematological systems, as well as pharmacokinetic changes. Both fetal and maternal morbidities are listed followed by management proposals in the antenatal, peripartum, and postpartum periods. This includes antenatal screening, criteria for anaesthetic referral for assessment and what this should include to plan for delivery. Suggestions for management during labour and during an operative delivery are made. Attention is given to the ramped position and enhanced pre-oxygenation prior to induction of general anaesthesia with CPAP and THRIVE. Practical considerations and technical challenges are discussed and include manual handling, IV access, monitoring, regional techniques, and previous bariatric surgery.

Mobility Improvements Are Found in Older Veterans After 6 Months of Gerofit Regardless of Body Mass Index Classification

Veterans represent a unique population of older adults, as they are more likely to self-report a disability and be overweight or obese compared with the general population. We sought to compare changes in mobility function across the obesity spectrum in older veterans participating in 6 months of Gerofit, a clinical exercise program. A total of 270 veterans (mean age: 74 years) completed baseline, 3-, and 6-month mobility assessments and were divided post hoc into groups: normal weight, overweight, and obese. The mobility assessments included 10-m walk time, 6-min walk distance, 30-s chair stands, and 8-foot up-and-go time. No significant weight × time interactions were found for any measure. However, clinically significant improvements of 7–20% were found for all mobility measures from baseline to 3 months and maintained at 6 months (all ps < .05). Six months of participation in Gerofit, if enacted nationwide, appears to be one way to improve mobility in older veterans at high risk for disability, regardless of weight status.

Parental Perceptions of Child’s Medical Care and Neighborhood and Child’s Behavioral Risk Factors for Obesity in U.S. Children by Body Mass Index Classification

Environmental factors, preventive medical care, and behaviors play a role in childhood obesity. This study used the National Survey of Children’s Health, 2011-2012, for 42,828 children, ages 10–17 years. Greater percent of children in the overweight/obese category performed no moderate-to-vigorous physical activity: 11.9 (10.6, 13.3) as compared to children in the underweight/normal weight category: 9.7 (8.9 10.6). No moderate-to-vigorous physical activity was associated with no preventive medical care, inadequate or no health care, parents reporting higher percent of no parks or playgrounds, and unsafe and unsupportive neighborhoods. Odds ratios of overweight/obesity were higher for males [OR = 2.06 (1.64, 2.60)], Hispanics [OR = 1.49 (1.17, 1.90)], non-Hispanic Black females [OR = 1.59 (1.20, 2.08)], younger females [OR10–12 yrs. = 1.35 (1.03, 1.79) and OR13–15 yrs. = 1.4. (1.06, 1.89) vs. OR = 1.0016-17 yrs.], children with high television viewing [OR0-1 hr./day = 0.72 (0.61, 0.86); OR>1 to <4 hrs./day 0.84 (0.72, 0.99) = vs. OR = 1.00≥ 4 hrs./day,] and lower categories of physical activity [OR 0 days/wk. = 1.38 (1.13, 1.62); OR1–3 days/wk. = 1.14 (1.22, 1.62) vs. OR7 days/wk. = 1.00], higher poverty, smoke exposure, and parental perception of their neighborhood as unsupportive. Promoting preventive medical care and neighborhood cooperation may have potential to lower childhood obesity.