Chelsea Jenter, MPH
A friend recently told me that she gained 30 pounds during the first trimester of her pregnancy. Because I work in obesity research, she asked me if that sounded like too much. I suggested that she talk to her doctor, and she said “Well, if it was a problem, wouldn’t my doctor bring it up with me?”
For almost everyone, weight is a touchy subject. Despite written guidelines and research on how clinicians can approach – and not offend – patients when discussing their weight, studies have long shown that both patients and providers are hesitant to bring up the topic during clinic visits. Add the complicating factor of pregnancy, and it may not come as a surprise that this reluctance extends to discussing weight gain with pregnant patients
In an earlier blog post, Emily Oken illustrated the importance of appropriate weight gain during pregnancy, describing how gaining too much weight during a pregnancy can have negative health consequences for both the mother and the child. But despite this evidence, some women, like my friend, expect the doctor to initiate conversation related to weight gain limits and concerns. Doctors are hesitant to bring up the topic as well.
One of the research projects in our group aims to address this issue. Our investigators are recruiting both pregnant women and their providers to participate in a two-part trial aimed at facilitating these tough discussions.
In the first part of the study, researchers are providing physicians with training and tools so they feel more comfortable addressing excess weight gain during pregnancy. Physicians are coached on strategies for addressing weight issues with patients, as well as new tools in the electronic health record that display growth trajectories during pregnancy. These trajectories will give physicians a quick way to determine whether patients are on track to gain a healthy amount of weight during pregnancy. Together, these tools and strategies are intended to facilitate delicate discussions of excess weight gain during pregnancy.
In the second part of the study, pregnant women will be paired with a mobile app and a health coach. The coach will work directly with the patient, discussing the woman’s weight goals, strategies to achieve those goals, and also noting whether her physician discussed weight gain with the patient. Our goal is to empower both patients and providers to have these difficult discussions, so that no one is left wondering after an appointment, “is that something I should have brought up?”
Jennifer Thompson, MPH
If you ever dare to venture into the comments section of any article about weight, weight loss, obesity, exercise or health, eventually you’ll find someone who says some version of the following: “All people have to do is eat less and exercise more, and they’ll lose weight.” In a broad sense, this is true; calories are energy, and our bodies use that energy to fuel our basic bodily functions, like circulation, respiration, digestion, and physical activity. Excess calories are stored by the body as fat. Yet it also grossly oversimplifies the complexity of our metabolisms.
Mike Seward, AB
In our traffic-light food labeling study at Harvard dining halls, recently published in the American Journal of Public Health, I used several nutrition criteria to label foods as “green”, or most nutrient rich; “yellow”, or nutrient neutral; and “red", or least nutrient rich. The most challenging criteria to assess were “Whole Grain” vs. “Refined Starch,” and with the public’s general fear of all things carbohydrate, it’s important to know the difference between types of carbs. But since whole grains account for only 10-15% of grains available for sale in supermarkets, how do we find them? After labeling hundreds of foods and beverages, here’s what I learned.
Wei Perng, PhD
Last week, I met with a prospective Master’s student wrapping up her B.S. in Nutritional Sciences. She told me about her background in nutrition, her laboratory training, and her desire to conduct nutrition-related research in human populations. I asked her whether there was a particular focus area that piqued her interest and she said, “I feel as though there isn’t a lot known regarding what a healthy diet is supposed to look like for normal people. I’d like to look into that.”
This caught me off guard, especially because the overarching goal of nutrition research is to characterize healthy diets in order to promote health, both for individuals and the broader population. As I thought more about our conversation, it occurred to me that perhaps the issue isn’t a lack of research on what constitutes a healthy diet, but rather that our views on this topic are constantly changing due to new research, and that translating and disseminating those findings to a lay audience is challenging.
Marie-France Hivert, MD, MMSc
Gestational diabetes is caused by an imbalance between the capacity of the pancreas to secrete insulin and the sensitivity of different tissues such as fat, liver and muscles to insulin. During pregnancy, these tissues become less sensitive to insulin because of hormonal changes that occur.
We can refine our definition of gestational diabetes by whether the imbalance is caused more by inadequate insulin secretion or low insulin sensitivity. In a large prospective cohort of about 800 pregnant women called Gen3G, we found that about half of the women with gestational diabetes had predominantly an insulin sensitivity defect, meaning that while their pancreas may make enough insulin, their tissues fail to respond to it. About 30% have mainly an insulin secretion defect, meaning that their pancreas makes too little insulin for the demands that pregnancy hormones induce on the body. Less than 20% have a mix of both defects. We showed that women with gestational diabetes due to an insulin sensitivity defect are the ones at higher risk of complications at delivery, with a higher rate of newborns classified as large-for-gestational age and that experience hypoglycemia soon after birth. These women are also more likely to need a caesarian section to deliver the baby. Pregnant women with gestational diabetes due to low insulin sensitivity had a higher BMI prior to pregnancy, but the risk of higher complications remained significant even after accounting for mother’s weight status. These higher rates of complications in pregnant women with gestational diabetes due to low insulin sensitivity were observed despite all women with gestational diabetes receiving similar clinical care and tight control of maternal glucose. This suggests factors other than maternal hyperglycemia might contribute to the rate of complications, such as inflammatory cytokines, adipokines, or some lipid fractions that increase with lower insulin sensitivity. Future studies will need to identify factors that might be contributing to these complications, and to assess whether we can target or treat these metabolic anomalies in addition to controlling maternal glucose.
Harvard Medical School has removed nutrition education from its curriculum.
Last summer, I taught a section of the week-long HMS nutrition course for second year medical students, and there were rumblings of this possibility then. But at least to me, it still seemed likely that with nutrition-related diseases being of such overwhelming concern to the general public, HMS leadership would change its mind.
Jason Block, MD, MPH
Several months ago, I got into a twitter spat. In response to a blog post that decried how inadequately doctors were treating patients with obesity, I wrote in a series of tweets: “When will we stop blaming doctors for what they fail to do about obesity and accept that they cannot reverse the epidemic? Primary care docs have a role but not enough support or time to spend on obesity while treating myriad other issues. Reversing obesity is more of a policy and societal challenge than a health care matter. Surgery and drugs can only do so much.” In response, the author of the original blog post wrote another piece, quoting me anonymously, lamenting that I thought there was nothing that doctors could do to treat obesity.
Jen Thompson, MPH
Full disclosure: all of my colleagues refused to write a blog post on this topic. “Ewww,” one said. “I don’t feel comfortable writing about that,” said another. Even when I pointed out that our department has written papers on very similar topics, they all declined. So I decided to tackle it myself, because a) it’s a topic that applies to everyone who was ever born, b) is biologically very important and interesting, and c), I think it’s an excellent example of how the implications of a small but interesting scientific study can be misinterpreted, exaggerated, or distorted.
Kristina Lewis, MD
Whatever your take on the Affordable Care Act (ACA), the Syrian refugee crisis, or the bailout of Wall Street, there is probably at least one area where we can (mostly) agree that the Obama Administration has earned high marks over the past 8 years – Obesity. Michelle Obama, with her “Let’s Move” campaign, has been a champion for healthful dietary choices and physical activity, with a strong focus on obesity prevention in children. As great as this has been for those of us who research, treat, or are generally passionate about obesity, the era is now coming to an end. Entering the heart of the 2016 presidential campaign, I often find myself wondering – how will Obama’s successor deal with this important issue? Will the nation’s current laser focus on health and wellness fade into the background as a new family, with new issues to promote, moves into the White House?
Wei Perng, PhD
Advancements in high-throughput technologies have enabled us to assess health from a more holistic point of view by considering our genetic code (“genomics”), actual expression of our genes (“epigenomics” and “transcriptomics”), the structure of proteins that carry out the biological processes (“proteomics”), and the unique chemical fingerprints that reflect our physiological response to external and internal conditions (“metabolomics”). Of particular interest to an obesity-prevention researcher is the possibility of “omics” to influence nutrition counseling, a one-on-one process between a patient and a nutritionist that aims to help the patient make and maintain dietary changes necessary for good health. These recommendations have historically been based on dietary recommendations derived from nutrient needs of heterogeneous populations. Enter the concept of personalized nutrition - a diet plan designed at the level of the individual, tailored to meet their specific health needs.