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A study published in the journal Diabetes, Obesity & Metabolism examined the effectiveness of a digital weight-loss service called Juniper in the UK. The study found that although the weight loss outcomes for the patients included in the analysis were significant, there was a high attrition rate, indicating low program adherence. The study also revealed that patients had limited communication with their care teams, and response times to urgent events were longer. The study concluded that improvements in adherence and care continuity are needed for digital weight-loss services to be considered reliable options for obesity care. The document also provides information on the peer review history and data availability for the article. [Extracted from the article]

Summary: Background: The prevalence of at‐risk metabolic dysfunction‐associated steatohepatitis (at‐risk MASH) has not been systematically assessed. Aim: To delineate the prevalence of at‐risk MASH in a large population‐based cohort. Methods: We conducted a cross‐sectional analysis of 40,189 patients in the UK Biobank who underwent liver MRI. Hepatic steatosis was determined by proton density fat fraction (PDFF) ≥5%. Based on AASLD criteria, participants were classified as alcohol‐associated steatotic liver disease (ALD), metabolic dysfunction‐associated steatotic liver disease (MASLD), combined metabolic alcoholic liver disease (MetALD) and at‐risk MASH. Results: Among 40,189 patients, 10,886 (27.0%) had a PDFF ≥5%, indicating SLD. Among patients with SLD, 1% had ALD, 89.0% had MASLD, 7.9% had MetALD and 2.2% had at‐risk MASH. The at‐risk MASH group, which included 0.6% of the general population, had the highest mean liver fat on MRI and the highest BMI. Serum biomarkers highlighted increased inflammation and metabolic changes in at‐risk MASH. The prevalence of MASLD was significantly higher among men with a BMI ≥30 kg/m2. Non‐obese women showed only a 12% risk of MASLD. Conversely, MetALD had similar prevalence in obese men and women and was absent in non‐obese women. Conclusions: MASLD is prevalent among patients with elevated PDFF on MRI. There are different sex‐ and BMI‐specific prevalence of different steatotic liver disorders. At‐risk MASH demonstrates the most severe metabolic and inflammatory profiles. This study provides novel estimates for the at‐risk MASH population that will be eligible for treatment with pharmacologic therapy when approved by regulatory authorities. [ABSTRACT FROM AUTHOR]

Aims: To investigate the combined association of adiposity and walking pace with incident type 2 diabetes. Methods: We undertook a prospective cohort study in 194 304 White‐European participants (mean age 56.5 years, 55.9% women). Participants' walking pace was self‐reported as brisk, average or slow. Adiposity measures included body mass index (BMI), waist circumference (WC) and body fat percentage (BF%). Associations were investigated using Cox proportional hazard models, with a 2‐year landmark analysis. A four‐way decomposition analysis was used for mediation and additive interaction. Results: The median (interquartile range) follow‐up was 5.4 (4.8‐6.3) years. During the follow‐up period, 4564 participants developed type 2 diabetes. Compared to brisk‐walking participants with normal BMI, those with obesity who walked briskly were at an approximately 10‐ to 12‐fold higher risk of type 2 diabetes (hazard ratio [HR] 9.64, 95% confidence interval [CI] 7.24‐12.84, in women; HR 11.91, 95% CI 8.80‐16.12, in men), whereas those with obesity and walked slowly had an approximately 12‐ to 15‐fold higher risk (HR 12.68, 95% CI 9.62‐16.71, in women; HR 15.41, 95% CI 11.27‐21.06, in men). There was evidence of an additive interaction between WC and BF% and walking pace among women, explaining 17.8% and 47.9% excess risk respectively. Obesity mediated the association in women and men, accounting for 60.1% and 44.9%, respectively. Conclusions: Slow walking pace is a risk factor for type 2 diabetes independent of adiposity. Promoting brisk walking as well as weight management might be an effective type 2 diabetes prevention strategy given their synergistic effects. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine the independent effects of obesity and dynapenia on falls risk, areal bone mineral density, and fracture risk (lower extremity or all other fractures). Methods: A total of 16,147 women (aged 60‐82 years) from the UK Biobank were categorized by handgrip strength (HGS; dynapenia status: HGS ≤ 21 kg) and body weight (BMI: normal weight, overweight, or obesity). Multiple logistic regression models examined the association among dynapenia and obesity and self‐reported falls (previous 12 months), lower extremity fractures, and all other fractures (previous 5 years). Results: A total of 3793/16,147 women fell, and 1413/15,570 (9.1%) eligible women experienced fall‐related fractures. Obesity (odds ratio [OR] 1.25; 95% CI: 1.12‐1.38) and dynapenia (OR 0.87; 95% CI: 0.77‐0.98) were both independently associated with greater lower extremity fracture risk, independently of areal bone mineral density. However, considering all other fracture sites, obesity conferred protection (OR 0.77; 95% CI: 0.61‐0.96), except in those with low HGS, who had an equivalent fracture risk to those with normal weight (OR 1.06; 95% CI: 0.82‐1.38). Conclusions: Dynapenia further increases the increased risk of leg and ankle fractures in obesity and counteracts the protective effects of obesity on fracture risk at all other sites (wrist, arm, hip, spine, other bones). [ABSTRACT FROM AUTHOR]

Summary: Two thirds of women report experiencing weight stigma during pregnancy. Newspaper media is powerful in framing health issues. This review synthesized UK newspaper media portrayal of maternal obesity. NexisUni was searched to identify newspaper articles, published January 2010 to May 2021, reporting content on obesity during pregnancy. Framework synthesis integrated quantitative and qualitative analysis of the content of articles. There were 442 articles included (59% tabloids and 41% broadsheets). Three overarching themes with interacting sub‐themes were as follows: (1) Women were blamed for their weight, risks, and NHS impact. (2) Women were solely responsible for solving obesity, gendered from school age. (3) Women with obesity were a burden on individuals (e.g., themselves, their children, and health professionals), to society, and the NHS. Catastrophizing language framed the "problem," "scale," and "public health concern" of maternal obesity, emphasizing risk, and danger and was alarmist, aggressive, and violent as to elicit fear or devalue women. Articles platformed 'expert' voices rather than women's lived experiences. This review identified that UK newspaper media negatively frames and oversimplifies the topic of maternal obesity. Exposure to blaming and alarmist messaging could increase women's guilt, stigma, and internalized weight bias. The newspaper media should be harnessed to de‐stigmatize maternal obesity and promote maternal well‐being. [ABSTRACT FROM AUTHOR]

Gestational diabetes mellitus (GDM) is one of the most prevalent obstetric conditions, particularly among women with obesity. Pathways to hyperglycaemia remain obscure and a better understanding of the pathophysiology would facilitate early detection and targeted intervention. Among obese women from the UK Pregnancies Better Eating and Activity Trial (UPBEAT), we aimed to compare metabolic profiles early and mid-pregnancy in women identified as high-risk of developing GDM, stratified by GDM diagnosis. Using a GDM prediction model combining maternal age, mid-arm circumference, systolic blood pressure, glucose, triglycerides and HbA1c, 231 women were identified as being at higher-risk, of whom 119 women developed GDM. Analyte data (nuclear magnetic resonance and conventional) were compared between higher-risk women who developed GDM and those who did not at timepoint 1 (15+0–18+6 weeks) and at timepoint 2 (23+2–30+0 weeks). The adjusted regression analyses revealed some differences in the early second trimester between those who developed GDM and those who did not, including lower adiponectin and glutamine concentrations, and higher C-peptide concentrations (FDR-adjusted p < 0.005, < 0.05, < 0.05 respectively). More differences were evident at the time of GDM diagnosis (timepoint 2) including greater impairment in β-cell function (as assessed by HOMA2-%B), an increase in the glycolysis-intermediate pyruvate (FDR-adjusted p < 0.001, < 0.05 respectively) and differing lipid profiles. The liver function marker γ-glutamyl transferase was higher at both timepoints (FDR-adjusted p < 0.05). This exploratory study underlines the difficulty in early prediction of GDM development in high-risk women but adds to the evidence that among pregnant women with obesity, insulin secretory dysfunction may be an important discriminator for those who develop GDM. [ABSTRACT FROM AUTHOR]

Background: In the United Kingdom, rates of childhood obesity are high and inequalities in obesity have widened in recent years. Children with obesity face heightened risks of living with obesity as adults and suffering from associated morbidities. Addressing population prevalence and inequalities in childhood obesity is a key priority for public health policymakers in the United Kingdom and elsewhere. Where randomized controlled trials are not possible, potential policy actions can be simulated using causal modeling techniques. Objectives: Using data from the Southampton Women's Survey (SWS), a cohort with high quality dietary and lifestyle data, the potential impact of policy‐relevant calorie‐reduction interventions on population prevalence and inequalities of childhood obesity was investigated. Methods: Predicted probabilities of obesity (using UK90 cut‐offs) at age 6–7 years were estimated from logistic marginal structural models adjusting for observed calorie consumption at age 3 years (using food diaries) and confounding. A series of policy‐relevant intervention scenarios were modeled to simulate reductions in energy intake (differing in effectiveness, the targeting mechanisms, and level of uptake). Results: At age 6–7 years, 8.3% of children were living with obesity, after accounting for observed energy intake and confounding. A universal intervention to lower median energy intake to the estimated average requirement (a 13% decrease), with an uptake of 75%, reduced obesity prevalence by 1% but relative and absolute inequalities remained broadly unchanged. Conclusions: Simulated interventions substantially reduced population prevalence of obesity, which may be useful in informing policymakers. [ABSTRACT FROM AUTHOR]

Background: Women with obesity who become pregnant after bariatric surgery have a reduced risk of several obstetric complications; however, limited data exist from the UK population. The present study aimed to characterise a case series of women who attended a medical antenatal clinic for pregnancy following bariatric surgery. Methods: Routine clinical information was collected retrospectively from the medical notes of women who had bariatric surgery and subsequently delivered between January 2012 and November 2018. All were seen in the medical antenatal clinic at Musgrove Park Hospital, Taunton. Results: Data were available for 46 pregnancies. Of these, 27.9% conceived in the first year after surgery. At 9 weeks of gestation, 13.3%, 28.9%, 33.3% and 24.4% were in the healthy, overweight, obese or severely obese category, respectively. Mean (SD) gestational weight gain was 11.9 (6.9) kg, with 54.1% gaining excess weight. Less than half (39.1%) of women were taking the recommended dose of 5 mg of folic acid when first seen. Some 56.1% and 64.6% had suboptimal iron or vitamin D statuses, respectively. Following advice from the clinic, a greater proportion of women took suitable micronutrient supplements. Subsequently, 93% of babies were born at full term, of whom 88% were of healthy weight. Conclusions: Despite the nutritional risks associated with bariatric surgery and the high prevalence of obesity during pregnancy, perinatal outcomes were generally positive, with low rates of infants born preterm or low birth weight. Nutritional supplementation practices and iron status improved with input from a specialist team, underlying the importance of individualised input in this population. [ABSTRACT FROM AUTHOR]

Summary: Background: The relationships between eating habits, behaviours, and the development of obesity in preschool children is not well established. Objective: As children of mothers with obesity are themselves at risk of obesity, we examined these relationships in a cohort of 482 three‐year‐old children of mothers with obesity from the UK Pregnancy Better Eating and Activity Trial (UPBEAT). Method: Dietary patterns were derived using factor analysis of an 85‐item food frequency questionnaire (FFQ). Eating behaviours were assessed using the Children's Eating Behaviour Questionnaire (CEBQ). Measures of body composition included age‐specific BMI cut‐offs, WHO z scores, sum of skinfolds, waist and arm circumferences, and body fat percentage. Using adjusted regression analysis, we examined associations between dietary patterns, eating behaviours, and measures of body composition. Results: Three distinct dietary patterns were defined: "healthy/prudent," "African/Caribbean," and "processed/snacking." The "processed/snacking" pattern was associated with greater odds of obesity; OR 1.53 (95% CI, 1.07‐2.19). The "African/Caribbean" and the "healthy/prudent" patterns were associated with a lower arm circumference (β = −0.23 cm [−0.45 to −0.01]) and sum of skinfolds (β = −1.36 cm [−2.88 to −0.37]), respectively. Lower enjoyment of food and food responsiveness, and greater slowness in eating and satiety, were associated with lower arm and waist circumferences, WHO z scores, and obesity (all P <.05). Conclusion: In children of mothers with obesity, those who had higher scores on a "processed/snacking" dietary pattern had greater odds of obesity. In contrast, slowness in eating was associated with lower measures of body composition. These novel findings highlight modifiable behaviours in high‐risk preschool children which could contribute to public health strategies for prevention of childhood obesity. [ABSTRACT FROM AUTHOR]

Background/objectives: Short sleep duration has been linked to maternal hyperglycaemia following a 1-h 50 g oral glucose tolerance test (OGTT) in observational studies conducted primarily in the USA. Our objective was to examine the relationship between objectively measured sleep duration and plasma glucose values following the 2-h 75 g OGTT routinely used in the UK amongst women with obesity.Methods: Sleep and OGTT data were available for 49 pregnant women who wore wrist actigraphs for at least two nights, and took a 2-h 75 g OGTT at the end of their second trimester. Multivariable regression was used to evaluate associations between sleep duration and OGTT results.Results: Higher 2-h plasma glucose values were significantly associated with shorter sleep duration and higher maternal age and BMI, with no association observed between wake after sleep onset (WASO) and 2-h plasma glucose values. No associations were observed between fasting plasma glucose values and any sleep parameters.Conclusions: We found that shorter sleep duration, as measured using actigraphy, is associated with higher 2-h plasma glucose values following a 2-h 75 g OGTT in the UK. These findings are in keeping with those observed elsewhere in the world, employing alternative OGTT protocols. Future studies should investigate sleep extension as a potential candidate for inclusion in future RCTs aiming to improve glucose tolerance and prevent GDM amongst those at risk. [ABSTRACT FROM AUTHOR]

Objective: Obesity is very common in patients with obstructive sleep apnoea (OSA) and polycystic ovary syndrome (PCOS). Longitudinal studies assessing OSA risk in PCOS and examining the role of obesity are lacking. Our objective was to assess the risk of OSA in women with vs without PCOS and to examine the role of obesity in the observed findings. Design: Population-based retrospective cohort study utilizing The Heal th Improvement Network (THIN), UK. Methods: 76 978 women with PCOS and 143 077 age-, BMI- and location-mat ched women without PCOS between January 2000 and May 2017 were identified. Hazard ratio (HR) for OSA among women with and without PCOS were calculated after controlling for confounding variables using mu ltivariate Cox models. Results: Median patient age was 30 (IQR: 25-35) years; median follow-up was 3.5 (IQR: 1.4-7.1) years. We found 298 OSA cases in PCOS women vs 222 in controls, with incidence rate s for OSA of 8.1 and 3.3 per 10 000 person years, respectively. Women with PCOS were at increased risk of developing OSA (adjusted HR = 2.26, 95% CI: 1.89-2.69, P < 0.001), with similar HRs for normal weight, overweight and obe se PCOS women. Conclusions: Women with PCOS are at increased risk of developing OSA compared to control women irrespective of obesity. Considering the significant metabolic morbidity associated with OSA, clinicians should have a low threshold to test for OSA in women with PCOS. Whether OSA treatment has an impact on PCOS symptoms and outcomes needs to be examined. [ABSTRACT FROM AUTHOR]

Background: Maternal obesity increases women's risk of poor birth outcomes, and statistics show that Pakistani and Bangladeshi women (who are born or settled) in the UK experience higher rates of perinatal mortality and congenital anomalies than white British or white Other women. This study compares the prevalence of maternal obesity in Indian, Pakistani, Bangladeshi and white British women using standard and Asian-specific BMI metrics.Method: Retrospective cross-sectional analysis using routinely recorded secondary data in Ciconia Maternity information System (CMiS), between 2008 and 2013. Mothers (n = 15,205) whose ethnicity was recorded as white British, Bangladeshi, Pakistani or Indian. Adjusted standardised residuals and Pearson Chi-square.Main Outcome Measures: Percentage of mothers stratified by ethnicity (Indian, Pakistani, Bangladeshi and white British) who are classified as overweight or obese using standard and revised World Health Organisation BMI thresholds.Results: Compared to standard BMI thresholds, using the revised BMI threshold resulted in a higher prevalence of obesity: 22.8% of Indian and 24.3% of Bangladeshi and 32.3% of Pakistani women. Pearson Chi-square confirmed that significantly more Pakistani women were classified as 'obese' compared with white British, Indian or Bangladeshi women (χ 2  = 499,88 df = 9, p < 0.001).Conclusions: There are differences in the prevalence of obese and overweight women stratified by maternal ethnicity of white British, Indian, Pakistani and Bangladeshi. Using revised anthropometric measures in Indian, Pakistani and Bangladeshi women has clinical implications for identifying risks associated with obesity and increased complications in pregnancy. [ABSTRACT FROM AUTHOR]

Objective: To explore the experiences of postnatal women who are obese [body mass index (BMI) ≥ 30 kg/m(2) ] in relation to making behaviour changes and use of behaviour change techniques (BCTs).Design: Qualitative interview study.Setting: Greater Manchester, UK.Population or Sample: Women who were 1 year postnatal aged ≥18 years, who had an uncomplicated singleton pregnancy, and an antenatal booking BMI ≥ 30 kg/m(2) .Methods: Eighteen semi-structured, audio-recorded interviews were conducted by a research midwife with women who volunteered to be interviewed 1 year after taking part in a pilot randomised controlled trial. The six stages of thematic analysis were followed to understand the qualitative data. The Behavior Change Technique Taxonomy (version 1) was used to label the behaviour change techniques (BCTs) reported by women.Main Outcome Measures: Themes derived from 1-year postnatal interview transcripts.Results: Two themes were evident: 1. A focused approach to postnatal weight management: women reported making specific changes to their eating and physical activity behaviours, and 2. Need for support: six BCTs were reported as helping women make changes to their eating and physical activity behaviours; three were reported more frequently than others: Self-monitoring of behaviour (2.3), Prompts/cues (7.1) and Social support (unspecified; 3.1). All of the BCTs required support from others for their delivery; food diaries were the most popular delivery method.Conclusion: Behaviour change techniques are useful to postnatal women who are obese, and have the potential to improve their physical and mental wellbeing. Midwives and obstetricians should be aware of such techniques, to encourage positive changes. [ABSTRACT FROM AUTHOR]

Objective:To explore the long-term effects of women's childbearing patterns on their body mass index.Design:Cross-sectional analysis.Setting:Population-based study of UK women.Participants:740 628 postmenopausal participants in the Million Women Study who reported their height, weight, reproductive histories and other relevant factors.Main Outcome Measures:Standardized mean BMI (kg m−2) in groups defined by their parity and breastfeeding history.Results:Women were aged 57.5 (s.d. 4) years on average, and had a mean BMI of 26.2 kg m−2 (s.d. 5); 88% were parous, with 2.1 (s.d. 1.2) children on average. The standardised mean BMI increased progressively with the number of births from 25.6 kg m−2 (95% confidence interval (CI): 25.5-25.6) in nulliparous women up to 27.2 kg m−2 (CI: 27.2-27.3) for women with four or more births, a difference of 1.7 kg m−2 (CI: 1.6-1.7). Among the parous women 70% had ever breastfed and their average total duration of breastfeeding was 7.7 (s.d. 8.8) months. At every parity level the standardised mean BMI was significantly lower among women who had breastfed than those who had not, decreasing by 0.22 kg m−2 (CI: 0.21-0.22) for every 6 months of breastfeeding, that is, women's mean BMI was 1% lower for every 6 months that they had breastfed. These associations were highly statistically significant (P<0.0001) and independent of the effects of socioeconomic group, region of residence, smoking and physical activity.Conclusions:Childbearing patterns have a persistent effect on adiposity in this population. The reduction in BMI associated with just 6 months breastfeeding in UK women could importantly reduce their risk of obesity-related disease as they age. [ABSTRACT FROM AUTHOR]

Abstract: From 2006 to 2008, 261 women in the United Kingdom died either as a direct or indirect result of pregnancy. More than half of these received critical care input. The support required varied from observation and supportive management to multi-organ support. In many women death occurred despite optimal care, but in a number substandard care was identified when the cases were reviewed as part of the Confidential Enquiry into Maternal Deaths. An understanding of the different types of organ support and treatment that are available in a critical care setting and when these are indicated is therefore crucial for medical professionals caring for these unwell obstetric patients. Described here are the technical aspects of organ support that can be utilized in a critical care setting and the alterations in physiology that occur in pregnancy which influence the use of each treatment modality. Also highlighted in more detail are conditions that are common or life threatening in pregnancy and key points about management of these conditions when they mandate critical care support. [Copyright &y& Elsevier]

Background. Confidential enquiries into maternal deaths in the UK have repeatedly highlighted increased maternal morbidity and mortality associated with maternal obesity. Objective. To determine the impact of increased body mass index (BMI) on intrapartum outcomes. Materials and Methods. A retrospective case-control analysis of intrapartum outcomes of the study group (100 women), with a BMI above 40 kg/m(2) (class III Obesity) at booking and a control group (100 women) with a booking BMI between 20 and 25 kg/m(2) was performed. Results. A statistically significant increase in delivery by caesarean section (OR 2.32, 95% CI 1.26-4.29), minor and major postpartum haemorrhage (OR 5.93, 95% CI 2.34-11.98, OR 16.11, 95% CI 2.08-125.09, resp.), perineal trauma (OR 2.59, 95% CI 1.44-4.69), and fetal macrosomia (OR 3.11, 95% CI 1.25-7.79) was noted in the study group. Babies also had an increased risk of having a lower APGAR scores in the study group as compared to the control group (OR 3.09, 95% CI 1.07-8.94). Conclusion. Women with a BMI > 40 kg/m(2) experience increased incidence of intrapartum complications and hence, input of skilled birth attendants during labour is essential to improve intrapartum outcomes. [ABSTRACT FROM AUTHOR]

Summary With the current prevalence of obesity and trends in ethnic diversity amongst parturients in UK maternity units, we performed a prospective, observational study to establish the effect of ethnicity and body mass index on the distance from skin to epidural space in parturients. A total of 1210 parturients participated in this study. The mean (SD) distance from skin to lumbar epidural space was 5.4 (1.1) cm. When tested in a multiple regression model, both body mass index and ethnicity significantly influenced the distance from skin to lumbar epidural space in parturients. The distance from skin to lumbar epidural space amongst ethnic groups differed at any given body mass index. It was significantly greater in Black/British Black and White parturients compared with their Asian and Chinese counterparts. You can respond to this article at [ABSTRACT FROM AUTHOR]

Obesity is a growing problem in obstetric practice. A recent study from Glasgow (UK) showed that 50% of women of childbearing age are either overweight (Body Mass Index [BMI] = 24.9–29.9kg/m2) or obese with 18% starting pregnancy as obese. Obesity prevalence has doubled over a decade from the early 1990’s. In the US it is estimated that 30% of reproductive-age women have a BMI greater than 30 kg/m while 7% have a BMI > 40 kg/m2. A recent report from the UK found that 5% of women had a BMI >35 kg/m2, 2% > 40 kg/m2 and 0.2% >50 kg/m2 with an association not only with social deprivation, but also with a higher prevalence of pre-existing medical disorders such as diabetes and hypertension and medical complications of pregnancy such as preeclampsia. Obesity was also associated with increased rates of macrosomia, operative delivery and postpartum haemorrhage. These data highlight the fact that obesity is an increasing health concern particularly in young women of childbearing age. Obesity will expose them to significant pregnancy complications ranging from miscarriage and fetal abnormality through to operative delivery and thromboembolism. There are also challenges for the delivery of maternity care to meet the needs of these women. As obesity is associated with significant pregnancy complications it is important that women enter pregnancy with an optimum body weight. Many complications, such as fetal abnormality occur in the first trimester and so pre-pregnancy weight reduction is preferred. Further, there is insufficient evidence to recommend specific dietary and/or physical activity interventions to reduce weight or moderate weight gain during pregnancy. [ABSTRACT FROM PUBLISHER]

Abstract: Obesity (Body mass index (BMI) above 30) is one of the major health issues of the 21st century. Over 1.1billion of the world''s population are now classified as obese. In the UK, women are more likely to be obese than men; over 50% of women of reproductive age are overweight or obese. Maternal obesity and the plethora of associated conditions, have a serious impact on the health and development of their offspring. In this review we describe the direct and indirect impact of maternal obesity on the health of the baby. Maternal obesity affects conception, duration and outcome of pregnancy. Offspring are at increased risk of both immediate and long term implications for health. We also briefly review potential mechanisms drawing on data from human and animal studies, and on the outcomes of clinical interventional studies. [Copyright &y& Elsevier]

The article presents a study which examines the prevalence of extreme obesity in pregnancy in Great Britain. Calculation of prevalence estimates was carried out with the 95%confidence intervals (CIs). Results show that there are 8.7 cases of extreme obesity in pregnant women per 10,000 deliveries wherein complications such as preeclampsia and gestational diabetes are present. The study concludes that pregnant women who are extremely obese are more prone to poor outcomes in pregnancy.

Background:There is an absence of national statistics for maternal obesity in the UK. This study is the first to describe a nationally representative maternal obesity research data set in England.Design:Retrospective epidemiological study of first trimester obesity.Methods:Data from 34 maternity units were analysed, including 619 323 births between 1989 and 2007. Data analysis included trends in first trimester maternal body bass index status over time, and geographical distribution of maternal obesity. Population demographics including maternal age, parity, ethnic group, deprivation and employment were analysed to identify any maternal obesity-associated health inequalities. All demographics were tested for multicollinearity. Logistic regression analyses were adjusted for all demographics as confounders.Results:First trimester maternal obesity is significantly increasing over time, having more than doubled from 7.6% to 15.6% over 19 years (P<0.001), and shows geographic variation in incidence. There are also demographic health inequalities associated with maternal obesity, including increased odds of being obese with increasing age, parity, Black ethnic group and deprivation. There is also an association between morbid obesity and increased levels of unemployment.Conclusions:The increase in maternal obesity has serious implications for the health of mothers, infants and service providers, yielding an additional 47 500 women per year requiring high dependency care in England. The demography of women most at risk of first trimester obesity highlights health inequalities associated with maternal obesity, which urgently needs to be addressed. [ABSTRACT FROM AUTHOR]

The increasing prevalence of obesity is presenting a critical challenge to healthcare services. We examined the effect of Body Mass Index in early pregnancy on adverse pregnancy outcome. We performed a population register-based cohort study using data from the North Western Perinatal survey ( N = 99,403 babies born during 2004–2006), based at The University of Manchester, UK. The main outcome measures were Caesarean section delivery, preterm birth, neonatal death, stillbirth, Macrosomia, small for gestational age and large for gestational age. The risk of preterm birth was reduced by almost 10% in overweight (RR = 0.89, [95% CI: 0.83, 0.95]) and obese women (RR = 0.90, [95% CI: 0.84, 0.97]) and was increased in underweight women (RR = 1.33, [95% CI: 1.16, 1.53]). Overweight (RR = 1.17, [95% CI: 1.09, 1.25]), obese (RR = 1.35, [95% CI: 1.25, 1.45]) and morbidly obese (RR = 1.24, [95% CI: 1.02, 1.52]) women had an elevated risk of post-term birth compared to normal women. The risk of fetal macrosomia and operative delivery increased with BMI such that morbidly obese women were at greatest risk of both (RR of macrosomia = 4.78 [95% CI: 3.86, 5.92] and RR of Caesarean section = 1.66 [95% CI: 1.61, 1.71] and a RR of emergency Caesarean section = 1.59 [95% CI: 1.45, 1.75]). Excessive leanness and obesity are associated with different adverse pregnancy outcomes with major maternal and fetal complications. Overweight and obese women have a higher risk of macrosomia and Caesarean delivery and lower risk of preterm delivery. The mechanism underlying this association is unclear and is worthy of further investigation. [ABSTRACT FROM AUTHOR]

Qualitative research may be able to provide an answer as to why adults and children do or do not participate in sport and physical activity. This paper systematically examines published and unpublished qualitative research studies of UK children's and adults' reasons for participation and non-participation in sport and physical activity. The review covers peer reviewed and gray literature from 1990 to 2004. Papers were entered into review if they: aimed to explore the participants' experiences of sport and physical activity and reasons for participation or non-participation in sport and physical activity, collected information on participants who lived in the United Kingdom and presented data collected using qualitative methods. From >1200 papers identified in the initial search, 24 papers met all inclusion criteria. The majority of these reported research with young people based in community settings. Weight management, social interaction and enjoyment were common reasons for participation in sport and physical activity. Concerns about maintaining a slim body shape motivated participation among young girls. Older people identified the importance of sport and physical activity in staving off the effects of aging and providing a social support network. Challenges to identity such as having to show others an unfit body, lacking confidence and competence in core skills or appearing overly masculine were barriers to participation. [ABSTRACT FROM AUTHOR]

Abstract: Three nations carried out large surveys of their non-institutionalized populations during the period 1976-81, with essentially similar techniques for measuring height and weight. Using criteria previously published for the British survey, we analyzed the Canadian and Untied Stales data and compared the prevalence of excessive weight for ages 20-64 in the three countries. Overweight was defined as a Quetelet index value of 25.1-30 and obesity as a value exceeding 30. Compared to their Canadian and British counterparts, American men are more likely to be overweight or obese, especially at the lower age levels. The proportion of excessively heavy men reaches a plateau around age 50 in all three countries, possibly indicative of a survivor phenomenon. Among women, the LIS hits the highest proportion of excessively heavy individuals at all ages except 20-24: this difference is especially marked at ages 45-54. Unlike men, there is no evidence that the proportion of overweight or obese women reaches a plateau by age 64. [ABSTRACT FROM AUTHOR]

Background: It is widely acknowledged that maternal obesity and excessive gestational weight gain (GWG) are associated with increased risk of fetal macrosomia and recent studies have suggested a role for the timing and composition of GWG.Aims: To examine the effect of the rate of change in GWG and maternal upper-body subcutaneous fat on neonatal anthropometric outcomes in a pilot observational study amongst women with obesity.Study Design: Expectant women with a body mass index (BMI) > 30 kg/m2 at first antenatal appointment were recruited at 12 weeks gestation. Maternal height, weight and skinfold thickness (SFT) measurements were collected at baseline and repeated at 28 and 36 weeks gestation. Following delivery, World Health Organisation (WHO)-UK infant birthweight z-scores were calculated, and infant anthropometric measurements were obtained.Results: The sum of upper body SFT measurements increased in mid-pregnancy (0.08 ± 0.71 mm/week) and decreased in late pregnancy (-0.04 ± 1.17 mm/week). After adjustment for maternal age, BMI and parity, mid- but not late- pregnancy GWG was positively associated with infant birthweight z-score (p<0.05), while mid- but not late-pregnancy changes in the sum of SFT were inversely associated with infant birthweight z-score (p<0.01).Conclusions: The present study suggests that mid- rather than late-pregnancy changes in weight and upper-body subcutaneous fat are associated with infant birthweight. Further research is required in larger, more diverse populations to explore whether pregnancy interventions aiming to improve maternal and offspring health can be personalised beyond BMI and GWG. [ABSTRACT FROM AUTHOR]

Background and purpose: The purpose of this study was to identify the incidence and prevalence of idiopathic intracranial hypertension (IIH) in Sheffield, UK. Methods: A retrospective review of case notes was conducted to identify cases of IIH seen between 1 January 2007 and 31 December 2008. Results: Sixteen (15 women and 1 man) new patients were identified to give an incidence within Sheffield of 1.56/100 000/year and 2.86/100 000/year for women. The incidence of IIH in obese women was 11.9/100 000/year. The prevalence of IIH was calculated as 10.9/100 000, and 85.7/100 000 in obese women. Conclusion: A higher incidence of IIH than previously reported UK data was found, which may be because of increasing obesity within the population, or improved case ascertainment. [ABSTRACT FROM AUTHOR]

Background: Preterm (< 37 weeks gestation) and post-term birth (≥42 weeks gestation) are associated with increased morbidity and mortality for mother and infant. Obesity (body mass index (BMI) ≥30 kg/m2) is increasing in women of reproductive age. Maternal obesity has been associated with adverse pregnancy outcomes including preterm and post-term birth. However, the effect sizes vary according to the subgroups of both maternal BMI and gestational age considered. The aim of this retrospective analysis was to determine the association between maternal obesity classes and gestational age at delivery.Methods: A secondary data analysis of 13 maternity units in England with information on 479,864 singleton live births between 1990 and 2007. BMI categories were: underweight (< 18.5 kg/m2), recommended weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2) and obesity classes I (30.0-34.9 kg/m2), II (35.0-39.9 kg/m2), IIIa (40-49.9 kg/m2) and IIIb (≥50 kg/m2). Gestational age at delivery categories were: Gestational age at delivery (weeks): extreme preterm (20-27), very preterm (28-31), moderately preterm (32-36), early term (37, 38), full term (39-40), late term (41) and post-term (≥42). The adjusted odds of births in each gestational age category (compared to full-term birth), according to maternal BMI categories were estimated using multinomial logistic regression. Missing data were estimated using multiple imputation with chained equations.Results: There was a J-shaped association between the absolute risk of extreme, very and moderate preterm birth and BMI category, with the greatest effect size for extreme preterm. The absolute risk of post-term birth increased monotonically as BMI category increased. The largest effect sizes were observed for class IIIb obesity and extreme preterm birth (adjusted OR 2.80, 95% CI 1.31-5.98).Conclusion: Women with class IIIb obesity have the greatest risks for inadequate gestational age. Combining obesity classes does not accurately represent risks for many women as it overestimates the risk of all preterm and post-term categories for women with class I obesity, and underestimates the risk for women in all other obesity classes. [ABSTRACT FROM AUTHOR]

The article features the experience of the author in counseling research in Great Britain. The author has been the researcher on a project set up to measure the benefit for obese women of groups that offer a psychotherapeutic and cognitive programme. These benefits are measured primarily in terms of weight loss. He then went through the process of applying for ethical approval through the on-line National Health Service ethics Web site. Prior to the ethics application, while seeking funding, he had also approached several local GP practices for the research project.

Investigates the mechanisms underlying the control of blood pressure by studying obese women in a slimming regimen in Great Britain. Maintenance of salt intake in the subjects; Reduction of blood pressure due to low-energy diet; Factors relevant in the hypotensive effect of semi-starvation.

The article discusses two research from the U.S. and Great Britain on the link between maternal weight and congenital anomalies in their offspring. A study conducted by James L. Mills et al. published in the "American Journal of Clinical Nutrition" found that obesity elevated the risk of some congenital heart defects. A study conducted by J. Rankin et al. in a 2010 issue of the "International Journal of Obesity" found that there is an increase in congenital anomalies in offspring of obese women.

The article discusses a study by G. K. Reeves et al. on the relation of cancer incidence and mortality to body mass index (BMI) which appeared in the "British Medical Journal." It notes that 17,203 deaths occurred during follow-up. The researchers observed a significant difference in the trend estimates between postmenopausal women who had never used hormone replacement therapy and premenopausal women. They attributed about 5% of all cancers among postmenopausal women in Great Britain to being overweight or obese.

The article focuses on the issue concerning obesity in women which highlights an urgent need for specific healthcare plans for overweight mothers in Great Britain. The study conducted by the Confidential Enquiry into Maternal and Child Health (CEMACH) indicates that more than half of women who died from direct and indirect causes in the region were obese. The statistics has alarmed the government for obesity is associated with high blood pressure, heart disease, cancer and respiratory problems.

The article provides an estimate of the obesity rate in Great Britain and looks at its implication on the nation's fertility. It highlights a study conducted by researcher Cecilia Ramlau-Hansen which revealed that the rate of obesity is continuously rising. According to the author, the government forecasts that around one third of the British adults will become obese by 2020.

The article reports that researchers in Great Britain have found a high level of obesity in women at the start of their pregnancy. Maternity records of over 35,000 women were analyzed to elucidate the relationships between socioeconomic and demographic factors and maternal obesity. Previous research has shown that maternal obesity is a risk factor for cesarean section, miscarriage, maternal death and stillbirth.

The article talks about the prevalence of obesity on pregnant women in Great Britain. Obesity can create pregnancy complications such as gestational diabetes and hypertension, and can complicate the performance and interpretation of ultrasound scans. Health services in the nation are reported to be spending significant sums to accommodate obese mothers. The article states that the best way is to begin pregnancy at a healthy weight.

The article focuses on a health recommendation by the British Fertility Society that obese women should not be able to have fertility treatment, due to health risks to their unborn babies. The National Health Service argues that women should be reminded of the health risks but still have access to treatment.