Are C-sections fueling the obesity epidemic?

[teflep1]

Since it is # Wednesday (and this was just talked about on NPR today)...

Young adults born via Cesarean section are more likely to be obese than those delivered vaginally, suggesting C-sections could be feeding the obesity epidemic, researchers have found.

But the theory is controversial. One expert cautioned that scientists are still a long way from pinning the expanding waistlines on higher rates of C-sections.

In the new study, Brazilian researchers found that among more than 2,000 23- to 25-year-olds, 15 percent of those delivered via C-section were obese compared to 10 percent of those born naturally.

The team looked at a number of other factors that could potentially explain the connection, like heavier birth weight, or income and education levels (more-educated mothers had a higher C-section rate).

But even after accounting for these factors, C-section remained linked to a 58-percent increase in the risk of adulthood obesity, according Dr. Helena Goldani and colleagues.

The findings do not prove cause-and-effect, Goldani, of Universidade Federal do Rio Grande do Sul in Porto Alegre, told Reuters Health in an email. And there could still be other explanations for the finding, she said.

Still, it's possible that C-sections could directly affect the risk of becoming obese later in life, the researchers speculate.

That's because infants born via C-section are not exposed to the beneficial bacteria in the birth canal, and so they might take longer to accumulate Bifidobacteria and other microbes that could influence their metabolism.

Similarly, obese adults tend to have fewer of those friendly bacteria in their digestive tract than normal-weight people do.

A researcher not involved in the study said that while the theory is "interesting," this study offers no proof that C-sections are to blame.

"I think all they have shown is an association. They have not shown any mechanism or cause-and-effect," said Dr. Xavier Pi-Sunyer, director of the New York Obesity Research Center at St. Luke's Hospital.

A major weakness, he told Reuters Health, is that the study had no information on mothers' weight.

Obese women are more likely than thinner women to need a C-section. Likewise, they are more likely to have overweight or obese children.

"That is a huge gap in the data," Pi-Sunyer said.

He noted, though, that other researchers are looking into the question of why obese people tend to have a different composition of bacteria in the intestines than thinner people.

One theory is that the variation in intestinal bacteria comes first and contributes to obesity by causing people to burn fewer calories and store more as fat.

Whether that is the case remains uncertain, however, and the role of C-sections is even less clear.

"This is an interesting finding," Pi-Sunyer said. "But it raises more questions than it answers, and it requires a lot more research."

He said that future studies will have to account for more "confounding" factors, like mothers' weight and pregnancy-related diabetes, to show whether the link between C-sections and obesity is real.

Goldani agreed that further studies in other countries are needed -- including studies that measure newborns' intestinal bacteria, then follow them over time to chart their weight changes.

Brazil has long had one of the highest C-section rates in the world. Of the 2,057 adults in this study, who were born in the late 1970s, 32 percent were born via C-section. It's now estimated that C-sections are done in about 44 percent of Brazilian births, many of which are thought to be medically unnecessary.

The C-section rate is also high in the U.S., where it accounts for about 33 percent of births.

"An underlying message in this (report) seems to be that there should be fewer C-sections performed," Pi-Sunyer said.

That may well be, he added, but not because it will do anything to solve the obesity problem.

www.reuters.com/article/2011/05/12/us-csections-obesity-idUSTRE74B68B20110512

[Deleted]

This is fascinating to me, but I think that this part says a lot:

"A major weakness, he told Reuters Health, is that the study had no information on mothers' weight.

Obese women are more likely than thinner women to need a C-section. Likewise, they are more likely to have overweight or obese children.

"That is a huge gap in the data," Pi-Sunyer said.

He noted, though, that other researchers are looking into the question of why obese people tend to have a different composition of bacteria in the intestines than thinner people."


I would think that for the study to be valid, you would have to account for the mother's weight as well.

[statlerwaldorf]

I don't understand why they wouldn't account for the mother's weight.

[marie427]

Ditto Laurier. I'm no scientist or medical expert but c-sections themselves causing obesity sounds ludicrous to me.

[Deleted]

May 23, 2012 9:01:55 GMT -5 marie427 said:

Ditto Laurier. I'm no scientist or medical expert but c-sections themselves causing obesity sounds ludicrous to me.

Well, they did have reasons why that might occur that sound all scientific and plausible, but as soon as it said they didn't account for mothers weight I was like, well, how do you really know?!

Most people I know have their mothers figure to a certain extent. I would think genes themselves play a larger role than whatever bacteria is in the birth canal.

[marie427]

May 23, 2012 9:04:48 GMT -5 @lauriergirl28 said:

May 23, 2012 9:01:55 GMT -5 marie427 said:

Ditto Laurier. I'm no scientist or medical expert but c-sections themselves causing obesity sounds ludicrous to me.

Well, they did have reasons why that might occur that sound all scientific and plausible, but as soon as it said they didn't account for mothers weight I was like, well, how do you really know?!

Most people I know have their mothers figure to a certain extent. I would think genes themselves play a larger role than whatever bacteria is in the birth canal.

I know, but even the scientific explanations they had seemed like poppycock to me. But again, I'm no expert.

[jaylea]

"A major weakness, he told Reuters Health, is that the study had no information on mothers' weight.

Obese women are more likely than thinner women to need a C-section. Likewise, they are more likely to have overweight or obese children."

This was exactly what was running through my mind as I was reading what they controlled for. This is a pretty big oversight. We know obese women are more likely to have c-sections, and have obese kids. Seems common sense that they should have investigated that link.

[chichimi]

If the birth canal bacteria is so beneficial, cant they swab it and put it on the baby? That seems to be the only true connection in this.

[Deleted]

not accounting for the mother's weight is a hole big enough to make me dismiss this report almost entirely.*

*note, i am not a scientist.

[atouchofklasse]

I'm sure the researchers would have preferred to control for maternal weight but didn't have the data available. I wouldn't call it an oversight but a data-related limitation.

[teflep]

On the air story mentioned something about not getting vital good bacteria during the natural birthing process.

[teflep]

Oops, just saw this was spoken about up thread.

[eddy]

Oh goody another way to shame moms!

[myst]

May 23, 2012 9:13:13 GMT -5 atouchofklasse said:

I'm sure the researchers would have preferred to control for maternal weight but didn't have the data available. I wouldn't call it an oversight but a data-related limitation.

The oversight was in attempting the study at all if they couldn't control for that. If you know two things are correlated to a common link (obesity and c-sections, obesity in mothers and obesity in children), you can't develop a causative relationship between the two, it's completely invalid.

Worthless waste of research $$.

[Deleted]

Mommy wars forevah!

[jaylea]

Well, this is interesting. It looks like they did have the pre-pregnancy weight of the mothers, and when they controlled for it, it showed no differences in obesity outcomes for the babies. After reading the journal article itself, there's a whole lotta nothing to see here, it seems.

"Recent analyses of the Brazilian Ribeirão Preto 1978–799 birth cohort showed an adjusted prevalence ratio for obesity of 1.58 (95% CI: 1.23, 2.02; P < 0.001) at 23–25 y of age for subjects born through CSs (10). Sex-stratified results are not shown, but the authors (10) reported that there was no interaction with sex. Their study included statistical adjustment for the subject's sex, birth weight, physical activity, smoking, schooling, and income, as well as for maternal schooling and smoking during pregnancy. Our analyses adjusted for all these factors and, in addition, for maternal family income, type of payment for delivery, skin color, parity, age, prepregnancy weight, and height.

Our adjusted results did not confirm such a high risk of obesity in subjects delivered by cesarean delivery. No significant associations of CSs and obesity at any age were shown in women. For male subjects, we showed a significant association at 4 y of age but only in the 1993 cohort; this significant association was not present in the same cohort at later ages or in the 2004 cohort at the same age. Most prevalence ratios for men and women remained above unity. "

[chichimi]

I dont know that this is about shaming moms. Unless you schedule a C-section ahead of time for non-medical purposes, its not really something you can help, right?
I think we can still learn from this and if vaginal bacteria is that important, we should find a way to introduce it to newborns.

[teflep]

I don't think this is shaming either. The NPR story really focused on this being a possible reason for the skyrocketing obesity epidemic. Not the only answer, for sure, but a factor. I don't see it as any different than bf vs ff. I know bf is best, but not doing so doesn't doom my kid...neither would a vb vs c-section.

[Melissa W.]

Even when a c-section is something that you can't avoid, people find a way to shame it.

[eddy]

May 23, 2012 9:28:09 GMT -5 @chichimi said:

I dont know that this is about shaming moms. Unless you schedule a C-section ahead of time for non-medical purposes, its not really something you can help, right?
I think we can still learn from this and if vaginal bacteria is that important, we should find a way to introduce it to newborns.

C sections as a whole carry a lot of guilt for many women regardless if they are needed. Sense of failure etc etc

Sure if we find out that bacteria is needed this is awesome. On the outside it just appears as another study to remind women how they are potentially failing their children. I expect to see cnn puplish this soon under their mom shaming section.

[teflep]

Who is shaming it? I guess this is like bf vs ff.

[eddy]

Sorry i wasn't clear. I dont think the purpose of this study is to shame. I think how the information is distributed by the media for example will be in a very mommy war type way.

[whitewolf]

oh, for the love of fuck.

[heightsyankee]

May 23, 2012 9:25:15 GMT -5 @habbsies said:

Mommy wars forevah!

Tale as old as time

[heightsyankee]

May 23, 2012 9:51:32 GMT -5 asdfjkl said:

Kristin Wiig with the tiny hands is probably my favorite SNL skit ever.

I don't think this is c-section shaming either, but I didn't have a c-section, so I don't know what kind of emotional baggage comes with it. I will say that of all my friends who have had c-sections, this is the first I've ever heard that there is a pervasive feeling of "guilt" that comes with it. Mostly, my friends are just pissed that their pubic hair line isn't as low as it used to be.

Did you see the season finale with Jon Hamm and her? Freaking priceless.

I had 2 c-sections and I don't find this to be shaming. With the obesity rates climbing past epidemic proportions, I think the medical community is trying to root out any and all causes. I just don't think they did a very good job here. At 5'5" and 168 lbs, I am considered obese by the latest BMI litmus test. Both my boys are in the 10-20% range for weight.

However, I also think it's valid to look at everything (but not to skew the info by leaving some things out, like mothers' weights) that is not "natural." Obviously the way we are doing things now is leading to this issue and there is going to be more than one cause.

[whitewolf]

May 23, 2012 9:51:32 GMT -5 asdfjkl said:

Kristin Wiig with the tiny hands is probably my favorite SNL skit ever.

I don't think this is c-section shaming either, but I didn't have a c-section, so I don't know what kind of emotional baggage comes with it. I will say that of all my friends who have had c-sections, this is the first I've ever heard that there is a pervasive feeling of "guilt" that comes with it.

oh, that's because you don't hang out on The Bump. With no snark at them intended, a lot of gals there (or hell, even on MeMo, the offobard) are haunted by their sections and adamant about VBAC. For my part, I never realized people could be so attached to their birth experiences.

C-sections are a very, very touchy subject-- akin to the breastfeeding/formula feeding degree of touchiness.

[eddy]

Say what now about this pubic hair line. This is brand new info since i am set to have a section next week. I am now more concerned with the state of my bush rather than if my kid will be a fatty or not. Priorities and all

[lyssbobiss, Command, B613]

Now, if we could find a way to pull breastfeeding into this somehow, it would be an amazing trifecta of awesomeness.

[eddy]

Also i am not very sensitive about my section because my kid will die and all if I have a vaginal birth, but i certainly feel judged a bit when i share the news about a scheduled section. More like i need to tell people it is very medically necessary when normally i wouldnt share personal news. There is a stigma for sure.

[jaylea]

May 23, 2012 10:00:23 GMT -5 lyssbobiss, Command, B613 said:

Now, if we could find a way to pull breastfeeding into this somehow, it would be an amazing trifecta of awesomeness.

It's mentioned in the journal article. lol.