The article headline tells it all:

“Obesity May Make Anesthesia Riskier
But It’s Still Safe for Obese People to Undergo Anesthesia, Study Shows”

http://www.webmd.com/diet/news/20051026/obesity-may-make-anesthesia-riskier

I think you’re looking for a complicated explanation when the obvious one is that doctors in general don’t like taking risk – in fact they put risk as a primary concern over patient welfare.

I’ll probably botch this explanation, but here goes. The relative risk for complications during surgery is much greater for the obese. But the absolute risk is very close to what it would be for someone who’s thin. So when you hear that someone who is obese has a chance of complications that are 12 times greater than someone of normal weight, it sounds scary. But then you realize that the real chances are 2 in a thousand versus 24 in a thousand, so it’s really the difference between buying one lottery ticket or two – though your odds doubled, that doesn’t mean a whole lot.

So if you’re fat, it’s not really that big a deal. Yeah, your odds of having complications are greater, but you’re talking about 0.1% vs 1.2% (hypothetical numbers!) so it’s nothing to get worked up over. Close to 99% chance of everything going smoothly in either case.

But from the other end, it’s a different story. Treating 500 patients with those same odds, if all were thin the chances of complications on any case would be about 40%. But if all of them were fat the chances on any case would be 99.8% That’s a HUGE difference from the viewpoint of an insurance company doing numbers on a doctor’s results.

So you have this paradox where risk from a patient’s viewpoint is psychologically very different from risk from a provider’s viewpoint. Of course, it goes without saying that the provider’s viewpoint is what will wind up being followed.

Right now, I’m about the size I was when I gave birth to my son in 2002. Oh yeah, *AT HOME*. He was a planned homebirth and it was awesome. My Midwife was amazing and so positive about my pregnancy and his birth–never once harping over my weight (though state mandated I had to the get “ok” from an OB because of my weight @@ WTFever) It was such a lovely difference from my daughter’s birth–with an OB (overweight himself) who was an ass about my weight.

One of THE best resources I used the 2nd time around was http://www.plus-size-pregnancy.org/

As for limiting wt gain in fat women, yes, famine in the Dutch during WW2 was linked to increased rates of obesity and disease in children exposed to the famine at the right point in pregnancy. It’s difficult to prove for sure that limiting wt gain in pregnant women today will cause a similar effect but it certainly is a real potential concern.

What these doctors have done, once again, is confuse causality and correlation. The study showed that the obese women who gained less wt had less pre-eclampsia (BP issues), less cesareans, etc. It did NOT show that *deliberately* limiting wt gain is effective in preventing these problems. It was observational, not an intervention study.

Now, why did the obese women in the study who gained less wt have less pre-eclampsia? Well, duh, one of the symptoms of pre-eclampsia (PE for short) is edema, retaining fluids. Many women who develop PE have higher wt gains than other women who don’t. It reflects the increased edema/water weight they gain. So isn’t it logical that the women in the study who had PE gained more? But that doesn’t necessarily mean that deliberately restricting calories and wt will prevent PE!

In fact, being too restrictive is thought by some to *raise* the risk for PE, because it interferes with the body’s ability to expand its blood volume enough to maintain a healthy pregnancy. There’s more to it than that, but this is already long enough so I’ll stop there.

I would also note that the prejudice in obstetrics against fat women is pretty extreme. In particular, they fear the combo of a fat woman who gains more wt in pregnancy than they approve of. So is it any wonder the c/s rate is higher in that group? This is the group they aggressively section and/or induce early, and induction is *strongly* related to risk of cesarean.

Yes, the cesarean rate in this country is about 1 in 3 right now; the rates in fat women are between 30-50% for first-time moms, more for women who have had kids before. If you are supersized, the rates are even higher. This is insane because surgery carries more risks for the person of size.

If you are a woman of size considering a pregnancy, my top hint is to NOT see an OB for your care. Go to a midwife. Don’t take for granted that a midwife is automatically size-friendly; there are fat-phobic ones there too. But as a group, their philosophy of care is much more likely to end with a normal vaginal birth, and infant outcomes are better with a midwife also (as per the CDC).

There is so much more to say on this topic, but it’s too long already. For more info, visit http://www.plus-size-pregnancy.org, my website. I have lots of research and articles there, including hints about lowering your chances for an unnecessary cesarean. Lots of birth stories of big moms there too! Enjoy. kmom

You also have other metabolic effects, like high cholesterol and hyperglycemia — but it’s an effect of the protease inhibitors, not of the patients becoming “just like everyone else in America” like they’re trying to spin it.

Bah. If I know this as a med student, ID docs should definitely know it.

http://www.emedicine.com/derm/topic877.htm

Type 2 diabetes runs in families, along with a predisposition to be unusually heavy. It’s likely that body size and the type 2 diabetes are related in some way (because they do correlate), but it’s not necessariy cause/effect.