Tackling obesity: challenges ahead

As highlighted by William Dietz and colleagues1 in the recent Lancet Obesity Series, the obesity pandemic is no longer a problem only for the developed world, and clinical care for obese patients must be addressed. We are concerned that increasing obesity in women in developing countries might impact negatively on existing maternal health services in low-resource settings. Women with obesity have greater risk of pre-eclampsia, gestational diabetes, premature delivery, macrosomia, dystocia, post-partum haemorrhage, and miscarriage,2 and their babies are at a 62% increased risk of dying within 48 hours after birth compared with newborn babies of mothers without obesity.3 Caesarean section rates are higher in women with obesity, with three times more emergency caesarean sections, often associated with intra-operative and postoperative complications.2, 4

Additional equipment required includes larger cuffs for measuring blood pressure or theatre tables stable enough to tolerate additional weight. Skilled personnel are required for registering fetal heart beats, finding veins, or positioning in some women with obesity. Caesarean sections can be more difficult and additional help is often required to retract abdominal tissues. For spinal and epidural anaesthesia, failures and repeated pricking have been reported,5 but longer spinal needles for such cases are often not available in low-resource settings. Post-partum and breastfeeding problems because of mechanical and endocrinological issues6 in women with obesity require attentive nursing support. Based on these observations, targeted actions are required, as the problem of obesity in developing countries will rapidly increase in the coming years and services have to be prepared to avoid obesity related maternal morbidity and mortality.