Baby weight watchers

An “alarming” crisis of large babies in Scotland was reported yesterday as evidence of a worsening obesity epidemic. Fat mothers were blamed for putting their babies’ health at risk by Tam Fry, honorary chairman of the Child Growth Foundation, who said: “There are a significant number of mothers who are not only obese but alarmingly so, and they are giving birth to alarmingly large babies. Scotland’s obesity problem has obviously caused the average weight of babies to zoom up.”

So how much does the average baby born in Scotland today weigh?

about 7 1/2 pounds (3,381 grams, ± 596 grams, to be precise)

And how much heavier is today’s average baby compared to 1980 — over a quarter of a century ago?

2.24 ounces (64.4 grams to be precise)

This is apparently being used by government officials as indicative of an alarming crisis. A Scottish Government spokesperson said: “Obese mothers and their babies are prone to a variety of complications... Obesity is an increasing problem and poses a serious threat to our nation’s health... Tackling Scotland's growing obesity problem will be key to the Scottish Government’s plans for health improvement over the next three years.” SNP ministers are planning to spend $29.78 million (U.S. dollars) to tackle obesity with various initiatives, including weight monitoring and free fruit for pregnant women.

With the Scottish Health Services reporting about 54,600 babies born in Scotland per year, that translates to about $181,806 per baby — or $82,640 per ounce. :)

That’s quite an expensive weight loss diet. Common sense aside, the actual study the news story was supposedly reporting does not lend support to a crisis of fat babies. In fact, the government’s own health data suggests that this is not the soundest use of already stretched public healthcare resources ... if the health and welfare of newborns is really the concern.

The facts don’t make exciting news copy or headlines, though, which might partly explain why media continues to quote the same spokespeople — not because they are medical professionals in obesity, obstetrics, nutrition, or childhood growth and development, but because they’re certain to make the most sensational statements. JFS readers will remember Mr. Fry from his news quote that childhood obesity “should be a punishable offense.” As he told the Times UK last year: “Very obese children are taking up NHS resources that should be used for legitimate purposes. Parents have got to be held accountable for overfeeding their children or letting their children become fat without taking action.” A former BBC Television producer, Fry advocated BMI checks on all children by the government, saying in the BBC News: “Parents are very ignorant about what a healthy weight is.” On his own bio at National Obesity Forum, Fry says he is “a surrogate endocrinologist for his infant grandchildren, routinely checking their growth on the kitchen floor.”

Even articles in baby magazines are telling new parents, “especially mothers,” they need to “fat-proof” their babies to save them from the health dangers that go along with a “fat-filled future.” In Baby Expert, mothers were given an eight-point plan for watching their baby’s weight to stop their baby from becoming a fat toddler. “Your child’s first 12 months are the most critical in setting him on the right path to a healthy weight,” Fry was quoted as saying.

Of course, as JFS readers know, none of this is based on sound science. In fact, even the Scottish NHS National Service's own figures have shown that claims of an epidemic of childhood obesity in Scotland are creative fiction. But how many mothers will begin to worry with all of the grim headlines about childhood obesity and criticisms about chubby babies, and start to underfeed their babies and young children and jeopardize their health?

The problem of media misinformation is compounded by reporters working from press statements and not going to original research. The study in the news was just published in the online journal BMC Pregnancy and Childbirth. Statisticians at Napier University in Edinburg, led by Sandra Bonellie, examined Scottish Health Service data on 100,133 singleton births in Scotland from 1998-2003. Much of it was actually information previously published in the Scottish Perinatal and Infant Mortality and Morbidity Report 2005, also funded by the Chief Scientists Office and led by Bonellie.

Both reports noted, first off, that average birthweights have been level since 1998 onwards. The average weight of babies has not been “zooming” up.

Both studies were primarily focused on modeling methods used to create centile charts of birthweights by gestational age (marked by 3rd percentile, 5th percentile, 10th percentile... through 97th percentiles) “that are used to identify babies that are small-for-dates, an indicator of potential intrauterine growth restriction,” as the 2005 report stated. “Indeed, such charts are often used to define such growth restriction.” This new 2008 paper emphasized:

“It is important to be able to differentiate between babies who are light because they are premature and those who are small-for-gestational age since the latter may have different health problems to the former. They may be growth restricted and have an increased risk of other complications such as perinatal asphyxia, symptomatic hypoglycaemia, congenital malformations, chronic intrauterine infection and pulmonary haemorrhage.”

National birth data showed that since 1980, while overall birthweights increased, there was also an increase in the variability of weights — while those weighing over 7.7 pounds slightly increased, the numbers of low birthweight babies <2,500 grams (5.5 pounds) also increased.

In general, of course, as gestational ages increases, so do average weights. The source of panic about big babies at the uppermost extreme primarily appears as babies near term (37 to 41 weeks) and fall slightly above the 97th percentile.

But which would be more of a health concern — a term baby weighing less than 5.5 pounds or one weighing 9.2 pounds? And, of babies born early at 30 weeks gestation, for instance, which has a better chance of survival: one below 1.3 pounds (3rd percentile) or over 4.3 pounds (97th percentile)? Clearly, as the researchers noted, prematurity (gestational age) and being underweight are especially critical concerns when it comes to the health and survival of babies.

An important trend missed in media reports, which diffuses the current national focus on big babies, is that, according to the health statistics, while most babies still fall in the middle ranges with slight increases in average weights,the percentage of babies weighing over 3500 grams (7.7 pounds) has actually dropped since 2000, while the percentage of underweight babies has slightly increased.

According to the latest NHS Maternity Statistics (2006), a total of 12.87% of hospital births in England were premature babies and 7.3% of babies were low birth weight. As Dr. Greenville F. Fox at Guy’s and St. Thomas’ Hospital, London, reported in Fetal and Maternal Medicine Review, premature birth is now the commonest cause of infant mortality. Not only are the rates of low birthweight babies and infant mortality higher in the UK than any other major European country, with only Greece having more underweight babies, according to ONS Health Statistics Quarterly 34, but Scotland has the highest overall infant mortality rate (5.2/1,000 live births) of any other region in the UK, except Northern Ireland. Scotland is at the bottom of the third quartile of twenty six countries for infant mortality. “A baby born in some parts of Scotland is over three times more likely to die than one born in the Home Counties.”

While more premies are surviving today than in 1980 — 71% of those 22-25 weeks gestation in 2000 survived, according to University College London Hospitals NHS Foundation Trust — there remains a critical problem of understaffed neonatal special care units and a shortage of neonatal special care units to care for premature and sick newborns. Last fall, a government report found that on average special neonatal units were understaffed by over a third, and units had been forced to close to new admissions an average of 24 days over a six month period. As reported in the BBC News, two-thirds of units didn’t have enough staff to care for the babies who had been admitted and a quarter of twins or triplets had to be cared for in different hospitals. Andy Cole, chief executive of the baby charity Bliss, said: “The first few days after birth are absolutely critical for babies born premature or sick, and the care they receive during this period shapes not only their chances of survival but also their future health....and that it is only thanks to the goodwill and commitment of doctors and nurses that babies are being cared for in some cases.”

Health minister Ivan Lewis was quoted in the BBC News last April 16th as saying: “There is nothing more important than the care and support we offer to sick babies and their parents.”

We know where he can find $29.78 million to start.

© 2008 Sandy Szwarc