Some doctors refuse to care for obese women

Fourteen of 105 obstetrics-gynecology practices surveyed by the South Florida Sun-Sentinel last month said they will not take on obese women as patients.

Representatives of six of the practices cited higher rates of complications in women who are obese, but other respondents said heavier women tax their exam tables and other equipment.

"People don't realize the risk we're taking by taking care of these patients," the paper quoted Dr. Albert Triana as saying. Dr. Triana is one of two physicians in a South Miami practice that turns away obese patients, according to the article. "There's more risk of something going wrong and more risk of getting sued."

Seventy-two million Americans — about one in three — meet the criteria for obesity, according to the Centers for Disease Control and Prevention in Atlanta, Ga.

"If I had that policy, I wouldn't have a practice. I'd lose half my patients," Dr. Maureen Whelihan, a West Palm Beach ob-gyn, told the Sun-Sentinel's Bob LaMendiola. "We never turn down anyone."

In a followup article in American Medical News, reporter Christine S. Moyer asked doctors to comment on the practice of turning patients away because of their weight.

"This is [primary care physicians'] patient population, and [they're] here to serve the patients," said one of them, Dr. David Bryman, a Phoenix family physician specializing in bariatric medicine, which deals with the causes, treatment and prevention of obesity. Dr. Bryman is president-elect of the American Society of Bariatric Physicians. "If that requires getting a little extra equipment to accommodate them, it's just part of the practice of medicine."

National Birth Defects Prevention Month

The focus this year during January, National Birth Defects Prevention Month, is on the judicious use of medicines before, during and after pregnancy.

That goes for prescription and over-the counter drugs, as well as herbal remedies and dietary supplements.

Perhaps two-thirds of women use some kind of medication during pregnancy, according to the Centers of Disease Control and Prevention in Atlanta, Ga. Yet many of the effects of these drugs are poorly understood.

Pregnant women are often excluded from drug trials because of concerns for their unborn babies. As a result, we often know little about how drugs will affect fetuses.

Birth defects affect about 3 percent of babies born in the United States and cause more than 20 percent of infant deaths, according to the CDC.

Clearing the first hurdle in breast-feeding

Fewer than 4 percent of births in the United States occur at facilities that are considered "baby friendly," according to the latest Breast-feeding Report Card, issued this week by the Centers for Disease Control and Prevention.Happy baby

That's interesting, in light of the fact that birth is the one point at which the nation's breast-feeding practices actually meet the goals set by Healthy People 2010.

And, it raises some questions: Are American women determined to breast-feed even in the teeth of an unsupportive environment? Or does strong support from the hospital not matter much in their decision? Do problems caused by settings where breast-feeding is not actively promoted only show up later?

Or are environments that come after the birth facility, including families, other medical advisers, child-care centers and workplaces, even less sympathetic to breast-feeding?

Only two hospitals in Illinois, my home state, are among the 99 "baby friendly" facilities recognized by the Baby-Friendly Hospital Initiative as providing "an optimal level of care for infant feeding." These are Pekin Hospital in Pekin and St. John's Hospital in Springfield.

Thirty of the hospitals on the list are in California.

"Although the hospital is not and should not be the only place a mother receives support for breastfeeding, hospitals provide a unique and critical link between the breastfeeding support provided prior to and after delivery," the BFHI's website states.

The BFHI is a joint global effort of the World Health Organization and the United Nations Children's Fund (UNICEF).

Mixed report on breast-feeding

Three-fourths of American babies start life on the breast, but moms are giving up on breast-feeding sooner than officials would like to see.

Healthy People 2010, a national statement of health goals, sets the bar for breast-feeding at birth at 74 percent. Fully 75 percent of American moms are breast-feeding at birth, so the country is (barely) meeting that objective.

However, the goals would have half of mothers breast-feeding at six months of life and a quarter continuing on at a year. In practice, 43 percent are breast-feeding at six months and 22 percent at one year.

"We need to direct even more effort toward making sure mothers have the support they need in hospitals, workplaces and communities to continue breastfeeding beyond the first few days of life, so they can make it to those six- and 12-month marks," said William Dietz, M.D., Ph.D., director of Nutrition, Physical Activity, and Obesity for the Centers for Disease Control and Prevention in Atlanta, Ga.

The CDC issues an annual report card of how "key community settings" like hospitals and child-care centers are supporting breast-feeding, which research has demonstrated can improve an individual's lifetime health outlook.

While the overall news is good for moms' getting a start on breast-feeding at birth, the swing among the various states ranges from 90 percent in Utah to to 53 percent in Mississipi.