Womb Insulin Toxicity Neglected by The New York Times, Again
Majid Ali, M.D.
This is an article of my series entitled “Insulin Blindness of The New York Times.” The Times regularly ignores the crucial issue of insulin toxicity in all its publications on the subjects of weight gain, obesity, prediabetes, diabetes, and diabetes complications. Why is it so? I provide examples and readers can decide for themselves if I am off the mark.
On April 6, 2015, the Times addressed the matter of obesity in pregnancy. I searched for the word insulin in it. I did not find it even once. I include here the Times’ text. Before that, here are crucial facts about womb insulin toxicity:
1. Excess insulin (hyperinsulinism) is toxic for pregnant women and their unborn babies.
2. Over two-thirds of adults and about one-third of children in America are overweight or obese.
3. With very uncommon exceptions, overweight or obese are insulin-toxic.
4. Obese pregnant women are much more likely to deliver large babies.
5. Babies delivered by obese pregnant women often weigh more than nine pounds.
6. Overweight newborns face a greater risk obesity and diabetes.
7. American Ob&Gyn doctors continue to ignore insulin toxicity of expecting mothers.
8. The New York Times continues to neglect the crucial issue of insulin toxicity during pregnancy.
The article which brought these letters to the article was published by The New York Times on March 29, 2015. I did a quick search of the article for any reference to insulin. I found none. I invite the reader to do a quick search and see if I did not do right. The text of that article is the subject of a companion article in my series entitled “Insulin Blindness of The New York Times.” As you read the letters, please take note of the writers.
To the Editor:
Re “Pregnant, Obese … and in Danger,” by Claire A. Putnam (Sunday Review, March 29):
Dr. Putnam could not have been more on the mark about the dangers of obesity in pregnancy and childbirth. While those of us in the field know very well how challenging pregnancy and childbirth are in the obese population, it is considered inappropriate to hammer away at it. In view of the fact that most of these women have tried for years to lose weight and have not succeeded, that seems reasonable.
However, the modifiable factor that is in the obstetrician’s reach is how much the patient will gain during pregnancy. If an obese woman gains very little weight — and this is where encouragement from her obstetrician will help — she and her baby will do better.
I am known for nudging my patients about diet and weight gain, and I am often battling deeply entrenched notions about starving their fetuses, standing in sharp contrast to some colleagues of mine who reassure their patients that they can eat what they want.
I am sometimes less popular for this, and have lost patients for my “old-fashioned” strictness, but I am doing what I can to avoid all the known dangers of obesity in pregnancy, including, by the way, stillbirth.
Great Neck, N.Y.
The writer is an obstetrician at North Shore University Hospital.
To the Editor:
As a practicing neurosurgeon for 37 years, I have seen all the health gains made by reducing the number of smokers in our population completely eliminated by obesity.
We physicians are now encouraged to record the body mass index on patients and then point out to them whether they are overweight and how this is affecting or creating their medical problems. Most of the time, the patients are well aware that they are heavy, but any lifestyle advice usually falls on deaf ears.
DAVID W. BECK
Mason City, Iowa
To the Editor:
I am obese and hypertensive, and I have delivered two children by cesarean section, the first early because of severe pre-eclampsia. I am precisely the kind of patient Dr. Claire A. Putnam believes to be in need of assistance.
Dr. Putnam says that one reason doctors do not talk to their obese patients about being overweight is a concern over “patient satisfaction scores.” However, the worry should be that patients will go without medical care rather than face shame at the office. Overweight and obese mothers may dread the prenatal weigh-in, knowing the lecture that all too often follows.
Not all obese patients are in denial, and obesity is not a simple question of patient choice but a condition with multiple roots. Scolding patients and telling them to control their weight gain is not a solution.
ALEXIS ROSOFF TREEBY
To the Editor:
Unfortunately, the medical and logistical issues involved in caring for obese people are not limited to labor and delivery.
Some 25 years ago, as a young attending neurologist, I was consulted on a 550-pound man who presented with frequent epileptic seizures. He desperately needed a brain scan to properly diagnose the cause.
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The scanner in my hospital could not handle patients over 350 pounds. I called every hospital in the greater Seattle area and got the same answer. Unfortunately, this man succumbed to what was found at his post-mortem to be a potentially treatable brain infection. I felt terrible breaking this news to his wife and two daughters, both of whom were massively obese. Little did I know at the time that this type of story would become commonplace.
Mercer Island, Wash.
To the Editor:
I’ve learned from my work with impoverished women that the issue of obesity — while pregnant or not — isn’t just about a lack of self-restraint. Many who live in segregated, poor communities reside in food deserts. In such areas, it is far cheaper and easier to eat poorly than to eat healthily.
It would be good to have doctors talk to women about nutrition and health. But these exchanges need to include an understanding of the realities of women in neighborhoods where small grocery stores displaying unappealing, mediocre and overpriced produce vie with a stupefying variety of fast food restaurants and reinforcing ads.
We need a comprehensive approach that sees obesity as a societal problem, and that begins with an examination of the fatty, sugary and salty food marketed to us.
The writer, an ethnographer who studies poverty, teaches sociology at the University of Chicago.