Atomic bombs and obesity: legacies for perinatal health

World War II was eventually brought to an end by the dropping of the second atomic bomb on the city of Nagasaki, Japan in August 1945. Codenamed ‘Fat Man’, this plutonium-fuelled weapon of mass destruction killed nearly 40,000 individuals, with a further 25,000 injured (Avalon Project, 2008). While there were major concerns about the prospect of an increased level of birth defects and possible intergenerational effects consequent upon radiation exposure, data from birth outcome monitoring post-war has not revealed a significant increase in birth defects in the children of survivors of both the Hiroshima and Nagasaki bombings (Radiation Effects Research Foundation, 2007). While studies continue, at present it would seem that the magnitude of the impact from such an event in relation to congenital birth defects has so far been limited.

We will now consider the clinically and morbidly obese pregnant women using fertility and maternity services who are currently the target of considerable public health concern. Obesity and, more specifically, increasing levels of obesity, is now considered one of the major health concerns, presenting both challenges and pressures on clinical services specifically (Simon et al., 2011) and population health generally, particularly in the West (Shaw, Caughey, & Edelman, 2012). Descriptions of an ‘epidemic’ of obesity across all age groups have pushed the constellation of issues that both orbit and define this topic into public consciousness (Gollust, Eboh, & Barry, 2012). Health promotion activities and strategies designed to address these issues are correspondingly developing and emerging in an attempt to address these issues at local, national, societal and individual level (Graff, Kappagoda, Wooten, McGowan, & Ashe, 2012). Obese and morbidly obese women are an important focus of some of these strategies and activities, and indeed, given the potential impact on their infants and children, this group of women might even be considered to represent one of the most important health improvement targets. Recent studies have demonstrated how perinatal services can be effective in modifying the clinical environment and systems of care to safely accommodate such women (Heslehurst, Lang, Rankin, Wilkinson, & Summerbell, 2007; Davis et al., 2012). However, resourcing such changes is costly, although considered worthwhile in order to address the needs of the individuals concerned and bearing in mind the longer-term impact on them, their children, families and on healthcare services. Indeed, contemporary qualitative studies have focused on the themes emerging from the experience of obese women as a source of unique data that provide a rich contribution to the understanding of their (Weir et al., 2010) and the experiences of staff working with this group (Smith, Cooke, & Lavender, 2012). While such approaches undoubtedly attempt to address individual needs, the issue of birth outcomes and complications associated with obese women’s appetitive behaviour can appear to be of secondary concern. Evidence shows that maternal obesity is linked to antenatal complications (Fiala, Egan, & Lashgari, 2006), gestational diabetes (Joy et al., 2012), pre-term and induced pre-term birth (MacDonald, Han, Mulla, & Beyene, 2010), pre-eclampsia (Kerrigan and Kingdon, 2010), genital and urinary tract infection (Sebire et al., 2001), emergency caesarean section (Kerrigan and Kingdon, 2010) and still births (Chu et al., 2007) and can affect the next generation directly and indirectly (Whittaker and Dietz, 1998; Ebbeling, Pawlak, & Ludwig, 2002).

Whether the influential ‘Changing Childbirth’ (Department of Health, 1993) report really had eating behaviour in mind as a key component of the maternal choice paradigm is probably unlikely. However, it could be argued that within a society where embracing diversity extends to modifying the clinical environment and in which obesity has to some extent become an acceptable norm, the possibility of deleterious birth outcomes must also be accepted. Given the known negative impact of obesity on maternal health and birth outcomes, it seems somewhat ironic that the rather different legacy of ‘Fat Man’ may pale by comparison to the scale of the enduring individual and society-wide potential health impact of ‘Fat Woman’.

The evidence on the impact of obesity, both in the short and longer term, is what has and is driving policy in the area of public health; however, the knowledge gained from research studies is likely to impact on individuals rather differently. Behaviour change in this area is not likely to be driven by policy unless this takes account of individual histories and needs and variation in these. Both quantitative and qualitative studies, especially those with a cohort design and long-term follow-up, can contribute to a better understanding of what might work and for whom, although ultimately clinical trials of complex interventions are likely to be needed. A range of papers reflecting the growing interest in this topic have been published in the journal, most recently by Phillips, King and Skouteris (2012) and Markey, Markey and Schulz (2012) focusing on the psychological aspects of weight management and the impact of women’s own weight-related concerns on early infant feeding.

At the same time there is an urgent need to consider priorities in addressing maternal obesity, not only in terms of clinical care and research focus, but also in terms of facilitating eating behaviour change and managing personal responsibility for individuals, a task well circumscribed within the remit and practice of the health and clinical psychologist.