The long-awaited revision of the 1990 recommendations puts a cap on the amount an obese mother should gain and places more emphasis on exercise. Some doctors wanted to see a lot more.
More than 60% of U.S. women of childbearing age are overweight or obese -- a significant increase from 20 years ago. And recent studies strongly suggest that either too much or too little nutrition in utero can increase a fetus' chance of becoming an overweight child and overweight adult.
Such data on the increasing girth of pregnant women and the growing rates of obesity in children led to pressure on the Institute of Medicine to revise a set of 1990 guidelines that were written primarily to prevent excessively low infant birth weights. Numerous medical journal articles in recent years have called the guidelines irrelevant to today's obstetrics patients.
On Thursday, the institute's advisory committee -- a task force of doctors and researchers -- issued the updated recommendations. But with few exceptions, such as putting a limit on how much weight obese women should gain, the new guidelines are the old guidelines wrapped up in a lecture.
The panel said that the existing guidelines were essentially fine. It's women and their doctors, the members said, who need to try harder -- often much harder -- to help the women reach a normal weight before pregnancy and avoid excessive weight gain during pregnancy.
"Although not dramatically different, fully implementing the guidelines will represent a change in the care provided to women of childbearing age," said Kathleen Rasmussen, chairwoman of the committee and a professor of nutrition at Cornell University.
The report was requested by six major health organizations so that doctors could better advise and care for their patients. Although nothing in the report is mandatory, healthcare professionals are expected to acknowledge and implement at least some of the panel's recommendations.
But several leading experts on maternal obesity and child health expressed disappointment with the document. A growing contingent of doctors says that obese women -- which includes one in every five pregnant women -- should gain little or no weight.
"In my opinion, the Institute of Medicine is missing an opportunity to address the issue of the obesity epidemic and the contribution that pregnancy makes to that epidemic," said Dr. Raul Artal, chairman of the department of obstetrics, gynecology and women's health at St. Louis University.
The recommendations call for a gestational weight gain of 28-40 pounds for underweight women, 25-35 pounds for women of normal weight, 15-25 pounds for overweight women and 11-20 pounds for obese women. The only change is for obese women, who were previously advised to gain at least 15 pounds, with no upper limit.
The problem is not the guidelines, but the failure to adhere to them and to address obesity in reproductive-age women, said Dr. Maxine Hayes, state health officer for the Washington State Department of Health and chairwoman of a 2006 panel that urged a reexamination of the guidelines. "If we wait for every woman to be advised about weight gain after they become pregnant, it's too late. It puts women and their babies on a trajectory that is unhealthy."
During the two-year process of reexamining the guidelines, committee members tried to balance the health needs of the fetus with the health needs of the mother, Rasmussen said, ultimately deciding that the recommendations were largely up-to-date already.
Not all experts in maternal-fetal health are convinced.
"We have been doing this same recommendation for 19 years, and it has been very unsuccessful," said Susan Y. Chu, a senior epidemiologist at the Centers for Disease Control and Prevention who has studied gestational weight gain. "But they did what was most critical, which was to put a cap on the obese category."
Several studies suggest that obese women may require little weight gain as long as it's clear that the fetus is growing.
"We have determined that overweight and obese women can benefit and have better pregnancy outcomes if they limit their weight gain," said Artal, the author of several studies on obese pregnant women. "The committee was cautious. They were concerned they might cause harm. But by maintaining the status quo, I think that may cause more harm."
A study in the June issue of the Journal of the National Medical Assn. found that obese pregnant women who followed well-balanced diets and gained little or no weight had better outcomes -- as did their babies -- than women who gained more weight.
That study's lead author, Dr. Yvonne S. Thornton, a professor of obstetrics and gynecology at New York Medical College, said the committee may have feared an increase in births of underweight infants if more pregnant women were placed on restricted diets. "This is a litigious society," she said. "If we did restrict calories and there was an untoward outcome, people might say, 'Well, you didn't feed me enough.' "
The suggested weight range of 11 to 20 pounds for obese women is aimed at women in the lower ranges of the obesity category, defined by a body mass index of 30 to 35, Rasmussen said. There is little data to guide recommendations for women in the higher ranges of obesity, she said. About 8% of women of childbearing age are morbidly obese, with a BMI of 40 or more.
Some doctors criticized the report's call for diet and exercise counseling as unrealistic. Few health insurance plans pay for such counseling, and doctors do not have the time to provide it, Hayes said.
However, the report was praised for its emphasis on exercise. "One can't look at diet alone," Artal said. "Exercise is very much a part of a healthy lifestyle during pregnancy."
The committee also called for more studies on gestational weight gain, including asking states to adopt a birth certificate that gathers information on weight before and during pregnancy.
Source: http://www.latimes.com/features/health/la-sci-pregnancy29-2009may29,0,476194.story
Friday, May 29, 2009
6 Ways to Boost Your Sex Life After Menopause
It should be a time of new sexual beginnings. But, from hot flashes to mood swings, menopause is often cast as the end of sexual intimacy. Yet its transformations don’t have to be for the worse.
Contrary to popular belief, menopause is a chance to reflect upon and strategize about one’s sex life. Often requiring new tricks and sexual experimentation, it can invite some of a couple’s most exciting sexual moments.
According to a 2003 article in “Sexual and Relationship Therapy,” while society perceives older women as less attractive and less functional, these women still feel young in many ways. As stated by the National Institute of Health, some women actually feel liberated post-menopause, even reporting an increased interest in sex.
This isn’t surprising when you consider that once a woman reaches menopause, she (and her partner) don’t have to worry about pregnancy, PMS pains or menstruation. The kids are grown and out of the house (hopefully!), so lovers are thrilled that the empty nest has been reclaimed as their love nest. All of these factors can make for more enjoyable, satisfying sex.
In a 2000 study published in the “Journal of Women’s Health & Gender-Based Medicine,” 65 percent of women between the ages of 51 and 64, and 74 percent of women over 65 engage in sexual activity at least once a week. So menopause isn’t sidelining as many women as one would think.
The physical and emotional changes that come with menopause are different for everyone. How this final phase of her reproductive cycle affects her sense of self and sexual relationship can vary from woman to woman.
As a woman approaches and experiences menopause, her sexual responsiveness may be affected by:
— Vaginal dryness, thanks to lower estrogen and testosterone levels;
— A slightly shorter and smaller vagina (meaning both in diameter and length);
— Less sensation during vaginal intercourse, due to tissue changes;
— Pain during penetration with thinning vaginal walls producing less vaginal lubrication;
— Reduction in number and intensity of vaginal contractions;
— Pain or soreness post-intercourse;
— Mood and energy changes, with the loss of estrogen.
Since some hormonal changes occur over the course of several years, a woman may notice the effects, like the fact that it takes her longer to get sexually excited, over time instead of all at once. Ultimately, any of these “symptoms” can lead to a low libido.
She may be plagued by body image issues. She may feel like her body isn't her own anymore. Excess weight may be stored on different parts of her body because of declining estrogen levels. She may also notice reduced muscle mass and tone due to lower testosterone levels.
On the other hand, many experience greater body acceptance and appreciation. They feel wiser and more wonderful as they learn more about the self and all the female form can endure.
Evie Abston, a post-menopausal blogger with "Good Vibrations" Magazine, wrote:
“I got to learn to appreciate who I am, to like my light and shadow self. To listen to my body when I was having hot flashes and asking myself what in my life is causing my intuition to let me know that this is something in my life I can now release — an old outdated message, an opportunity to assert myself instead of stuffing it.”
If you want to own your sexuality during and after menopause, you need to approach this period in your life as a new sexual chapter. You’ll need to be sexually adventuresome, as the same, old tricks may not work. In order to expand your repertoire, consider pursuing the following:
1. Practice patience. It can take up to three minutes for a post-menopausal woman to become lubricated for comfortable intercourse. Couples should engage in plenty of foreplay and have lubrication handy.
2. Masturbate. Pleasuring yourself regularly can keep her vagina sexually “fit,” as in flexible and suppler. Exercising your pelvic floor muscles on a regular basis can further make for healthy muscle tone.
3. Experiment. This may involve using a vibrator for more direct and intense stimulation to elevate arousal. Couples will also want to try positions offering greater comfort, like spooning, or ones where she’s more in charge, like woman-on-top.
4. Take steps to boost self-perception. Don’t buy into common assumptions about the elderly and sex — that they’re asexual, sexless, ridden with sexual dysfunction. You need to believe that you’re sexually desirable. Maintaining positive body image is a huge part of this.
5. Have regular sex. Doing so helps to prevent the pain from thinning vaginal walls, which can become severe with menopause and aging.
6. Communicate. Talk to your partner and let him or her know about any issues or changes. Many lovers want to be supportive and in-the-know, but are often too shy to ask. Allow your partner to be part of the process, especially when it comes to your better sex efforts.
Source: http://www.foxnews.com/story/0,2933,522658,00.html?test=latestnews
Contrary to popular belief, menopause is a chance to reflect upon and strategize about one’s sex life. Often requiring new tricks and sexual experimentation, it can invite some of a couple’s most exciting sexual moments.
According to a 2003 article in “Sexual and Relationship Therapy,” while society perceives older women as less attractive and less functional, these women still feel young in many ways. As stated by the National Institute of Health, some women actually feel liberated post-menopause, even reporting an increased interest in sex.
This isn’t surprising when you consider that once a woman reaches menopause, she (and her partner) don’t have to worry about pregnancy, PMS pains or menstruation. The kids are grown and out of the house (hopefully!), so lovers are thrilled that the empty nest has been reclaimed as their love nest. All of these factors can make for more enjoyable, satisfying sex.
In a 2000 study published in the “Journal of Women’s Health & Gender-Based Medicine,” 65 percent of women between the ages of 51 and 64, and 74 percent of women over 65 engage in sexual activity at least once a week. So menopause isn’t sidelining as many women as one would think.
The physical and emotional changes that come with menopause are different for everyone. How this final phase of her reproductive cycle affects her sense of self and sexual relationship can vary from woman to woman.
As a woman approaches and experiences menopause, her sexual responsiveness may be affected by:
— Vaginal dryness, thanks to lower estrogen and testosterone levels;
— A slightly shorter and smaller vagina (meaning both in diameter and length);
— Less sensation during vaginal intercourse, due to tissue changes;
— Pain during penetration with thinning vaginal walls producing less vaginal lubrication;
— Reduction in number and intensity of vaginal contractions;
— Pain or soreness post-intercourse;
— Mood and energy changes, with the loss of estrogen.
Since some hormonal changes occur over the course of several years, a woman may notice the effects, like the fact that it takes her longer to get sexually excited, over time instead of all at once. Ultimately, any of these “symptoms” can lead to a low libido.
She may be plagued by body image issues. She may feel like her body isn't her own anymore. Excess weight may be stored on different parts of her body because of declining estrogen levels. She may also notice reduced muscle mass and tone due to lower testosterone levels.
On the other hand, many experience greater body acceptance and appreciation. They feel wiser and more wonderful as they learn more about the self and all the female form can endure.
Evie Abston, a post-menopausal blogger with "Good Vibrations" Magazine, wrote:
“I got to learn to appreciate who I am, to like my light and shadow self. To listen to my body when I was having hot flashes and asking myself what in my life is causing my intuition to let me know that this is something in my life I can now release — an old outdated message, an opportunity to assert myself instead of stuffing it.”
If you want to own your sexuality during and after menopause, you need to approach this period in your life as a new sexual chapter. You’ll need to be sexually adventuresome, as the same, old tricks may not work. In order to expand your repertoire, consider pursuing the following:
1. Practice patience. It can take up to three minutes for a post-menopausal woman to become lubricated for comfortable intercourse. Couples should engage in plenty of foreplay and have lubrication handy.
2. Masturbate. Pleasuring yourself regularly can keep her vagina sexually “fit,” as in flexible and suppler. Exercising your pelvic floor muscles on a regular basis can further make for healthy muscle tone.
3. Experiment. This may involve using a vibrator for more direct and intense stimulation to elevate arousal. Couples will also want to try positions offering greater comfort, like spooning, or ones where she’s more in charge, like woman-on-top.
4. Take steps to boost self-perception. Don’t buy into common assumptions about the elderly and sex — that they’re asexual, sexless, ridden with sexual dysfunction. You need to believe that you’re sexually desirable. Maintaining positive body image is a huge part of this.
5. Have regular sex. Doing so helps to prevent the pain from thinning vaginal walls, which can become severe with menopause and aging.
6. Communicate. Talk to your partner and let him or her know about any issues or changes. Many lovers want to be supportive and in-the-know, but are often too shy to ask. Allow your partner to be part of the process, especially when it comes to your better sex efforts.
Source: http://www.foxnews.com/story/0,2933,522658,00.html?test=latestnews
Cancer death rate dropped nearly 20 percent in 15 years
The death rate due to cancer has declined in the United States in recent years, largely due to better prevention and treatment. In fact, 650,000 lives were spared from cancer between 1990 to 2005, according to new statistics from the American Cancer Society.
During the 15-year period, the cancer death rate among men dropped by 19.2 percent, mainly due to decreases in lung, prostate, and colon cancer deaths. In women, the cancer death rate fell by 11.4 percent, largely due to a drop in breast and colorectal cancer deaths.
"This is good news because cancer death rates have continued to decrease since the early 1990s because of prevention and improved treatment for many cancers," said lead author Dr. Ahmedin Jemal, the strategic director of cancer surveillance at the American Cancer Society in Atlanta, Georgia. "We have to be optimistic based on the trends. We are on the right track."
The findings are published in the July/August issue of CA: A Cancer Journal for Clinicians.
Despite the optimism, however, there is still much work to be done to win the war on cancer, experts stress. There will be close to 1.5 million new cancer diagnoses in the U.S. in 2009, and 562,340 people are expected to die of the disease. This means that more than 1,500 people will die of cancer each day in 2009; the most common lethal cancers in men and women are lung, prostate, breast, and colon cancers. Health.com: How to avoid colorectal cancer
A drop in hormone replacement therapy leads to a decline in breast cancer cases
The decrease in deaths from breast cancer accounted for 37 percent of the reduction in the death rate among women during the 15-year period.
"Any life spared from cancer or serious illness is a victory, but success comes in little steps -- one life at a time," said Dr. Marisa Weiss, the president and founder of advocacy group Breastcancer.org and the author of several books, including Taking Care of Your Girls: A Breast Health Guide for Girls, Teens, and In-Betweens. Weiss is also the director of breast radiation oncology and breast health outreach at Lankenau Hospital in Wynnewood, Pennsylvania.
"It's great news that a large chunk of the decreased death rates in women can be attributed to breast cancer," she said. This is largely due to a decreased use of hormone replacement therapy (HRT), which has been shown to increase a woman's risk of developing breast cancer. HRT fell from grace after a large government-funded study known as the Women's Health Initiative was stopped early because the risks of HRT, including an increased risk of breast cancer, greatly outnumbered the benefits of the therapy. Health.com: What breast cancer really feels like
Another reason for the decline in breast cancer deaths, however, is delayed diagnosis due to the fact that many women are not getting their yearly X-ray or mammogram.
"Fewer women are getting mammography and that's why fewer women are getting diagnosed with breast cancer, so eventually that will come back and bite us in the rear end," Weiss said.
Black women continue to die of breast cancer at a greater rate than their white counterparts, she pointed out.
What's more, the current obesity epidemic may fuel a rise in the rates.
"Fat makes extra hormones, which lead to extra cell activity and extra abnormal cell activity," she said. "Fat is a storing facility for hormonally active pollutants, so if you are overweight, you're more likely to hold on to some chemicals in the environment that enter your body from food and water." Health.com: How to keep your food cravings at bay while you lose weight
And that's not all: "Fat brings on puberty earlier and early puberty is a risk factor for breast cancer," Weiss said.
"These areas of disappointment are areas of opportunity," she added. But greater efforts are needed to encourage healthy eating and exercise to help combat obesity, especially in adolescents, she said. Health.com: Melt pounds with mix-and-match cardio routines
Another encouraging sign is a drop in colorectal cancer deaths due to better and more widespread screening.
"Colorectal cancer screening saves lives because it detects cancer at early stages when treatment is more effective, and it also removes precancerous lesions," said Jemal. The current recommendation for people at average risk of colon cancer is to be screened every year, starting at age 50.
Not all good news
Death rates from breast and colon cancers are falling, but the death rates from pancreatic (women), liver (men and women), and esophageal cancer (men) are increasing -- largely because of the obesity epidemic. Among men, death rates for the fatal form of skin cancer melanoma are also on the rise.
Although there has been a decrease in lung cancer deaths among men (due to smoking-cessation efforts), the death rates for women with lung cancer are still on the rise. Lung cancer is expected to account for 26 percent of all cancer deaths in women in 2009, according to the new statistics. Health.com: My smoker's cough turned out to be emphysema.
Source: http://www.cnn.com/2009/HEALTH/05/27/health.cancer.death.rate/?iref=mpstoryview
During the 15-year period, the cancer death rate among men dropped by 19.2 percent, mainly due to decreases in lung, prostate, and colon cancer deaths. In women, the cancer death rate fell by 11.4 percent, largely due to a drop in breast and colorectal cancer deaths.
"This is good news because cancer death rates have continued to decrease since the early 1990s because of prevention and improved treatment for many cancers," said lead author Dr. Ahmedin Jemal, the strategic director of cancer surveillance at the American Cancer Society in Atlanta, Georgia. "We have to be optimistic based on the trends. We are on the right track."
The findings are published in the July/August issue of CA: A Cancer Journal for Clinicians.
Despite the optimism, however, there is still much work to be done to win the war on cancer, experts stress. There will be close to 1.5 million new cancer diagnoses in the U.S. in 2009, and 562,340 people are expected to die of the disease. This means that more than 1,500 people will die of cancer each day in 2009; the most common lethal cancers in men and women are lung, prostate, breast, and colon cancers. Health.com: How to avoid colorectal cancer
A drop in hormone replacement therapy leads to a decline in breast cancer cases
The decrease in deaths from breast cancer accounted for 37 percent of the reduction in the death rate among women during the 15-year period.
"Any life spared from cancer or serious illness is a victory, but success comes in little steps -- one life at a time," said Dr. Marisa Weiss, the president and founder of advocacy group Breastcancer.org and the author of several books, including Taking Care of Your Girls: A Breast Health Guide for Girls, Teens, and In-Betweens. Weiss is also the director of breast radiation oncology and breast health outreach at Lankenau Hospital in Wynnewood, Pennsylvania.
"It's great news that a large chunk of the decreased death rates in women can be attributed to breast cancer," she said. This is largely due to a decreased use of hormone replacement therapy (HRT), which has been shown to increase a woman's risk of developing breast cancer. HRT fell from grace after a large government-funded study known as the Women's Health Initiative was stopped early because the risks of HRT, including an increased risk of breast cancer, greatly outnumbered the benefits of the therapy. Health.com: What breast cancer really feels like
Another reason for the decline in breast cancer deaths, however, is delayed diagnosis due to the fact that many women are not getting their yearly X-ray or mammogram.
"Fewer women are getting mammography and that's why fewer women are getting diagnosed with breast cancer, so eventually that will come back and bite us in the rear end," Weiss said.
Black women continue to die of breast cancer at a greater rate than their white counterparts, she pointed out.
What's more, the current obesity epidemic may fuel a rise in the rates.
"Fat makes extra hormones, which lead to extra cell activity and extra abnormal cell activity," she said. "Fat is a storing facility for hormonally active pollutants, so if you are overweight, you're more likely to hold on to some chemicals in the environment that enter your body from food and water." Health.com: How to keep your food cravings at bay while you lose weight
And that's not all: "Fat brings on puberty earlier and early puberty is a risk factor for breast cancer," Weiss said.
"These areas of disappointment are areas of opportunity," she added. But greater efforts are needed to encourage healthy eating and exercise to help combat obesity, especially in adolescents, she said. Health.com: Melt pounds with mix-and-match cardio routines
Another encouraging sign is a drop in colorectal cancer deaths due to better and more widespread screening.
"Colorectal cancer screening saves lives because it detects cancer at early stages when treatment is more effective, and it also removes precancerous lesions," said Jemal. The current recommendation for people at average risk of colon cancer is to be screened every year, starting at age 50.
Not all good news
Death rates from breast and colon cancers are falling, but the death rates from pancreatic (women), liver (men and women), and esophageal cancer (men) are increasing -- largely because of the obesity epidemic. Among men, death rates for the fatal form of skin cancer melanoma are also on the rise.
Although there has been a decrease in lung cancer deaths among men (due to smoking-cessation efforts), the death rates for women with lung cancer are still on the rise. Lung cancer is expected to account for 26 percent of all cancer deaths in women in 2009, according to the new statistics. Health.com: My smoker's cough turned out to be emphysema.
Source: http://www.cnn.com/2009/HEALTH/05/27/health.cancer.death.rate/?iref=mpstoryview
Subscribe to:
Posts (Atom)
