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The proportion of obese people in our world has increased and has now reached alarming proportions. Today, more people die from obesity-related diseases/complications than from starvation. Since 1980, the percentage of obese people in the world has increased from 857 million to over two billion, according to a report in the reputable journal The Lancet. This means that nearly one in three people on our planet is obese.
Egypt is one of the countries with the highest number of overweight inhabitants. Here, as much as 36 percent of the population is reported to be overweight. The United States is not far behind in the "obesity league." Nearly 78 million people in the US are overweight, which means that about 33 percent of the American population is considered obese. Many small countries in the Pacific have also been severely affected. In countries like Nauru, Tonga, the Cook Islands, Niue, and Samoa, up to 50 percent of the population is overweight.
In childbearing age
The percentage of obese women of childbearing age is also continuously increasing. Approximately one in four women of fertile age in Stockholm is overweight (BMI > 25), and one in ten pregnant women is obese (BMI > 30) when they enroll in Maternity and Child Health Care (MVC). The risk of complications during pregnancy and childbirth increases with obesity. Some of these complications could have been avoided if our knowledge and our ability to communicate were different.
Inspired by a British project - The "Viktig" Project
The "Viktig" project was named "Viktig" because the women in the project are obese during pregnancy (vikt is the Swedish word for weight), but also because this is a very important patient group who, experientially, seek healthcare to a lesser extent than others. Before the start of the "Viktig" project, we were inspired by the so-called SWMS (Special Weight Management Service) project in the United Kingdom.
The British project was launched in 2012 when the growing problem of pregnancy and obesity was increasingly recognized. At the same time, new guidelines were established in the UK for the management of obesity during pregnancy. The British "SWMS project" targeted pregnant women with a BMI > 35 at the start of pregnancy.
The project aimed to help women achieve a healthier lifestyle during pregnancy and, if possible, minimize weight gain. The project offered assistance to women over 18 months, both during and after pregnancy. The women were referred for maternity care, but many women sought the project voluntarily.
Interdisciplinary team
The project involved an interdisciplinary team consisting of midwives, dietitians, physiotherapists, occupational therapists, and interested obstetricians working together. They employed a patient-centered behavior change approach that sought to engage women in making positive lifestyle changes while pregnant. The project also helped women access other services such as smoking cessation, breastfeeding networks, and other health promotion projects.
A special effort was made in particularly vulnerable residential areas, where a kind of "drop-in facility" was established to improve accessibility for disadvantaged groups. This interdisciplinary strategy was unique at the time the project was conducted and the project's statistics showed great success in terms of the measures taken.
The "Viktig" Project at SÖS - for women who are obese during pregnancy
The "Viktig" project is currently ongoing at the Women's Clinic at SÖS and targets women who are overweight/obese when enrolling in Maternity and Child Health Care in Stockholm. The goal is for the woman to meet "her obstetrician" on at least two occasions during the current pregnancy.
During the first visit, the woman's current health and medications are reviewed together. Previous pregnancies and experiences are also discussed, along with fears and concerns about the current pregnancy. Several blood tests are performed to analyze the woman's blood status, liver function, electrolytes, vitamins, and trace elements. This is because deficiencies are known to occur in this patient category, despite a high intake of food.
Meeting with an anesthesiologist, obstetrician, and delivery midwife
During the second visit, the focus is more on the upcoming delivery. The woman meets an anesthesiologist to discuss the possible need for pain relief during childbirth. Sometimes it can be challenging, for example, to administer epidural anesthesia when the woman is significantly overweight. In such cases, preparation may be needed, and an ultrasound technician may be used for administering the anesthesia.
The woman also meets "her obstetrician" to discuss the best care for her during the upcoming delivery. The goal is a normal delivery. The woman is also offered the opportunity to meet with a delivery midwife. Together with her, practical questions related to childbirth are discussed. Are there adequately sized clothes available? Will delivery beds, bathtubs, etc., work for me? Which delivery position will be suitable for me?
The Goal of the "Viktig" Project
The overall goal of the "Viktig" project is to improve the care and management of obese pregnant women in Stockholm. The effect will be better and more equitable care regardless of BMI, as well as, hopefully, better utilization of the resources in maternity care.
The most crucial part of the project is to acquire more knowledge and create effective guidelines for managing pregnancy and childbirth when the woman is overweight. This is currently lacking in Sweden. With increased knowledge and better care following international models, there are high hopes that the risks for this "important" patient group will decrease.
The project, funded by the Innovation Fund in Stockholm, will continue until 2023, followed by an evaluation.
Sounds interesting? You can contact us directly at: viktigmottagning@gmail.com or through our Instagram account: viktigmottagning.
Referral from your midwife at Maternity and Child Health Care to the Specialist Maternity and Child Health Care at SÖS is also welcome.
To be continued.
/Doctor Eva
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