Eating yourself sick in pregnancy: why it would be NICE to understand the historical context

Earlier this month the UK’s National Institute for Health and Clinical Excellence produced very welcome guidance  for all of those who have a direct or indirect role in, and responsibility for women who are pregnant or who are planning a pregnancy and mothers who have had a baby in the last 2 years.

http://guidance.nice.org.uk/PH27

As a GP I welcome this guidance. Like everyone working in healthcare in the UK today I am acutely aware of the importance of this issue. Nevertheless I find myself asking where, amongst all the important and interesting information in this guidance is the historical context for the nutritional status of pregnant women? How, in other words, did we move, within a matter of two or three generations, from a time when the health of babies and mothers were threatened by insufficient calories and nutrition to a time when a surfeit is now the problem?

As I say, I welcome the guidance which lays out clearly the evidence that obesity in pregnant women is a major and increasingly common cause of both maternal and neonatal morbidity and mortality, as well as infertility and miscarriage. I also welcome the evidence based guidance for how health professionals might try to address this problem. But what the guidance doesn’t do is provide anything other than a statistical context for how the UK got to the point where maternal obesity is, arguably, the major threat to maternal, fetal and neonatal health.

Answering that question, I would argue, requires an understanding of the broader context within which obesity levels in both developed and many developing nations continue to rise. Whilst plotting that rise is informative it offers little guidance on how to stop it. Understanding the complex historical, social, economic and political reasons behind it just might. On a professional level I ‘ve been alerted to the importance- and the paucity- of historical research into the role of food in health by two recent papers and a linked editorial in Medical Humanities.

In the first of these historian Emily Mayhew wonders why so little resources are allocated to trying to understand how eating and nutrition have changed over time and why. Reading through the NICE guidance on obesity in pregnancy, I was struck by the lack of such historical context. Dietary advice and support may all be well and good but will it really make a dent in the overall problem if the level of obesity in the broader population continues to climb? Call me simplistic if you like but it seems self-evident to me that if we fail to appreciate how we got to where we are then we’ve got little or no chance of doing anything about it.

There is it turns out some very important historical research that is beginning to help build a more nuanced understanding of what is often called the obesity epidemic, including the unintended role that a post war US farming subsidy had on the prevelance of corn syrup in processed foods, or the equally unintended consequence of the use of trans-fats to prolong the shelf life of various foods to name but two.  And of course there is a huge amount of work taking place within social sciences to help understand obesity in all its multi-layered glory.

None of this features in the NICE guidance. Maybe the authors didn’t know about it. Maybe that’s not their fault, maybe no historians or social scientists responded to their consultation, or maybe no one thought to ask them. What’s clear is that there’s some work to be done to get these two groups talking so that they begin to understand how related and interlinked their work is, or at least should be. Which is, of course, where medical humanities, both as an area of interdisciplinary enquiry and collaboration comes in, and where Medical Humanities can provide a forum for clinically relevant cross fertilisation between the arts and sciences.

http://mh.bmj.com/content/36/1/2.full

http://mh.bmj.com/content/36/1/14.full

http://mh.bmj.com/content/36/1/52.full