“Eating for two” is no excuse to become obese during pregnancy, British health experts say.

In new guidelines for doctors and midwives, the U.K. National Institute of Health and Clinical Excellence (NICE) says women need reliable information on how to manage their weight because obese women and their babies face serious health risks.

The guidelines suggest women stay away from fried foods and sweets and monitor portion sizes, despite cravings.

The recommendations also suggest women need to exercise, making “walking, cycling, swimming, aerobics and gardening a part of everyday life.”

The guidelines say, “Health professionals should encourage women to check their weight and waist measurement periodically or, as a simple alternative, check the fit of their clothes.”

“This new guidance is about helping health professionals to help women have a healthy pregnancy — it’s not about preaching to women. About half of women of childbearing age are either overweight or obese and although obese women can have healthy babies, the evidence does suggest that there are more risks associated with pregnancies in women who have a BMI of over 30 when they become pregnant,” NICE director Mike Kelly said in a release.

“At the moment, health professionals do not generally give women information about the risks of obesity during pregnancy and the importance of weight management before or after pregnancy.”

The guidelines also suggest women who are overweight or obese before they become pregnant be encouraged to lose weight before conceiving.

Kelly added there are also guidelines for women after they give birth.

“It’s also important that women do not feel pressured into rapid weight loss or crash diets after pregnancy; they should understand that weight loss after birth takes time and that physical activity and gradual weight loss will not affect their ability to breastfeed. Losing weight gradually can actually help women maintain a healthy weight in the long-term,” he said.

Louise Silverton of the Royal College of Midwives agrees that something needs to be done.

“As a result of the increase in obesity among pregnant women, midwives are, (on top of the continuing baby boom) dealing with more complex births. These women need to see a midwife as early as possible in their pregnancy. They need more time to spend with a midwife to help and advise them as well as involving the wider health care team,” Silverton said.

LONDON – An updated edition of a mental health bible for doctors may include diagnoses for “disorders“ such as toddler tantrums and binge eating, experts say, and could mean that soon no one will be classed as normal.

Leading mental health experts gave a briefing on Tuesday to warn that a new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is being revised now for publication in 2013, could devalue the seriousness of mental illness and label almost everyone as having some kind of disorder.

Citing examples of new additions like “mild anxiety depression”, “psychosis risk syndrome”, and “temper dysregulation disorder”, they said many people previously seen as perfectly healthy could in future be told they are ill.

“It’s leaking into normality. It is shrinking the pool of what is normal to a puddle,” said Til Wykes of the Institute of Psychiatry at Kings College London.

The DSM is published by the American Psychiatric Association (APA) and contains descriptions, symptoms, and other criteria for diagnosing mental disorders. It is seen as the global diagnostic bible for the field of mental health medicine.

The criteria are designed to provide clear definitions for professionals who treat patients with mental disorders, and for researchers and pharmaceutical drug companies seeking to develop new ways of treating them.

Wykes and colleagues Felicity Callard, also of Kings’ Institute of Psychiatry, and Nick Craddock of Cardiff University’s department of psychological medicine and neurology, said many in the psychiatric community are worried that the further the guidelines are expanded, the more likely it will become that nobody will be classed as normal any more.

“Technically, with the classification of so many new disorders, we will all have disorders,” they said in a joint statement. “This may lead to the belief that many more of us ’need’ drugs to treat our ‘conditions’ — (and) many of these drugs will have unpleasant or dangerous side effects.”

The scientists said “psychosis risk syndrome””diagnosis was particularly worrying, since it could falsely label young people who may only have a small risk of developing an illness.

“It’s a bit like telling 10 people with a common cold that they are “at risk for pneumonia syndrome””when only one is likely to get the disorder,” Wykes told the briefing.

The American Psychiatric Association did not immediately respond to a request for comment.

The scientists gave examples from the previous revision to the DSM, which was called DSM 4 and included broader diagnoses and categories for attention deficit hyperactivity disorder (ADHD), autism and childhood bipolar disorders.

This, they said, had “contributed to three false epidemics“ of these conditions, particularly in the United States.

“During the last decade, how many doctors were harangued by worried parents into giving drugs like Ritalin to children who didn’t really need it?,” their statement asked.

Millions of people across the world, many of them children, take ADHD drugs including Novartis’ NOVN.VX Ritalin, which is known generically as methylphenidate, and similar drugs such as Shire Plc’s SHP.L Adderall and Vyvanse. In the United States alone, sales of these drugs was about $4.8 billion in 2008.

Wykes and Callard published a comment in The Journal of Mental Health expressing their concern about the upcoming DSM revision and highlighting another 10 or more papers in the same journal from other scientists who were also worried. DSM 5 is due to be published in May 2013.

(Editing by Peter Graff)

DUNDEE, Scotland – Moira Christie has to ring the doorbell when she goes to visit friends these days. That’s a new thing for her. Until a few months ago, everyone knew she was coming because they could hear her hacking smoker’s cough from far down the street.

“My cough was my calling card,” the tiny 54-year-old Scot says with a laugh. “But not any more. I’m not coughing now. My friends and relatives can’t believe it. They say ‘You’ve never given up! You? Never!’ — but I have, I’ve done it, and I feel so much healthier already.”

Christie is not only quieter and healthier, she’s a little richer too. That’s because the local health authority paid her to quit. The scheme is one of a clutch of experiments cropping up across Europe, the United States and parts of Latin America which use financial incentives — cash payments, gift cards, shopping vouchers and the like — to encourage or cajole people to drop their bad habits and live more healthily. “The underlying rationale of incentives is that healthier people are less costly to the system than sick ones,” says Harald Schmidt at the Harvard School of Public Health.

The experiments have grown out of studies in the relatively new discipline of behavioural economics, which examines how emotional factors affect economic choices. Some public health experts are yet to be convinced that bribing people can work. But as healthcare costs keep rising in such heavyweight nations as the United States and heavy-smoking locations as Dundee, and as governments move to cut huge budget deficits, hundreds of local authorities, employers and health insurers — even the occasional former investment banker — are dabbling with health incentive schemes.

PAY NOW, SAVE LATER

The idea is simple: pay people to act now and governments will reap the rewards later in lower healthcare costs. Statistically speaking, people who shun harmful habits are more productive and have less need for expensive hospitals, doctors and medicines.By changing “habitual health-related behaviours,” says Theresa Marteau, director of the Centre for the Study of Incentives in Health and a psychology professor at King’s College London, those behind the schemes aim to make more people healthier for longer. Specifically, “they’re trying to tackle the big four that are responsible for most of the world’s premature deaths and illnesses — excessive eating, smoking, drinking and lack of exercise,” says Marteau.

Many in Dundee are at risk from all four. Moira Christie had smoked for around 35 years by the time she joined her incentive programme, which is called Quit 4 U. The scheme is backed by Britain’s National Health Service and was born out of a similar project, Give It Up For Baby, which aims to reduce shockingly high rates of smoking among mums-to-be in Dundee. In some of the poorest areas of the city up to 40 percent of pregnant women and half of all adults smoke, while rates of obesity and alcohol-related illness are among the highest in Europe.

“What we have here is a cocktail of influences on our most deprived communities who have the worst health — a cocktail which ensures that trying to change their behaviour through simplistic messages is just not going to work,” says Andrew Radley, a public health expert who along with colleague Paul Ballard has championed Quit 4 U and is now overseeing its expansion into other areas. “You therefore have to work with them to come up with motivators that are actually part of their way of thinking.”

Participants get 12.50 pounds ($19) on a grocery store card every week they stay off tobacco, building to a potential total of 150 pounds after three months. For mums-to-be who stay off cigarettes, the payments continue until the baby is three months old. Anyone who gets that far would take home 650 pounds. Participants in both schemes commit to regular carbon monoxide breath tests to prove they’re not cheating.

The lure of extra cash has so far proved enough to get even some of the most die-hard tobacco addicts to quit. Margaret Robertson, a former 40-a-day smoker who attends the weekly breath test and support group sessions alongside Christie, is proud of the little nest egg she’s nurturing. “I’m letting it build up until Christmas. That’s when it’ll really help,” says Robertson, 61, who started smoking when she was 11 years old and has just completed her sixth smoke-free week in 50 years.

MEGA UNHEALTHY

When Dundee’s first pilot project started in 2007, critics condemned the idea of incentives as little more than state bribery. So far, though, the results have been impressive: 12-week quit rates are more than double those achieved in any previous years.

By the end of the first year, 55 mothers in the city of Dundee, which has a population of 140,000, had quit smoking using the incentive scheme, and 140 had quit across the coastal Tayside region of eastern Scotland. The year before, just six pregnant women had made contact with Tayside’s stop smoking services — and none of them stayed in touch beyond four weeks.

Even these pilots can be cost-effective, argue Ballard and Radley. They put the overall cost per quitter at 1,700 pounds, which might sound a lot until you consider that smoking costs Britain’s taxpayer-funded health system some 5 billion pounds a year according to a 2009 study by Oxford University researchers. Globally, the World Lung Foundation estimates the annual cost of smoking is $500 billion in medical expenses, lost productivity and environmental harm.

“The whole methodology of this incentive scheme is defined by community-based research. It is driven by what is of most value to the target audience,” says Ballard. If you get it right, it can be “an approach that can really deliver results.”

There is no doubt Scotland can do with the help. It is known, after all, as the land whose citizens don’t just eat Mars Bars and pizza in perilously large amounts, but deep-fry them first. A study published last month found that almost the entire adult popuation of Scotland — 97.5 percent — have habits that are deemed “dangerous to health” including smoking, heavy drinking, taking no exercise, being overweight and eating a poor diet.

Ballard calls Dundee an “incredibly unhealthy” city in a “mega unhealthy” nation. In truth, the rest of the developed world is not much better. Obesity, smoking, alcohol and lack of exercise are causing more protracted and expensive diseases, and killing more residents of the rich world earlier, than anything else. The World Health Organisation (WHO) predicts that by 2015, around 2.3 billion adults worldwide will be overweight and more than 700 million will be obese.

In Europe, the WHO reckons obesity alone is already responsible for up to 8 percent of all health costs and between 10 and 13 percent of deaths. Experts predict that in Britain almost nine out of 10 adults and two thirds of children will be overweight or obese by 2050. By then the medical bill and loss of productivity could top 50 billion pounds a year.

CALGARY – Infants’ response to speech patterns could hold clues to the early detection of autism, say University of Calgary researchers.

A study of infants whose siblings are already diagnosed with autism spectrum disorder (ASD) suggests recognizing characteristics of early speech development and communication could allow for quicker treatment, said Suzanne Curtin.

“The sooner we can see differences in behaviours that are specific to infants who go on to receive a diagnosis of ASD, the sooner we can send these infants to targeted intervention programs,” said Curtin, head of the U of C’s speech development lab.

Earlier detection leads to more effective treatment, she said.

The research found evidence young children who don’t respond well to so-called infant-directed speech could have trouble communicating later — a symptom of ASD.

It’s vital to determine how infants acknowledge speech rhythms, said Jennifer Ference, a masters of science student in clinical psychology.

“A vital step in language learning is the infant’s ability to identify words in speech and one way they can do this is by relying on their knowledge of their language’s rhythmic pattern,” said Ference.

It’s been found that older ASD children have difficulty deciphering certain speech patterns that include speaker emotion or sarcasm.

The speech lab is seeking new study subjects — particularly families with children already diagnosed with ASD and a younger sibling aged between two months and two years.

The lab’s number is 403-220-2444.

bill.kaufmann@sunmedia.ca

“Sex at age 90 is like trying to shoot pool with a rope,” quipped comic George Burns before he or anyone had ever heard of Viagra. Today, the little blue pill and other erectile dysfunction (ED) drugs offer a solution to the estimated one in ten North American men who suffer from ED. But better sex doesn’t mean safer sex. Even though sexually transmitted diseases (STDs) are more pronounced among younger men, a study by Boston’s Dr. Anupam Jena found that men over the age of 40 who used ED drugs were more likely to have STDs than were non-users.

“Anyone who does not practice safer sex, no matter their age, can contract an STD,” says Dr. Jena of the Massachusetts General Hospital’s Department of Medicine, whose study investigated the associations between STDs and ED use among 1.4 million privately insured U.S. men over the age of 40.

His report echoes the findings of other studies when it comes to the increase in STDs among older adults, including one from the United Kingdom which showed the doubling of STDs among adults aged 45 years or older from 1996 to 2003. An earlier study from Harvard showed that STDs rose by 83% for older, recently bereaved men from 1998 onward.

Safe sex reminders do appear on ED drug company websites (along with warnings of possible four hour erections). But there are many reasons that older men may be ignoring or not processing the safe sex message. One is that many older men are simply unaware of STDs – think of Austin Powers’ quip of “Only sailors wear condoms, baby” after time-travelling from the 1960s to the late 1990s. Others, having come from an age when the language of sex and the courtship dance was different, would rather eat nails than ask someone their sexual history.

Older men are often the ones not using condoms, says Dr. Jena. “The reason is that their awareness of STDs is lower, and, even if they know they exist, they think STDs are not that common.” The main reason that young adults use protection is to prevent pregnancy, something that older couples don’t usually worry about, he adds. Older people over the age of 50 are also less likely to be tested for HIV infection.

In the study, Dr. Jena and his co-authors discovered that in both the year before and the year after users filled their first ED drug prescription, they had significantly higher rates of STDs than non-users. “The first implication of that finding is that men who are using ED drugs aren’t necessarily men who aren’t having any sex at all. That’s not the public you see these ads directed to,” says Dr. Jena. (Indeed, the medical community has expressed concern that ED drugs have become lifestyle drugs used to enhance sexual pleasure, even in men who have no ED.)

Dr. Jena stresses that the study does not conclude that ED drugs cause STDs but that the men who use them have a higher sexual risk profile (and STD rates two to three times higher) than men who are non-users. These rates include HIV infection.

An editorial in last week’s Annals of Internal Medicine, which published the July 6th report, notes that despite the study’s limitations, the findings are both “believable and alarming.” This study, writes Dr. Thomas Fekete, “reminds us that STD counselling should not stop at age 40.”

And that doctors shouldn’t assume that older people don’t have sex. Dr. Jena adds that doctors routinely address lifestyle and sexual issues – everything from tobacco use to safe sex — in younger patients: “We ask if he or she is monogamous, or if they have multiple partners, are they practising safe sex. We ask that whole set of questions to men and women who are young, but we haven’t been asking them of adults over the age of 40 or 50.”

What are STDs?

STDs are sexually transmitted diseases and include herpes, chlamydia, gonorrhea, HPV, HIV, trichomonas, syphilis and others. They are transmitted by kissing, touching, or by oral, vaginal or anal sex. For more on STDs, go to www.phac-aspc.gc.ca.

The language of sex

Your grandparents knew them as venereal diseases – words never uttered in polite company and associated with being dirty. In fact, a WWII poster from the military shows the face of a pretty young woman with the headline, “She may look clean, but…”

Today, they are known as STDs but are sometimes also referred to as STIs or sexually transmitted infections in order to include infections that may be asymptomatic.

According to www.sexualityandu.ca, in 2003, 854,817 Canadians aged 18 to 49 who have ever had sexual intercourse reported being diagnosed with a sexually transmitted infection. There are more than 25 classifications of STIs; they can lead to genital warts, blisters, infertility, spontaneous abortion, cancer and death. Some, including genital herpes, HPV and HIV are not curable.

What puts you at risk?

Despite STD rates being highest in younger populations, anyone who has sex with someone who already has an STD is at risk – no matter what your age. Having had multiple sex partners increases the risk that one of them may have passed on an STD to you. Condoms offer protection; if you think you might be infected, get tested so you can be treated.

LONDON – Mothers who eat a high fat diet before and during pregnancy may be putting their offspring at risk of birth defects, scientists said on Tuesday.

British researchers studying mice found that a pregnant mother’s diet may interact with the genes her unborn baby inherits and influence the type or severity of birth defects such as congenital heart disease and cleft palate.

“These are very important findings as we have been able to show for the first time that gene-environment interactions can affect development of the embryo in the womb,” said Jamie Bentham of the Wellcome Trust Centre for Human Genetics at the Oxford University, who led the study.

“We know that poor diet and defective genes can both affect development, but here we have seen the two combine to cause a much greater risk of developing health problems and more severe problems. We are excited by this as it suggests that congenital heart defects may be preventable by measures such as altering maternal diet,” he said in a statement about the findings.

Congenital heart disease is the most common form of birth defect, and previous studies have shown that children born to mothers who have diabetes or who are overweight have an increased risk of it.

It is also known that certain genetic changes — such as deficiency in Cited2 — can give rise to congenital heart disease, but until now scientists did not know if external factors such as a mother’s diet could interact with genetic changes to affect their babies.

The British researchers, whose findings were published in the journal Human Molecular Genetics, compared healthy mice with those lacking a gene called Cited2.

Cited2 deficiency results in heart defects in mice and in humans and can also lead to a serious type of heart defect called atrial isomerism, where the left-right asymmetry of the heart is disturbed.

Researchers fed the mice a high fat diet before and during pregnancy and then studied the development of their babies using magnetic resonance imaging. The results were compared to mice from a second group who were fed a balanced diet.

Among offspring mice that were deficient in Cited2, the risk of atrial isomerism more than doubled, the researchers found, and the risk of cleft palate increased more than seven-fold when the mothers were fed a high fat diet.

The changes did not happen in the genetically normal offspring of mothers who had a high fat diet, suggesting that it is the combination of high fat diet and the genetic defect that is responsible, they said.

Jeremy Pearson, associate medical director of the British Heart Foundation charity, which part-funded the study, said the findings could shed light on human birth defects.

“This research shows that diet during pregnancy can directly affect which genes get switched on in unborn offspring. The study was with mice, but a similar link may exist in humans, leading to some cases of congenital heart disease.”

He said the research reinforced the need for pregnant women to have a balanced diet and avoid eating too much fatty food.

To prevent injuries in babies, car seats should stay in the car. That’s the message of a new study, published today in the journal Pediatrics, which shows that almost 9,000 infants go to the emergency room (ER) every year for car seat-related injuries that happen outside the car.

If the seat does have to come out of the car, said co-author Lindsay Wilson, parents should make sure their babies are always strapped in.

Wilson and Dr. Shital Parikh, both from the orthopedics division of Cincinnati Children’s Hospital Medical Center, reviewed five years worth of data from a national U.S. surveillance system to find records of babies less than one year old that were taken to the ER for car seat injuries.

From 2003-2007, almost 2,000 babies in the sample – so about 43,500 in the entire U.S., the authors estimated – were brought to the ER for a car seat injury. Most of those injuries happened when babies fell out of their car seat or were in the seat when it fell off a table, counter or shopping cart.

Head or neck injuries were most common, especially in the youngest babies, who were also more likely to go to the ER. About half of the injuries happened at home.

There were only a few car seat-related deaths recorded in the authors’ sample, so they weren’t able to calculate a national estimate.

Part of the reason these injuries are so common, the authors write, is that parents may assume that babies won’t be moving around because they haven’t developed good coordination yet. So they commonly leave the baby in a car seat without strapping it in, or set the seat somewhere that puts the child at eye level.

“Often parents don’t use the safety harnesses or safety strap in the seat or in the carriage and so the kids … wiggle and they slide right out,” Dr. Gary Smith, director of the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio, who was not involved in the study, told Reuters Health.

According to the Centers for Disease Control and Prevention, babies less than a year old go to the ER at a higher rate than any other age group. In 2006, there were 84.5 ER visits for every 100 infants – or about 3.5 million total visits. The most common cause of injury in babies is some sort of fall.

The authors hope the study will help educate parents on safe car seat use. For a lot of parents, Wilson said, “it’s just easier to leave the kid in the car seat, set them on the countertop, and go on with what you need to do.”

But if possible, Smith said, babies should instead be moved to a crib, play pen, or carrier. “Child safety seats were intended for use in motor vehicles to prevent injury in the event of a crash,” he said. “That’s their purpose and that’s what they should be used for.”

CALGARY — When it comes to nutritional value, many food products targeted at babies and toddlers are so sweet, they’re sour.

Research out of the University of Calgary and funded by the Centre for Science in the Public Interest Canada shows more than half of the food products studied are of poor nutritional quality.

Charlene Elliott, an associate professor of communications studies, said established guidelines suggest food is unhealthy if more than 20% of the calories in it are derived from sugar. But she found that 53% of the foods she studied met that criteria.

“In a childhood obesity epidemic, you have to wonder why food manufacturers would be promoting highly-sugared foods to young children,” she said.

“Certainly, babies do not demand salt or sugar in their foods.”

The study looked at 186 products, including pureed dinners, toddler entrees, fruit snacks, cereal bars, yogurt, snack bars and desserts.

It did not include simple fruit and vegetable purees, juice or formula designed to be mixed with breast milk or water.

Elliott said one of her biggest concerns is that babies are eating dessert as part of their meals.

“How have we got to the point where feeding your baby desserts is acceptable? Ten years ago, that wouldn’t be the case,” she said.

The study showed 40% of the products studied listed sugar — or some variant of it, such as corn syrup or dextrose — in the first four ingredients on the nutritional label, while 19% listed it as either the first or second ingredient.

Elliott said parents often overlook the nutritional value of the food their children are eating, assuming it will be healthy in what she calls a halo effect.

“Parents reasonably assume it would be held to a higher nutritional standard and they often let their guard down,” she said.

However, the baby and toddler foods studied weren’t any better than their adult counterparts in terms of sugar, and in fact, some were worse.

Elliott’s study is published in the advanced online version of The Journal of Public Health.

In a study of more than 8,500 UK adults followed since their birth in 1958, researchers found that the study participants’ young children were 50 percent more likely to be overweight or obese than they themselves had been back in the 1960s.

When the researchers looked at factors that could be associated with the trend, they found that mothers’ full-time employment, which was more common in the younger generation, appeared to be one.

The findings, published in the American Journal of Epidemiology, do not prove that moms’ full-time work, per se, contributes to the risk of childhood obesity.

One possibility, according to the researchers, is that children of full-time working moms have fewer family meals or less-healthy diets in general.

So the trend in mothers’ employment over the past few decades may be one of the variables contributing to a general erosion in children’s diets; the explosion in sugary junk foods on the market, food advertising aimed at kids, and the increasing availability of high- fat, high-sugar fare in schools are among the other factors that have been blamed.

The current study lacked information on the children’s diets and exercise habits, so it is not known whether kids of working moms did in fact have poorer-quality diets or were less active.

For the study, Dr. Leah Li and colleagues at the University College London analyzed data from a project that has followed a large group of Britons since their birth in 1958. They focused on 8,552 participants who, in 1991, had a total of 1,889 children between the ages of 4 and 9.

Overall, the children were more likely to be overweight or obese than their parents had been back in 1965: 12 percent of boys were overweight or obese, versus 8 percent of their fathers in childhood; and 18 percent of girls were heavy, versus of 11 percent in their mothers’ generation.

Li’s team found that both parents’ current weight and mothers’ employment status were associated with the risk of their children being overweight.

Children of mothers who worked full-time were 48 percent more likely to be overweight or obese than children of non-working mothers. That was with factors such as socioeconomics, parents’ weight and breastfeeding (which some studies have linked to a lower risk of childhood obesity) taken into account.

When parents were obese, the odds of the child being overweight were three to six times greater than when parents were normal-weight.

Rates of both parental obesity and full-time work among mothers increased between the two generations. In 1991, 60 percent of mothers worked, including 15 per cent who were full-time; that compared with 45 per cent and 10 per cent, respectively, in 1965.

Similarly, about 12 percent of parents were obese in 1991, versus 5 to 7 percent of the first generation’s parents in 1965.

So it’s possible, according to Li and her colleagues, that both factors (parents’ weight, in particular) contributed to the intergeneration increase in childhood weight.

However, even if mothers’ employment is a factor in the rise of childhood obesity, it would only account for a small portion of that increase, the current findings suggest.

Based on their data, the researchers estimate that in 1991, less than 8 percent of cases of childhood overweight or obesity could be attributable to mothers’ employment.

In general, experts believe that a complex mix of societal factors — from shifts in eating habits, to greater reliance on cars and increasing hours logged in front of the TV or computer — has been behind the rise in childhood weight problems in recent decades.