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The World Health Organization has identified obesity as a global health problem of epidemic proportions. When combined, obesity and overweight body mass index (BMI) categories are the fifth leading cause of death worldwide.1 Women alone comprise nearly 300 million of the currently obese population, posing significant challenges for women’s health care.1 The Centers for Disease Control and Prevention (CDC) via the Behavioral Risk Factor Surveillance System (BRFSS) in 1990 did not identify a prevalence of obesity more than 25% in any of the states in the United States. This is a marked contrast with the data from 2007 where the BRFSS noted a prevalence of more than 25% in at least 30 of the states in the United States. This suggests roughly one out of every four individuals residing in those states was obese.2 The most recent CDC analysis from 2011 to 2012 suggests a leveling in the incidence of obesity between 2003 and 2010 for adults but the prevalence remains high at 34.9%.3 Obesity during pregnancy confers long-term complications for both mothers and their offspring. Children of obese mothers have doubled the rate of childhood obesity when compared with children born to normal weight mothers.4 Mothers who are obese have difficulty adhering to dietary guidelines during pregnancy,5 often gaining excessive weight which is retained postpartum and propels them into a higher BMI category.5,6


The BMI has been identified as the most practical noninvasive measure of body fat and is determined by dividing weight by height2 (kg/m2). Overweight and obese categories as used by the CDC to define weights in excess of what is generally thought as healthy for a given height.7 Using the BMI as a surrogate measure, obesity in general for an adult is defined as a BMI ≥30 kg/m2 and can be more specifically subdivided into categories reflecting increasing levels of obesity8 (Table 17-1). The prevalence of Grade 3 obesity in adults is 6.4% (95% confidence interval [CI], 5.2-7.7), is noted more often in women (8.3%; 95% CI, 6.9-9.8) than men (4.4%; 95% CI, 2.8-6.8), and for those 20 to 39 years of age, the most reproductive years, there is a prevalence of 5.6% (95% CI, 4.4-7.1).3

TABLE 17-1BMI Classification and Gestational Weight Gain for Obese Women with a Singleton Pregnancy

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