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Childhood Obesity Speeds the Onset of Puberty in Girls

Tuesday, April 24th, 2012

When I was young, even though my Dad wanted to “plump up” me and my sisters so that we would be less attractive to boys, for the most part, sitting down at the family table meant eating a well-balanced meal and reconnecting with each other after a busy day.  This time wasn’t just important for the bonding opportunity it provided, but for the proper nutrition it allowed my sisters and I to receive.  It was there that we learned what a balanced diet was and to appreciate the food we had.  Snacking throughout the day was a privilege and eating snacks between meals was a luxury a poor person could ill afford. Unfortunately now days, it seems that many parents don’t have time for traditional dinners or are unwilling to make time for time them.  Snacks are cheap, ubiquitous and filled with carbohydrates. With so many people reaching for the quickest, easiest foods, families are moving to a culture of convenience and their kids are paying the price.

Childhood obesity is on the rise and it’s having effects in some unexpected areas.  Studies are now suggesting that girls who are overweight start menstruation at much younger ages.  The average age of onset of menstruation (menarche) in the late 20th century was between 12.6 to 12.8 years.  Recently, that age has decreased to 12.43 years.   It has been argued that girls need to reach a critical weight (47.8 Kg) to initiate pubertal changes; it is more likely that what is needed is a shift of body composition, with an increase in the percentage of body fat. The percentage of body fat in children (16%) needs to rise to 23.5% to initiate puberty.  A 2011 study found that each 1 kg/m2 increase in childhood body-mass index (BMI) can be expected to result in a 6.5% higher absolute risk of early menarche (before age 12 years).

Normally, once a young woman reaches a particular body mass index, that tells her body she is of childbearing weight.  This starts the menstruation cycle.  If a young girl, say of about eight or nine, is overweight, she will reach this body mass index much sooner, triggering her body to go into early puberty.  While early childhood obesity is itself a problem, early puberty can also lead to a shortened growth span.  Most girls stop growing a few years after starting menstruation.  If they start this too soon, they will also stop growing much earlier than normal.  If childhood obesity continues to increase, the rise in early maturation is likely to follow.  In 1965, about 5% of kids were considered obese in the US.  Obesity in children has increased three-fold over the past 30 years.  In 1980 obesity in children, ages 6-11, was a mere 6.5% but by 2008 it increased to 19.6%.

Today, about 25 million children are either overweight or obese.  Researchers are finding that increases in the number of girls hitting puberty early seems to be in keeping with these obesity statistics.  The First Lady is even promoting a change in our habits that affect childhood obesity.

Although convenient, fattening foods have flooded the markets; there are still plenty of healthy foods out there.  Parents cannot expect their kids to make smart choices about their diets, especially at such young ages.  It’s up to them to teach their children how to eat, so they can grow up to make good choices for themselves and their own families.  There’s something to be said for those traditional sit-down dinners, because they truly benefit the health of our children in more ways than one.

— Yvonne S. Thornton, M. D., M. P. H.





Obesity and early puberty

Saturday, July 31st, 2010

A new study confirms what earlier studies have found: girls who are obese begin puberty earlier.

With childhood obesity approaching an epidemic, early puberty is becoming more common. There appears to be a critical weight for girls, above which the body starts its journey to womanhood with thelarche (breast buds), pubarche (pubic and axillary hair) and finally, menarche (onset of menses).   So, in general, the heavier a young girl is, the earlier the onset of her secondary sexual characteristics.

While we don’t know all the possible consequences of early puberty, we know that puberty is a time of emotional turmoil. For a younger child, that’s going to be more difficult.

We also know that youngsters have a great need to feel like they fit in and the combination of obesity and early puberty can punch a hole in a young girl’s self-esteem.

So, watch the eating habits of your whole family, and help your children make good choices –  just as you make healthier choices for yourself. As I’ve said before, when it comes to battling the bulge, I’ve been there, so I know it’s a struggle. But maintaining a healthy weight is essential, for everyone.

– Yvonne S. Thornton, MD, MPH

Why your Ob-Gyn should be board-certified

Wednesday, July 22nd, 2009

It’s almost impossible to judge a professional’s skills if you’re not a member of that profession. Only a radiologist can say whether another radiologist accurately read a CT scan. Only a dentist can attest to the quality of the crown another dentist fits over a molar.

So how do you, a layperson, judge the qualifications of your doctor? If they drive fancy cars, wear designer clothes, and charge the highest fees in the community, you can be sure they’re successful. But does that mean they’re qualified? You can ask your girlfriends or your sister or mother to recommend someone. You can determine whether you have rapport with a physician. But that won’t tell you about qualifications, either.

If you want to know whether the kind, caring person you select has the minimum qualifications, there’s one way to determine that. Go here to see whether your doctor is board-certified.

Board certification isn’t mandatory. Once a doctor gets a medical degree and a state license to practice medicine and surgery, he or she can practice any specialty. No law requires a doctor to complete a four-year residency in a specialty, such as ob-gyn, in order to be called a specialist. Nothing prevents a doctor from giving him or herself the title of obstetrician or fertility expert or perinatal specialist or really, almost anything.

But only board certification assures you that the doctor has earned that title.

A board certified doctor has gone a giant step further than a physician who hasn’t passed her boards. After completing a residency program, passing a written test in the specialty, and practicing for a year or two, she’s gathered up all her cases and submitted them to an august body known as the American Board of Obstetrics and Gynecology. Before these distinguished university professors and chairs of departments, she’s been extensively questioned about real and hypothetical situations and asked about diagnoses, patient management and treatment.

As an oral examiner for the American Board of Ob-Gyn since 1997, I’ve certified hundreds of new ob-gyn candidates who have proven their capabilities under difficult circumstances. And there were some who did not pass because they didn’t meet those high standards.

So I speak from experience when I say that board certification is the minimum you should expect from your doctor.

Yvonne S. Thornton, MD, MPH

Pregnancy and the pill

Tuesday, June 16th, 2009

For many women, taking the pill is more a matter of delaying pregnancy until the time is right rather than preventing it all together.

So, the big question becomes, how long after you stop taking the pill can you expect to become pregnant? No two women are alike but, generally speaking, pregnancy is possible the next time you ovulate. You may ovulate within two weeks after finishing up your last package of birth control pills. So, theoretically, you could become pregnant almost immediately. However, as we all know, there are many variables. Some couples try for years to become parents without success.

It almost seems an unfair trick of the heavens that it’s sometimes the women who don’t want to become pregnant who easily do.

That means, if you’re dead set against pregnancy, and you stop the pill, you need to begin another form of contraception immediately. I actually recommend that my patients begin using an alternate contraceptive before getting off the pill so they get into the habit of using it.

Otherwise, you may have to get into the habit of changing diapers.

– Yvonne Thornton, MD, MPH

“Is it hot in here – or is it just me?”

Friday, June 12th, 2009

If you’ve ever gotten a hot flash, you know how odd it can feel. Usually, hot flashes don’t have a major impact on a woman’s life but some women suffer more than others. About 80 percent of women experience hot flashes and night sweats, which are short bursts of intense heat of the face and neck. Usually they begin in the early years of the transition to menopause and peak one or two years after the last menstrual period, remain for several years and then resolve over a period of time. I’ve had patients come in to see me feeling downright miserable due to pre-menopausal and menopausal symptoms. Some complain of waking up dripping wet at 2:00 a.m. with night sweats or feeling like tiny bugs are crawling all over them.

These symptoms will pass as your hormone levels adjust but what do you do in the meantime? Other than buying a small hand fan, there’s no single answer. Treatment has to be individualized for each woman. Avoidance of triggers, such as cigarette smoking, hot beverages, foods containing nitrites or sulphites, spicy foods and alcohol, may  help limit hot flashes. Blood pressure medications have been prescribed off-label with some success. SSRIs (selective serotonin reuptake inhibitors) such as Prozac® and Zoloft® or antidepressants such as Effexor® (venlafaxine) also offer relief.  Oral estrogens or transdermal estrogen patches have been found to be very effective in reducing the incidence and the intensity of hot flashes.  However, if estrogen is used, unless you have had a hysterectomy, an additional hormone, progesterone, must be added to the estrogen in order to decrease your risk of developing uterine cancer.  Relaxation techniques, such as deep slow breathing, may also help with hot flashes.

Some women think first of herbal remedies such as dong quai, evening primrose oil or red clover. However, I discourage my patients from using herbs as they’re often ineffective. Soy (a phytoestrogen or plant estrogen) has been touted as a remedy for hot flashes.  However, there is no conclusive evidence  for its benefit and there are no long-term safety studies. If you are convinced that you want to go the herbal route, I strongly urge you to discuss these remedies with your doctor beforehand. Don’t assume that because you get it over the counter, it’s safe. Herbs are not regulated through government health agencies and can have potent unintended effects, and may interfere with other medications or cause harmful interactions.

– Yvonne S. Thornton, MD, MPH

When are irregular periods or spotting cause for concern?

Friday, May 29th, 2009

Are your periods coming at different intervals than in the past? And, if so, should you worry?

That depends.

Some women have regular periods every two months. Others have regular periods every 21 days. So, if your periods aren’t on a 28-day schedule, it may not be a problem at all, as long as it’s regular for you. And your cycle’s schedule may change over time. In your 20s, you may menstruate every 30 days, then every 33 days in your 30s. In  your 40s, the intervals could change again. There’s no one-size-fits-all cycle.

If you’re used to getting your period every 28 days and it’s now 45 days without a sign of menstruation, the first thing you should do is to see your gynecologist.  A blood test (not urine testing) for pregnancy would probably be ordered.

But what if you haven’t been sexually active? Ask yourself, what else in your life has changed? Have you been on a starvation diet? Undergone some very stressful event? If so, mention these changes when you discuss your menstrual cycle with your doctor.  The menstrual irregularity may be the first sign of thyroid dysfunction, or other metabolic or endocrine disorders.

The “take home” message here is that you should always be sure to keep an accurate menstrual calendar every month so you can tell your doctor when your period started, when it ended, when you had intercourse, and when you have spotting.

Speaking of spotting between periods, sometimes it’s a sign of a problem but often it’s not. Certain women will spot right in the middle of their cycles, when they ovulate. This sort of spotting can be perfectly normal. There’s even a German name for it: mittelschmerz,  But, if it continues, even in the middle of your cycle or if you’re spotting at odd intervals, like three days after your period ends, it’s time to make a gynecologist’s appointment.

– Yvonne Thornton, MD, MPH