C O N V E R S A T I O N S W I T H C O L L E A G U E S

Maintaining; a Healthy Weight for Life

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In counseling women about maintaining a healthy weight, how do you figure body mass index (BMI), and what’s considered a healthy BMI? Also, is the new drug sibutramine (Meridia) safe?

According to the American Cancer Society, the New A * England Journal of Medicine,

and the Harvard Women’s Health Watch, a BMI greater than 21 has been determined to increase a woman’s health risks and her risk for death.

To compute BMI, multiply a woman’s weight in pounds by 700. Then take that number and divide it by her height in inches squared. For example, for a 5’7” woman weigh- ing 130 pounds, you would multi- ply 130 by 700 to get 91,000. Then you would calculate her height in inches squared: 67 inches multiplied by 67 inches equals 4,489. Finally, you would divide 91,000 by 4,489 for a BMI of 20.2.

BMI and its related risks also appear to be somewhat age-sensitive. For women between the ages of 45 and 55, the risk for death started to rise sharply with a BMI greater than 25; however, for women over the age of 65, the risk was not a factor, according to the writers in Harvard Women’s Health Watch (March,

Refusing Neonatal Treatment Do parents have the right to refuse treatment for premature . or low-birth-weight infants?

That’s a tough ethical ques- ’ tion that remains highly debat-

ed and as-of-yet unanswered, write the editors of the Healthcare Reform & Ethics Review (May, 1998). From an institutional stand- point, the cost associated with low- birth-weight babies is approximately $1 18,000 per infant, and according to a study in Pediatrics (1 998; 10 1:344-348), proposals

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1988). A BMI of 27 or greater is also linked with hypertension.

Overall, the researchers agreed with the authors of the Nurses’ Health Study, who found that main- taining a moderate weight through a woman’s middle age helps reduce the risk for premature death.

With regard to the new weight- loss drug sibutramine, obesity experts at the Mayo Clinic say that the problems associated with the use of serotonin-enhancing diet drugs, such as dexfenfluramine and fenfluramine, should make women skeptical and/or “wary” of using drugs for weight loss. Writing in the Mayo Clinic Health Letter (April, 1998), the experts indicated that sibutramine affects the brain chemicals serotonin and norepi- nephrine that work to help control appetite. Although sibutramine works differently and studies haven’t linked the drug with an increased heart-related risk, only those women who are significantly obese and have serious,health prob- lems should take the drug.

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have been made to withhold “tech- nology to very low-birth-weight babies.” The study’s authors looked at 1,361 infants admitted to the NICU weighing between 31 1 and 1,500 grams each, and concluded that the smallest infants (less than 600 grams) actually used very few resources within the neonatal inten- sive care unit, but their survivor costs were highest, at approximately $250,000 per survivor. The authors concluded that “changing the cutoff point for low-birth-weight results in a slow rise in cost savings and a ‘brisk increase’ in mortality.”

ROP and light Reduction Does light reduction affect the development of the potentially om blinding eye disorder called

retinopatby of prematurity (ROP) in low-bivth-weight newborns?

Researchers funded by the National Eye Institute have A m determined that light reduc-

tion doesn’t effect the development of ROP in low-birth-weight infants. The disease, which primarily affects premature infants weighing 1,250 grams or less with a gestational age of 31 weeks or less, develops as the result of other factors that have yet to be explored, according to their research published in the May 28th edition of the New England Journal of Medicine.

Although lighting levels in hospi- tal nurseries have been suggested as a factor in ROP, studies to date have been conflicting and inconclusive. The multicenter clinical trial studied one group of 204 infants exposed to normal nursery lighting (control group) and another 205 infants who wore specialized goggles that dra- matically reduced light levels. Researchers found that the differ- ence in the incidence of confirmed ROP between the two groups wasn’t statistically significant: 54 percent for the infants wearing the goggles and 58 percent for the control group. The amount of light permit- ted through the goggles was equiva- lent to wearing very dark sunglasses.

ROP is caused when abnormal blood vessels grow and spread throughout the retina, the nerve tis- sue that lines the back of the eye. The scarring and bleeding caused by the excess growth can lead to retinal scarring or detachment from the back of the eye, resulting in vision loss. There are approximately 3.9 million infants born in the U.S. each year, and of those, approximately 28,000 weigh less than 2 314 pounds. Of those infants, about half are affect- ed by ROP, but the disease usually digresses. Only about 1,500 infants with ROP require cryotherapy, the most common intervention. Approximately 600 infants with ROP become legally blind each year. +

August 1998 A W H O N N L i f e l i n e s 17