Elena Nieves hardly looks like a poster girl for an obesity program for pregnant moms.
The 5-foot-8 23-year-old recently lost more than 50 pounds and looks healthy. But 15 weeks into her third pregnancy, she was gaining the weight back — too fast.
"I found out I was pregnant in December. I didn't go to the doctor until mid-January and I had already gained 15 pounds," said Nieves. Having struggled with excess weight in her last pregnancy, she decided to take action.
Nieves became the newest member of an experimental program at Northwestern Memorial Hospital in Chicago designed to help pregnant mothers keep their weight in check.
It is based on new research suggesting that excessive weight gain in pregnancy hurts both the mother and her fetus, raising the risk of complications during pregnancy and putting the child at risk for obesity and diabetes later in life.
"We've known for a long time that children of overweight mothers are more likely to be overweight themselves," said Dr. Robert Kushner, who directs the Northwestern Comprehensive Center on Obesity.
But he said researchers had assumed that was simply because the mother passed along her bad eating and lifestyle habits to her child after birth. Now, animal studies suggest the environment the fetus is growing in influences the genes.
"The whole idea is, as that child comes out of the birth canal, you've already imprinted that child's vulnerability to be overweight," Kushner said.
"It's like being born with handcuffs on. In this environment, how do they have a fighting chance?" said Kushner, referring to the growing obesity epidemic that affects a third of adults and nearly 17 percent of children in the United States.
U.S. Centers for Disease Control and Prevention estimates nearly one quarter of the 4 million births each year in the United States involve obese women.
Obesity raises the risk for diabetes, hypertension, heart disease, osteoarthritis, stroke, gallbladder disease, sleep apnea, respiratory problems and even some cancers.
A 2000 report by the U.S. Surgeon General estimated the direct and indirect cost of obesity at $117 billion each year.
Kushner said the program at Northwestern is among the first in the country to tackle obesity in pregnancy. He said pregnant women have often been considered hands off because of fear of harming the developing baby.
But it now seems doing nothing may be doing more harm.
Doctors have referred about 20 women since the program started in November, and new ones come in each week.
Women meet for classes every other week on nutrition, stress and exercise and keep daily logs of their diet and activity levels. That is proving difficult for some women, who are already juggling work, child care and weekly appointments with their obstetrician.
Charlotte Niznik, an advanced practice nurse who coordinates the program, said the team may start offering some of the services online. "Everything is flexible. If we're rigid, we'll never get participation."
A three-year grant allows the team to offer the program for free. They hope to attract more black and Hispanic women, who are at highest risk for obesity and its complications.
Niznik said several women in the program have had gastric bypass surgery and fear gaining too much weight.
"They are motivated to maintain a normal weight gain in pregnancy, which is no more than 15 pounds (7 kg), because these women are obese," Niznik said. "They are 300 (136 kg) to 400 pounds (180 kg)."
At 195 pounds (90 kg), Nieves weighs considerably less than that, but her previous weight battles and rapid weight gain -- 20 pounds (9 kg) so far -- make her a candidate.
During her last pregnancy, Nieves felt pressured by her obstetrician to gain weight. "I was about 220 pounds (100 kg). I would tell him, 'I'm already overweight. I don't want to gain the weight,'" she said.
"He would just tell me, 'You have to gain a pound a week.' That's 40 pounds at the end of the pregnancy!"
She hopes the program will give her ammunition to resist some of the pressure she is getting to gain weight.
"My background is Hispanic," she said. "My mother-in-law is like, 'Oh my God, you are pregnant. Eat, eat, eat. The baby has to be nice and fat.'"
Dr. Alan Peaceman, an obstetrician who co-directs the pregnancy and obesity program, said the near-term goal is to help women like Nieves have healthy pregnancies.
Down the road, they hope to gather data to see if it helped reduce complications for mothers and gave babies a better shot at having a healthy weight.
"If we can show that weight control during pregnancy reverses these trends, this is going to be one of the first successful approaches toward reducing childhood obesity, and that will be a major accomplishment," he said.