Obesity is a growing problem in obstetric practice. A recent study from Glasgow (UK) showed that 50% of women of childbearing age are either overweight (Body Mass Index [BMI] = 24.9–29.9kg/m2) or obese with 18% starting pregnancy as obese. Obesity prevalence has doubled over a decade from the early 1990’s. In the US it is estimated that 30% of reproductive-age women have a BMI greater than 30 kg/m while 7% have a BMI > 40 kg/m2. A recent report from the UK found that 5% of women had a BMI >35 kg/m2, 2% > 40 kg/m2 and 0.2% >50 kg/m2 with an association not only with social deprivation, but also with a higher prevalence of pre-existing medical disorders such as diabetes and hypertension and medical complications of pregnancy such as preeclampsia. Obesity was also associated with increased rates of macrosomia, operative delivery and postpartum haemorrhage. These data highlight the fact that obesity is an increasing health concern particularly in young women of childbearing age. Obesity will expose them to significant pregnancy complications ranging from miscarriage and fetal abnormality through to operative delivery and thromboembolism. There are also challenges for the delivery of maternity care to meet the needs of these women. As obesity is associated with significant pregnancy complications it is important that women enter pregnancy with an optimum body weight. Many complications, such as fetal abnormality occur in the first trimester and so pre-pregnancy weight reduction is preferred. Further, there is insufficient evidence to recommend specific dietary and/or physical activity interventions to reduce weight or moderate weight gain during pregnancy.

Obesity is the modern health epidemic of Western society. The World Health Organisation estimated in the year 2000 that as many as 300 million people worldwide are clinically obese. European countries are now following the worrying trends set by our American neighbours with as many as 30% of adults now classified as overweight and obese (Table 1). In the recent British Women's Heart and Health Study over 4000 women from 23 towns in England, Scotland and Wales were surveyed to establish the prevalence of cardiovascular risk factors. Over one quarter of the participants were obese (Body mass index (BMI)>30 kg/m2) with the mean BMI of the sample being 27.7 kg/m2 (SD 5.2). One fifth of the women were inactive (participated in less than one episode of moderate activity per week) and two fifths of women did not eat a portion of fresh fruit at least daily. In Sweden, 5600 individuals were surveyed to assess the trends for lifestyle changes between the periods 1986 and 1994. The prevalence of obesity (BMI>30 kg/m2) increased from 6.1% to 9.8% and overweight (BMI 25–29.9 kg/m2) from 19.6%–29.1% in women over this time period. In support of this the proportion of leisure time physical inactivity increased from 19.4% to 26.7%. Perhaps of more concern is the alarming increase in the prevalence of obesity in children. Data from a nationally representative sample of 2630 English children showed that the frequency of overweight (>85th centile) ranged from 22% at age 6 years to 31% at age 15 years and that of obesity (>95th centile) ranged from 10% at age 6 years to 17% at age 15 years. Obesity rates also vary in different ethnic groups with Afro-Caribbean and Pakistani girls living in the UK being more likely to be obese than the general population (OR 2.74 (95%CI 1.74–4.31), OR 1.71 (95%CI 1.06–2.76) respectively. A recent study has suggested that these concerning statistics may not be totally attributable to poor diet but also to a decline in total energy expenditure. For example, at age three the median time spent in sedentary behaviour was 79% of monitored hours and 76% by age five. In general these children spent only 20–25 minutes per day in moderate to vigorous physical activity. The most severe consequences of these observations is the fact that type 2 diabetes, once virtually unheard of in adolescence, now accounts for as many as half of all new diagnoses of diabetes in some populations in North America.

Among the various methods of assessing morbid anxiety the psychiatric interview remains pre-eminent. By this means, we attempt to elicit what patients actually feel—the criterion against which all other measurements are validated. Dissatisfaction with the subjective nature of psychiatric interviews and with their low reliability (Cattell and Scheier, 1958; Kreitman, Sainsbury, Morrissey, Towers, and Scrivener, 1961) has led, on the one hand, to the use of rating scales which quantify subjective clinical judgements (Kellner, Kelly and Sheffield, 1968), and, on the other, to the development of techniques which purport to measure anxiety objectively. The latter fall into two broad categories: (i) questionnaires such as the Manifest Anxiety Scale (Taylor, 1953) and the IPAT Anxiety Scale (Cattell and Scheier, 1963), and (ii) measurements of somatic correlates of anxiety, in particular the various endocrine and physiological responses reviewed by Mason (1968) and Lader (1969), respectively.

D-L-propranolol has been reported as having a beneficial effect in anxiety (Granville-Grossman and Turner, 1966; Wheatley, 1969; Suzman, 1971). The effect is believed to be due to the drug's (β-adrenergic blocking action which suppresses many of the somatic manifestations of anxiety, such as tachycardia (Turner, Granville-Grossman and Smart, 1965) and tremor (Marsden, Gimlette, McAllister, Owen and Miller, 1968). Although the peripheral manifestations of anxiety may be ameliorated by propranolol it is not clear whether the drug has any effect on the subjective, central feelings of anxiety experienced by the patient (Marsden, 1971).