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Editorial November
2009
Obesity and Women’s Health
Ronald T. Burkman, MD
This month’s issue of
The Female Patient highlights yet another issue faced by obese
women: sexual dysfunction. Unfortunately, obesity in the United
States has reached epidemic proportions (Sidebar).
The prevalence of adult obesity
in the United States increased from 15% to 24% in the decade
ending in 2005. Among repro-ductive-aged women in 2004, the
prevalence of obesity was 29%. Further, certain groups of reproductive-aged
women are affected disproportionately. For example, half of
non-Hispanic black women and just over one-third
of Mexican American women
are obese.
The toll on health due to obesity is significant. Compared
with normal-weight individuals, obese women face increased
risks for atherosclerotic heart disease; hypertension; stroke;
diabetes mellitus; hyperlipidemia; osteoarthritis; cancer of
the endometrium, breast, and colon; liver
and gallbladder disease; and
the respiratory complications associated with sleep apnea.
All this equates to at least 112,000 deaths due to obesity
annually
in the United States, and a cost of $51 billion to $79 billion
in health care expenditures.
In addition to the increase in endometrial and breast cancer,
other reproductive health issues include anovulation or oligo-ovulation
often associated with polycystic ovary syndrome. Obesity also
decreases the success of ovulation induction techniques, leading
to persistent infertility. Further, even if obese women ovulate,
they often have reduced fertility, perhaps due to higher insulin
levels.
Once pregnant, obese women have an increased risk for a number
of problems that can complicate their pregnancies. Obese pregnant
women have higher rates of spontaneous abortion, hypertension
and preeclampsia, gestational diabetes, venous thromboembolism,
congenital anomalies, preterm birth, and postterm pregnancy.
They tend
to have longer labors and higher rates of cesarean delivery,
approaching 50% for the morbidly obese in some studies.
Postoperatively, obese women have higher rates of infection,
including wound infection and endometritis. Finally, they also
have higher rates of postpartum hemorrhage. Although women
who have had bariatric surgery appear to have reasonably favorable
pregnancy outcomes, there are a number of nutritional and gastrointestinal
complications associated with this surgery.5
Thus, it is clear that obese women face a number of general
health and reproductive health problems. Further, society often
stigmatizes obese individuals, since they are not what some
view as the normal body type. Although a sedentary lifestyle
coupled with excessive intake
of calories has been blamed for the obesity epidemic, it is
also important to understand that some individuals, due to
their genetic makeup, are more likely than others to gain weight
and body fat.
Given that ObGyns provide
primary preventive health
care, we need to ask ourselves how effective we are in obesity
prevention and treatment.
In general, the news is good.
A cross-sectional survey of
900 ObGyns conducted by
ACOG in 2005 revealed that 80% of those surveyed counseled
women about weight control, often recommending strategies such
as limiting intake of specific foods and reducing caloric intake.
However, only a minority
(27%) referred women for behavioral therapy, and only 35%
ever prescribed weight-loss medication.
It should also be noted that about 36% of those surveyed
indicated that training in weight control was inadequate or
non-existent. The data suggest that most of us want to help
individ-uals lose weight and become healthier, but we also
feel our lack of adequate training interferes with our ability
to counsel appropriately. Thus, better
nutritional training in medical school and residency, as well
as effective postgraduate courses, would likely go a long way
to allow us to more effectively do our part in dealing with
the obesity epidemic.
back to top
Ronald T. Burkman, MD, Editor-in-Chief
References
- Flegal KM, Graubard BI, Williamson DF,
Gail MH. Excess deaths associated with underweight, overweight,
and obesity. JAMA. 2005;293(15):1861-1867.
- Power ML, Cogswell ME, Schulkin J. Obesity prevention and treatment practices
of US obstetrician-gynecologists. Obstet Gynecol. 2006;108(4):961-968.
- ACOG. ACOG Committee Opinion Number 315, September 2005: Obesity in pregnancy.
Obstet Gynecol. 2005;106(3): 671-675.
- ACOG. ACOG Practice Bulletin Number 105: Bariatric surgery and pregnancy.
Obstet Gynecol. 2009;113(6):1405-1413.
- DeMaria EJ. Bariatric surgery for morbid obesity. N
Engl J Med. 2007;356(21):
2176-2183.
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