Obesity in Women: Paying a High Price

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Key points

  • Obesity affects women in ways that are different from the experience of men.

  • The physiologic processes of pregnancy in obese women may result in an increased risk of obesity for the future child.

  • Polycystic ovary syndrome is a condition that can be exacerbated by obesity.

  • Insulin excess in obesity interferes with processes necessary for ovulation and conception.

  • Patient-centered care and collaboration with the patient are key to success in improving health in women with obesity.

Consequences of obesity labels and measures

In 2013, there was an intense debate at the annual meeting of the American Medical Association over whether to classify obesity as a disease; some argued that obesity is a condition that can be identified and treated independent of other health problems. Those opposed to affixing the disease label cited the inability to identify a clear pathogenesis and universally effective treatments. Eventually, the delegates were able to come to consensus and obesity was assigned a unique diagnosis code.

Obesity in childbearing

Linkages between maternal obesity and the development of obesity in offspring beyond the influence of heredity have been described. The insulin resistance and inflammation that lead to the increased storage of fat (adipogenesis) and breakdown of fat tissue (lipolysis) are characteristics of both obesity and pregnancy. An abnormal increase in circulating lipids in the mother during pregnancy can lead to an increased risk of the metabolic syndrome in their offspring.9 There is a body of evidence

Impact of obesity on the female reproductive system

Overweight and obesity have been associated with disruption of the menstrual cycle through several interacting mechanisms. An excess in central adipose tissue (fat centered around the waist) is associated with an increase in resistance to the action of insulin for transporting glucose into cells for the energy needed to perform various cellular and metabolic functions. As a result of this resistance to the action of insulin, the system sends out signals to initiate corrective action to overcome

Social stigma for women

Simply being identified as having a disease can instigate stigma, particularly if the condition is chronic. The stigma associated with obesity has been demonstrated to adversely affect women with obesity disproportionately both in comparison with thin women and men who also have obesity.4 Until the early twentieth century, stoutness was associated with health, wealth, and higher social status. At the turn of the last century, excess weight began to be linked to sinful behavior as in a moral

Approaches to the diagnosis and management of obesity in women

The US Preventive Services Task Force recommends that all adults should be screened for obesity.20 As mentioned elsewhere in this article, although the BMI measurement is a relatively simple way to initially screen men and women for obesity in a clinical setting, it should not be the sole means to assess for excess adipose tissue. The American Academy of Family Physicians published a comprehensive monograph detailing the diagnosis and management of obesity, including pharmacologic, surgical,

Clinics care points

  • BMI should be paired with waist circumference and waist/hip ratio measurements when assessing and monitoring obesity in women.

  • Many of the factors contributing to obesity are not under the control of women.

  • Obesity during pregnancy can increase the risk of obesity in the child.

  • A weight loss of as little as 5% can improve some of the symptoms experienced by women owing to obesity.

  • Obesity can intensify the signs and symptoms associated with PCOS.

  • Obese women who have infrequent or no menses should

Disclosure

The author has no commercial or financial conflicts of interest related to this article. The author received no funding for the preparation of this article.

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