Obesity is a global problem and a health threat to
developing and developed countries as its prevalence is rising. It is estimated
that more than 1 billion people are overweight with 300 million meeting the criteria
for obesity. Twenty six percent of non-pregnant women ages 20-39 are overweight
and 29% are obese.
Classification of
Obesity Based on Body Mass Index (BMI)
Classification
|
BMI (kg/m2)
|
Underweight
|
<18.5
|
Normal weight
|
18.5-24.9
|
Overweight
|
25.0-29.9
|
Obese Class I
|
30.0-34.9
|
Obese Class II
|
35.0-39.9
|
Obese Class III
|
>40.0
|
·
Class III = EXTREME/MORBID OBESITY
The above table shows a
classification for overweight and obesity based on BMI. Another classification
is based on waist circumference. In women, a waist circumference of > 35
inches (88cm) is high risk and in men, the level is > 40 inches (102cm).
Health Risks For Women
An increased risk of Diabetes
Mellitus (DM) was seen in women with BMI values > 24 and a waist-to-hip
ratio > 0.76. The risk increases with the degree and duration of being
overweight or obese and with a more central or visceral distribution of fat.
Increased central fat enhances the degree of insulin resistance and increased
risk of metabolic syndrome (DM and cardiovascular syndrome).
Compared to normal population,
women with a BMI > 35 have an increased risk 2.7 times for developing
coronary artery diseases and 5.4 times for hypertension.
More than 31% of obese adults
have arthritis compared with only 16% of non-obese adults. Obesity at age of 23
increases the risk of low back pain onset for women within 10 years. Studies
showed that women with a diagnosis of knee osteoarthritis (OA) have an average
BMI that is 24% higher than women without OA. An estimated 69% of knee
replacements in middle-aged women have been attributable to obesity.
Obesity is frequently associated
with menstrual problems. About 30-47% of overweight and obese women have
irregular menses. Obesity affects fertility throughout a woman’s life. Abdominal
obesity is associated with an increase in circulating insulin level, hormonal
imbalance and menstrual cycle abnormalities which result in anovulatory cycles
(no egg production) and subfertility. Some studies demonstrate increased female
sexual dysfunction in obese patients whether caused by the physical or
psychological impacts of obesity on female sexuality.
An Australian study found that
34% of pregnant women were overweight, obese or extremely obese. Prepregnancy
obesity contributes to development of pregnancy complications including
pregnancy-induced hypertension, pre-eclampsia, gestational diabetes, Caesarean
section and congenital fetal abnormalities neonatal death.
Maternal obesity is associated
with a decreased intention to breastfeed, decreased initiation of
breast-feeding and decreased duration of breast-feeding. Obese women are at
greater risk of a delay in milk production due to lower hormone (prolactin)
responses to suckling in the first week compared to normal-weight women.
There are a lot of evidence that
obesity is a risk factor for developing gynaecologic and breast cancers.
Endometrial cancer (lining tissue of the uterus) is strongly related to
obesity. Obese women have 2-5 times increased risk of developing endometrial
cancer compared to normal-weight women. This is mainly due to hormonal
imbalance, irregular scanty menses result in an endometrium is chronically
exposed to oestrogen. This causes cancerous changes in the endometrium. Obesity
increases risk of breast cancer for postmenopausal women with poorer outcomes –
more aggressive diseases, a higher likelihood of delayed detection and
treatment failure.
Evidence from studies on body
weight and ovarian cancer has been inconsistent and showed no correlation
between obesity and ovarian cancer. However obese women are at an increased
risk of complications from ovarian cancer surgeries like infection, bleeding,
organ injuries and venous thrombosis. Studies shows increased incidence and
mortality from cervical cancer among obese women. It could be due to decreased
screening compliance among obese women, because of embarrassment or discomfort.
Importance of weight loss for risk reduction measurement
Weight loss is the most important
measures to reduce health risk for obese women. Combined management with
dietitians, endocrinologists, bariatric surgeons and gynaecologists may produce
desirable results. Patients must be motivated throughout the weight loss
programme.
Weight loss surgery can be
considered if conservative measures fail. Researches show that bariatric
surgery resulted in complete resolution of diabetes in 78% of patients and
improvement in diabetic control more than 86% of patients. This surgery also
improved lipidaemia in 70% of patients, 62% resolved hypertension and 62%
improved hypertension. In these researches, 72-80% of patients are women.
A reduction 10 % of body weight
may regulate menses, increased ovulation and fertility rate for obese women.
Weight-loss intervention (mainly diet and exercise) is the best initial
management of infertile overweight and obese women.
Weight loss especially after
obesity surgery reduces risk of endometrial cancer but no significant impacts
on reduction in incidence of breast, cervical and ovarian cancers.
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