Around 650 million people worldwide are diagnosed as obese. However, the management of obesity in women is often different from that of men. This premise is explored by a new article published in the Journal of progress in heart diseaseWhich provides a women’s health perspective on obesity.
Study: A women’s health perspective on obesity management. Image credit: jacblund/Shutterstock.com
The researchers present an overall view of the condition and its management in the context of female physiology. Such recognition could pave the way for better prevention and treatment of female obesity.
Little is known about the differentiating factors of male obesity versus female obesity. More needs to be known about the effects of gender, ethnicity and comorbidities.
However, several hypotheses have been made around the observed gender differences in weight gain.
These include weight gain associated with the stages of female life ie puberty, pregnancy and menopause when there are drastic changes in female sex hormones. The effects of aging are exacerbated by a decrease in ovarian function and an increase in androgen production during perimenopause.
Neural and behavioral factors are also postulated to influence women’s greater response to high-calorie foods, especially those high in carbohydrates.
measure body fat
Body mass index (BMI) is the most common benchmark for diagnosing obesity.
As described by several researchers, however, BMI fails in many cases. Not only is it unable to separate lean body mass from fat mass, but it also does not take into account race and gender differences, and leaves no room for bone density differences.
These are important in differentiating healthy body mass from unhealthy body mass and help push most of the population into obesity territory, albeit unfairly. Other measurements such as waist circumference and waist-to-hip ratio also cannot differentiate visceral fat mass from other body components.
More accurate methods such as dual-energy X-ray absorptiometry (DEXA) are available to directly assess body fat mass, but are not cost-effective in a clinical scenario. Digital anthropometry may fill the void, but further studies are needed to confirm it as an affordable option.
How to fix the above mentioned problems? The document suggests a comprehensive assessment of the individual as the first step. It begins, as usual, with a story focusing on the duration of the weight gain, the factors leading to the weight gain, including diet, exercise, medications, and life events. The influence of pregnancy and menopause in women is important, as is family history.
Sleep and stress history are also important, as well as the socioeconomic environment that often compels the individual and/or family to make unhealthy food choices.
Medications such as steroids, often used in chronic inflammatory conditions, antihistamines and antipsychotics are associated with metabolic changes that lead to weight gain.
Finally, psychological conditions such as bulimia and night eating syndrome are also frequent in obese patients and require specific interventions to improve their mental health.
,Recognizes that obesity is not caused solely by an individual’s choices (i.e. diet, amount of exercise, or willpower),
…thereby reducing the social stigma associated with obesity and providing healthy ways to move forward.
How to treat female obesity?
Given the range of factors influencing female obesity, its treatment must also be multifaceted and adapted to the patient and her cultural environment. Financial well-being is just as important as the stability of the intervention plan.
For example, a comprehensive drug review is indicated to eliminate, replace, or supplement those that induce or promote obesity.
Lifestyle therapies are the backbone of weight loss efforts, requiring complementary medicine or surgical intervention. Nutritional advice and support are important to enable the patient to adapt to a nutritious but non-obese dietary pattern.
Physical activity helps prevent weight gain but generally cannot promote it. However, when combined with a nutritional program, it enhances cardiovascular fitness, improves physical function and increases energy expenditure, helping to maintain a stable weight.
It is important to identify and correct sleep disorders and conditions such as gastroesophageal reflux disease (GERD) and depression, or asthma, that contribute to the intensification of obesity and its morbid effects.
Stress relief should also be part of the intervention, as external stressors and weight-related stigma can stand in the way of successful weight loss efforts.
Drug therapy is limited to those whose weight loss goals have failed using lifestyle therapy alone, provided the patient is not breast-feeding and is obese or overweight with associated diseases. Several approved drugs are currently in use for long-term use. Some other antidiabetic drugs are used off-label for the same purpose.
Bariatric surgery is another option for these patients, with most procedures involving the removal of most of the stomach and diversion of gastric contents to bypass part of the small intestine, leading to malabsorption.
These are very effective in rapid and severe weight loss, but their long-term effects are less certain and their use has been associated with malnutrition, micronutrient deficiencies, and acid reflux.
Pregnancy is a special risk factor for obesity in women, and vice versa. Pregnancies in overweight women may be complicated by fetal abnormalities, large babies, prematurity, stillbirth, gestational diabetes and pre-eclampsia. The latter may or may not continue exceptionally into later life.
Women who are already overweight or obese before pregnancy should lose weight at this stage through lifestyle strategies to optimize their chances of a healthy pregnancy.
Ovulatory disorders such as anovulatory polycystic ovary syndrome are often corrected or improved, and the effectiveness of assisted reproductive technology (ART) is often superior to weight loss.
However, maintaining pre-pregnancy weight loss during pregnancy requires intensive support. About 50% of women experience excessive weight gain during pregnancy, which continues into later life.
Again, about three-quarters of pregnant women retained the weight gained during the first year postpartum, with an average gain of 4–5 kg a year.
Exclusive breastfeeding and psychological support can reduce this retention, which is associated with long-term weight problems, heart disease, type 2 diabetes and endometrial/breast cancer, cycle irregular periods and fertility problems, as well as pelvic floor disorders.
Physical activity is known to improve maternal well-being, but in most cases, it needs social support to become a part of life.
What are the implications?
Weight gain in women can have many causes, leading to obesity and associated co-morbidities.
Obesity in women can increase the risk of heart disease, especially after menopause, which is itself a cardiovascular risk factor for all overweight women.
From a biological perspective, the treatment of obesity in women is different from that in men and varies according to the age and stage of development of the woman., ,
This should guide the development of interventions to achieve weight loss and maintain it while successfully navigating the different stages of a woman’s life. Next steps should address disparities in obesity rates and treatment options in high-prevalence segments of the population.