by Dr. Rainier Bautista
Obesity is a significant public health issue, particularly for women, who are disproportionately affected.
According to the 2017-2018 NHANES data, among adults aged 20 and older, there was no significant difference in the overall prevalence of obesity between men and women.
However, the data revealed that severe obesity (defined as a BMI of 40 or higher) was much more common in women, affecting 11.5% of women compared to 6.9% of men.
The impact of obesity on women’s health is profound and multifaceted.
Obese women are at a significantly higher risk of developing cardiovascular diseases, with studies showing that they are more than twice as likely to suffer from conditions such as heart disease and stroke compared to their non-obese counterparts.
Additionally, obesity in women is strongly linked to an increased risk of certain cancers, including endometrial, breast, and ovarian cancers.
These risks are compounded by the fact that obesity often exacerbates other health conditions such as diabetes and hypertension, creating a complex web of health challenges that can significantly reduce the quality of life and increase mortality rates among women.
Addressing obesity is not only crucial for improving overall health outcomes but also for reducing the burden of these life-threatening diseases.
Specific health challenges
Obesity also plays a significant role in conditions unique to women, such as polycystic ovary syndrome (PCOS).
PCOS is a common endocrine disorder that affects up to 10% of women of reproductive age, and obesity is a major contributing factor. Women with obesity are more likely to develop insulin resistance, a key component of PCOS, which can exacerbate symptoms such as irregular menstrual cycles, infertility, and excessive hair growth.
Furthermore, obesity worsens the hormonal imbalances associated with PCOS, making it more challenging to manage and increasing the risk of developing type 2 diabetes and cardiovascular disease in the long term.
Another critical area where obesity impacts women’s health is during pregnancy.
In Hawai‘i, nearly 1 in 6 women (15.8%) are obese before conception, and 1 in 5 women (21.4%) are overweight.
Certain populations are particularly affected, with Samoans having the highest rate of preconception obesity at 50.2%, followed by Other Pacific Islanders at 27.7% and Hawaiian mothers at 23.3%.
Maternal obesity is associated with a higher risk of adverse outcomes for both the mother and the fetus, including gestational diabetes, preeclampsia, and an increased likelihood of requiring a cesarean section.
These conditions not only complicate pregnancy but also pose significant health risks during delivery and postpartum.
For the fetus, maternal obesity increases the risk of congenital anomalies, preterm birth, and macrosomia (excessive birth weight), which can lead to complications during delivery and increase the likelihood of childhood obesity and metabolic disorders later in life.
The intergenerational impact of obesity underscores the importance of managing weight before and during pregnancy to improve outcomes for both mother and child.
Tailored strategies for women
Treating obesity requires a multifaceted approach that considers both lifestyle modifications and, in some cases, medical or surgical interventions.
For women, certain unique factors must be taken into account when developing an effective treatment plan. Hormonal fluctuations, particularly those associated with menstrual cycles, pregnancy, and menopause, can significantly impact weight management efforts.
For instance, women often experience weight gain during menopause due to a decrease in estrogen levels, which can slow metabolism and lead to an increase in visceral fat.
Tailoring treatment plans to address these hormonal changes is essential for long-term success.
Additionally, women may face psychological and social challenges related to obesity that differ from those experienced by men.
Societal pressures and stigmatization can lead to body image issues and disordered eating patterns, such as binge eating or emotional eating, which need to be addressed as part of a comprehensive treatment plan.
Mental health support, including counseling and therapy, plays a crucial role in helping women overcome these barriers and develop healthier relationships with food and their bodies.
In terms of specific treatments, lifestyle interventions, including diet, exercise, and behavioral therapy, remain the cornerstone of obesity management.
However, for those who struggle to achieve significant weight loss through these methods alone, pharmacotherapy or bariatric surgery may be considered.
When choosing these treatments, it is important to consider the potential impacts on reproductive health, such as the effects of weight-loss medications on fertility or the implications of surgery for future pregnancies.
Collaborative care involving primary care providers, specialists, and mental health professionals is essential to address the complex needs of women battling obesity and to support them in achieving and maintaining a healthy weight.
DR. RAINIER BAUTISTA is a board-certified physician specializing in both Obesity Medicine and Family Medicine. He currently practices at the Primary Care Clinic of Hawaii and serves as the president of the Philippine Medical Association of Hawaii.
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