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The Perils of Obesity in Women

How putting on weight puts your health at risk

women legs with overweightThe worldwide prevalence of obesity is increasing steadily. In Singapore, the percentage of obese adults has increased from 6.9% in 2004 to 10.8% in 2010.

In 2010, 9.5% of female adults were classified as obese.

What is obesity?

Obesity is defined as having a Body Mass Index (BMI) equal to or more than 30kg/m2. To calculate your Body Mass Index, use the equation below to divide your weight (in kilogrammes) by the square of your height (in metres).

For example, Mrs Tan who weighs 55kg and is 1.62m tall, has a BMI of 20.9kg/m2 calculated by the following:

The higher the BMI, the greater the risk of developing obesity-related health problems. Depending on their BMI value, obese individuals are classified into the various severity levels.

table 1

Complications of Obesity

Although obesity may cause many physical inconveniences, obesity by itself usually does not result in any symptoms. With time, however, it may increase the risk of developing other medical problems such as:

iStock_000015923224_MediumA. Type 2 Diabetes Mellitus

Comparing against women with BMI of 20kg/m2, women with BMI of 30 are more than ten times as prone to suffer from diabetes. It is believed that increased body fat decreases the body’s sensitivity to insulin, a hormone produced in response to high sugar levels after a meal. Left uncorrected, the body is unable to utilise the sugar in the blood appropriately and this eventually results in the development of diabetes. Diabetes brings about its own list of health harms to the other organs, including the kidneys, eyes and nerves. The risk of developing diabetes increases with the severity as well as the duration of being overweight.

Restricting calories and weight loss helps improve glucose homeostasis in diabetic obese individuals. In a review of studies on bariatric (weight loss) surgery for morbid obesity where 80% of 135000 patients were women, 78% were reported to be in remission for diabetes and 86% showed improvement in glycemic (blood glucose) control after surgery.

BHeart Disease

Research has shown that women with BMI of > 35kg/m2 are up to three times as likely to suffer from heart disease and five times as likely to suffer from high blood pressure (hypertension). Women with a bigger waist circumference (> 88cm) or a waist-to-hip ratio of > 0.88 were more likely to die from a heart attack.

A pooled analysis of 22000 patients of which 72% were women reported 70% improvement in hyperlipidemia (high lipid levels) and 78% improvement in high blood pressure after bariatric surgery.

Knee runner injuryC. Joint Pain

Overweight women are more likely to complain of knee and back pains. Obesity increases mechanical stress on the spine and weight-bearing joints, especially the knee joints. Obesity at a younger age increases the risk of low back ache for women within ten years, and the proportion of obese women presenting with joint pain over the years increases steadily.

 

On average, for every two units of BMI gain, the risk of knee arthritis increases by 36%. Research has shown that patients reported less pain and better function just by losing 10% of their body weight. However, there is not enough data to suggest that weight loss can be a therapy once back ache has set in.

D. Infertility

Overweight women are more likely to suffer from fertility problems. Studies have shown that about 40% of overweight women have irregular menstrual cycles. Increased abdominal fat results in hormonal imbalances and elevation of oestrogen level in the bloodstream, which interferes with the menstrual cycle and ovulation, thereby contributing to difficulties in conceiving and playing a major role in diseases such as polycystic ovarian syndrome.

iStock_000003333479_MediumE.  Problems in Pregnancy

Pregnant mothers who are obese are more likely to develop conditions such as pregnancy-induced (gestational) diabetes and hypertension (pre-eclampsia), which puts both mother and baby at a higher risk of complications. Obese mothers are more likely to require a caesarean section for delivery. Furthermore, research has shown that babies of obese mothers are up to twice as likely to have birth defects.

Maternal obesity is also known to be associated with a decreased initiation and duration of breastfeeding.

F. Cancer

Recent research has shown that obesity is a major risk factor for developing cancer of the breast and reproductive system (e.g. endometrium, cervix and ovarian) in women.

There is a strong link between obesity and development of breast cancer. Prolonged high levels of blood oestrogens predispose obese women to development of breast cancer. Overweight women going for breast cancer surgery also tend to face complications such as higher wound infection rates, which may prolong recovery time.

woman with healthy foodMedical Management of Obesity

Obesity is most commonly caused by a combination of excessive food intake, lack of physical activity and genetic susceptibility. Lifestyle modification is recommended and includes steps such as:

  • Maintaining a healthy diet – This involves restricting calorie intake (recommended 1700 Kcal/day for women and 2200 Kcal/day for men), and taking more fruits and vegetables.
  • Increasing physical activity – The Health Promotion Board (HPB) recommends 150 – 300 minutes of moderate-intensity aerobic activity per week for optimal weight loss.

measuring tape with tabletsOther obesity-related medical conditions, if present, should also be kept under control by taking prescribed medications regularly and correctly.

Surgical Treatment of Obesity

It was not commonly known that people can undergo weight reduction surgery (also known as bariatric surgery) to prevent the onset or to reduce the risk of developing obesity-related complications. Weight loss surgery can be considered in people who are severely obese (BMI > 40) or those who are obese with major health problems.

Bariatric surgery not only helps with improvement of one’s image and self-confidence, it also helps to control and reduce obesity-related complications. Recently, it has been shown that more than 60% of obese patients with diabetes who undergo bariatric surgery achieved remission of diabetes mellitus. More than 80% of patients had improved sugar level control. Furthermore, cholesterol levels and blood pressure control also improved in 50% to 70% of patients.

Weight loss following bariatric surgery has also been shown to decrease pregnancy complications such as gestational diabetes, hypertension and foetal anomalies. There is emerging evidence that fertility may improve in obese patients who undergo bariatric surgery. However, the incidence of cancers does not seem to decrease after obese patients undergo weight loss surgery. Hence, prevention is still the best policy when it comes to combating obesity.

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Assistant Professor Asim Shabbir is a Senior Consultant at the National University Hospital’s Centre for Obesity Management and Surgery, and an Assistant Professor at the National University of Singapore. His clinical interests and research are focused on gastric cancer, bariatric and metabolic surgery. He is currently the Post-Graduate Education Director for the Department of Surgery.
Posted by ezyhealth on Mar 5 2015. Filed under Health. You can follow any responses to this entry through the RSS 2.0. Both comments and pings are currently closed.

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