Obesity, or too much body fat, has become a serious health threat for women at every stage of life.  It is linked as a serious factor in more than 30 conditions that effect women.  As the prevalence of obesity has grown significantly, obesity has become the second largest cause of preventable death in the United States, following tobacco. Today's children and young adults are on track to mature into the most obese generation in US history, creating pressure on the health care system to deal with fat related disease.  This document highlights some research being done to understand the effect of obesity on women and its treatment.

Conditions that link obesity as a risk factor or aggravating agent:
(Underlined conditions indicates additional information later in this summary)

Body Fat Impact on Morbidity

Preliminary research has shown that body fat decreases may extend human longevity and that weight loss may only extend longevity if it is associated with sufficient body fat loss.  In some cases weight loss is related to an increase in mortality, possibly due to a loss of lean body mass. (Pietrobelli A, et al. Fat-Loss Decreases and Weight Loss Increases All-Cause Mortality: Results From Two Epidemiologic Studies. Int J Obs, 1998)

Breast Cancer

Recent research is clarifying the relationship of obesity to breast cancer. The Nurses Health Study investigated 95,256 nurses, aged 30 to 55, for 16 years showed that weight gain after the age of 18 was associated with breast cancer incidence after menopause.

"The percentage of postmenopausal breast cancer accounted for by weight gain alone was approximately 16% and by hormone replacement therapy alone was 5% but when the interaction between these variables was considered, together they accounted for about one-third of postmenopausal breast cancers." (Huang Z et al. Dual Effects of Weight and Weight Gain on Breast Cancer Risk. JAMA, 1997;278(17):1407-1411)

Endometrial Cancer

Endometrial cancer-attributable risk estimates of 34-56% due to overweight. (Ballard-Barbash, R Swanson CA, Body Weight: Estimation of Risk for Breast and Endometrial Cancers. Am J Clin Nutr, 1996;63(suppl):4375-41S)

Birth Defects

NTD, spina bifida, non-neural tube defects of the central nervous system, great vessel defects, ventral wall defects and other intestinal defects have all been associated with obesity.  (Waller DK et al, Are Obese Women At Higher Risk for Producing Malformed Offspring? Am J Obstet Gynecol, 1997;170:541-548)

Obstetric and Gynecologic Complications

Excess body fat is related to menstrual abnormality, infertility, miscarriage and difficulties in performing assisted reproduction. High pre-pregnancy weight is associated with an increased risk in pregnancy of hypertension, toxemia, gestational diabetes, urinary infection, macrosomia and cesarean section. (Norman RJ, Clark AM. Obesity and Reproductive Disorders: A Review. Reprod Fertil Dev, 1998;10:55-63)

Infertility

Reduction in weight using exercise and diet has been found to significantly improve outcomes for obese subjects.  In one study of obese infertile women who lost an average of 10.2 kg/m2 in a 6 month exercise and diet program found that the majority resumed spontaneous ovulation and achieved pregnancy. Cost of fertility treatments prior to the weight loss program was $275,000 per baby. Following the program it dropped to $4600 per baby. (Clark AM et al. Weight loss in Obese Infertile Women Results in Improvement in Reproductive Outcome for All Forms of Fertility Treatment. Hum Reprod, 1998;13(6)1502-5)

Cardiovascular Disease

Obesity is a determinant of higher levels of triglycerides, elevated LDL-C, and low HDL-C all risk factors for CVD.  Weight loss has a beneficial effect: Triglycerides decrease, HDL-C increases, and LDL-C decreases. (Krass RM et al, Obesity Impact on Cardiovascular Disease. Circulation, 1998;98:1475-1475)

Heavier weight was positively associated with CVD and its risk factors in middle and old age groups, especially for women. (Harris TB et al, Carrying the Burden of Cardiovascular Risk in Old Age: Associations of Weight and Weight change with prevalent Cardiovascular Disease, Risk Factors and Health Status in the Cardiovascular Study. Am J Clin Nutr. 1997;66:837-844)

Type 2 Diabetes

"Obesity not only increases the risk of developing type 2 diabetes but also complicates its management. The presence of obesity exacerbates metabolic abnormalities of type 2 diabetes including hyperglycemia., hyperinsulinemia, and dyslipidemia. Obesity also increases insulin resistance and glucose intolerance. Obesity may contribute to excessive morbidity in type 2 diabetes.

The risk of developing hypertension and cardiovascular disease is increased with the coexistence of obesity and type 2 diabetes increasing morbidity and mortality. Body weights 20-30% above the ideal have mortality rates 2.5 to 3.3 times higher than for those of normal weight with type 2 diabetes. (Maggio, CA, Pi-Sunyer, FX. The prevention and treatment of Obesity Application to Type 2 Diabetes. Diabetes Care, 1997;20:1744-1766)

Urinary Stress Incontinence

"Obesity is a well documented risk factor for not only stress incontinence, but also urge incontinence and urgency." Obesity was found to be a strong risk factor for several urinary symptoms after pregnancy and delivery or as long as 6-18 months postpartum. (Rasmussen KL et al. Obesity as a Predictor of Postpartum Urinary Symptoms. Acta Obstet Gynecol Scand, 1997;96:359-362)

Measurement and Tracking

There are numerous methods for determining and tracking body fat in the treatment of obesity. BMI is often used to diagnose obesity by approximating body fat levels. A BMI greater than 30 indicates clinical obesity. BMI is not a reliable tool for everyone, for example competitive athletes, bodybuilders, elderly, women who are pregnant or breast feeding, some inactive adults, children and chronically ill patients.  'Gold Standard' clinical methods of measurement include DEXA and Under Water Weighing which are expensive, require significant time and may cause some discomfort during testing. Tanita BIA is a well researched, accurate, easy to use, method of measuring and tracking body fat in women.

*Reprinted from Tanita Corporation of America, Inc.

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