Obesity negatively impacts the health of women in many ways. Being overweight or obese increases the relative risk of diabetes and coronary artery disease in women. Women who are obese have a higher risk of low back pain and knee osteoarthritis. Obesity negatively affects both contraception and fertility as well. Maternal obesity is linked with higher rates of cesarean section as well as higher rates of highrisk obstetrical conditions such as diabetes and hypertension. Pregnancy outcomes are negatively affected by maternal obesity (increased risk of neonatal mortality and malformations). Maternal obesity is associated with a decreased intention to breastfeed, decreased initiation of breastfeeding, and decreased duration of breastfeeding. There seems to be an association between obesity and depression in women, though cultural factors may influence this association. Obese women are at higher risk for multiple cancers, including endometrial cancer, cervical cancer, breast cancer, and perhaps ovarian cancer. The prevalence of obesity is rising. The World Health Organization estimates that more than 1 billion people are overweight, with 300 million meeting the criteria for obesity. 1 Twenty-six percent of nonpregnant women ages 20 to 39 are overweight and 29% are obese. 2 This article will review the wide-ranging effects that obesity has on both reproductive health and chronic medical conditions in women.A PubMed search was performed using the key words "obesity," "overweight," "body mass index" (BMI), "gender," "women's health," and the condition reviewed. The most recent evidence-based articles were included in the review. The evidence level of each article was determined by the authors based on the type of study, randomization, the number of participants, and loss to follow-up. Table 1 provides a classification for overweight and obesity based on BMI. 3 Waist circumference can also be used to classify overweight and obesity. In women, a waist circumference of Ͼ35 inches (88 cm) is high risk, whereas in men the level is Ͼ40 inches (102 cm). Research varies in the measurements of obesity used to classify participants in each study. Obesity and Type 2 Diabetes MellitusThe risk of diabetes mellitus (DM) increases with the degree and duration of being overweight or obese and with a more central or visceral distribution of body fat. Increased visceral fat enhances the degree of insulin resistance associated with obesity. 4 In turn, insulin resistance and increased visceral fat are the hallmarks of metabolic syndrome, an assembly of risk factors for developing diabetes and cardiovascular disease. 4 -6 The Nurses' Health Study followed 84,000 female nurses for 16 years and found that being overweight or obese was the single most important predictor of DM. 7 An increased risk of DM was seen in women with BMI values Ͼ24 and a waistto-hip ratio Ͼ0.76. 8 After adjusting for age, family history of diabetes, smoking, exercise, and several This article was externally peer reviewed.

Background and Physiology

Obesity is increasing in the United

Women with physical and cognitive disabilities are at high risk for osteoporosis and osteoporosis-related fractures. Women with physical disabilities frequently are nonambulatory and have bone loss due to immobility. Women with cognitive disabilities have high rates of osteopenia and osteoporosis, likely partially due to high rates of anticonvulsant medication use. Women with Down syndrome are at especially high risk of osteopenia and osteoporosis, possibly because of lower peak bone density levels. Prevention of osteoporosis and related fractures in this population includes population-based measures, such as calcium and vitamin D supplementation and risk-based screening procedures. Primary care providers and specialists need to prioritize osteoporosis prevention strategies when taking care of women with disabilities. Future research is needed to determine optimal screening and prevention strategies in this very high risk population.

Hypermobility spectrum disorders (HSDs) encompass an array of connective tissue disorders characterized by joint instability and chronic pain. Fatigue and other systemic symptoms that affect daily functioning may occur, as well. Accurate data on incidence and prevalence of HSDs is hampered by lack of awareness of these conditions and the wide heterogeneity of their clinical presentation. Identifying which type of HSD is present is important in guiding appropriate care. In particular, making the diagnosis of hypermobile Ehlers-Danlos syndrome (hEDS) is important, as individuals with hEDS may be at risk for more significant multisystem involvement. Diagnostic criteria for hEDS include measures of joint hypermobility, skin and other connective tissue findings, and lack of evidence of a different type of Ehlers-Danlos syndrome. Beyond accurate diagnosis, HSDs pose many challenges for primary care providers, as ongoing patient education, patient empowerment, and coordination of a multidisciplinary treatment team are integral to proper care. This article describes the incidence and prevalence, pathophysiology, diagnosis, and management of HSDs, including clinical cases exemplifying how joint hypermobility might present within a primary care setting.