Obesity in Women: Insights for the Clinician

Abstract

As a leading cause of morbidity and mortality in the United States and worldwide, obesity is a disease that is frequently encountered in clinical practice today and requires a range of medical interventions. While obesity affects both men and women across all ages, multiple issues are particularly germane to women's health, particularly as obesity is more prevalent among women than men in the United States and obesity among women of reproductive health relates to the growing issue of childhood obesity. Discussed herein are the epidemiology and pathophysiology of obesity along with the impact of perinatal obesity on fetal programming. Guidance on screening and management of obesity through lifestyle intervention, pharmacologic therapy, and bariatric surgery, as well as avoidance of weight-promoting medications wherever possible, is elaborated. Particular attention is paid to the contribution of these modalities to weight loss as well as their impact on obesity-related comorbidities that affect a woman's overall health, such as type 2 diabetes and hypertension, and her reproductive and gynecologic health. With modest weight loss, women with obesity can achieve notable improvements in chronic medical conditions, fertility, pregnancy outcomes, and symptoms of pelvic floor disorders. Moreover, as children born to women after bariatric surgery-induced weight loss show improved metabolic outcomes, this demonstrates a role for maternal weight loss in reducing risk of development of metabolic disturbances in children. In light of the immense cost burden and mortality from obesity, it is important to emphasize the role of lifestyle intervention, pharmacologic management, and bariatric surgery for weight loss in clinical practice to mitigate the impact of obesity on women's health.

Socioeconomic inequalities in obesity among Korean women aged 19-79 years: the 2016 Korean Study of Women’s Health-Related Issues

“…Furthermore, the prevalence of obesity among Korean women sharply increased after menopause. Despite a similar trend of increases in overweight and obesity for women aged 45-64 years, no additional socioeconomic inequalities were identified [16,34,36].…”

Adipokines: A gear shift in puberty

“…From an evolutionary point of view, body fat increases in mammalian females during puberty onset, and it highlights the need to guarantee a healthy pregnancy, offspring, and maternal survival . An improper level of body fat, sex‐hormones, and neuroendocrine alterations can evolve in menstrual dysfunction, for instance, in women with severe obesity or in women with anorexia nervosa . Importantly, body fat distribution, particularly body fat localized predominantly on the gluteofemoral fat depots, is profoundly associated with start of menarche, more than amount of total body fat .…”

Use of social media, search queries, and demographic data to assess obesity prevalence in the United States

“…However, major disparities such as, differences in the mention of high intensity physical activities (Cesare et al, 2019) agrees with data suggesting that women are less likely to meet physical activity recommendations compared to men (Centers for Disease Control and Prevention, 2018b). Furthermore, women report foods with higher calories and have an overall higher obesity prevalence Flegal et al, 2016;Tauqeer et al, 2018). These observations support the need for separate approaches for estimating male and female obesity prevalence.…”

“…Neither of these studies included sex-specific analysis. Sex-specific analysis is important because obesity prevalence varies by sex in the U.S. with higher prevalence reported for females than males in recent years Flegal et al, 2016;Tauqeer et al, 2018).…”