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Obesity in Women; A Life Cycle of Risk

April 2009

Newsletter from Dr David Ashton

Medical Director, Healthier Weight


Hello!
 

In today’s environment, more women than ever before are becoming obese, many of them seriously so. This is important for many reasons, not the least of which that women seem to be at a greater risk of developing many of the health complications associated with obesity.  In a recent comprehensive review of this subject, the risks at each stage of a woman’s life – during adolescence, pregnancy, middle- and old-age were discussed. This is a brief summary of the key points from that study.


Adolescence and young adulthood

In young women obesity can have a major impact on psychological health and social functioning, manifesting itself as low self-esteem, depression and social isolation. Moreover, compared with men, women suffer more from the stigmatization imposed by obesity.  At a socio-economic level, compared with normal weight women, obese women with higher education or in upper white-collar positions have significantly lower incomes. Excess body weight is not associated with similar income disadvantage in men. 

As women enter childbearing years, obesity has a negative impact on reproductive health.  Obesity is associated with increased rates of infertility and risk for polycystic ovary syndrome (PCOS). Not only do obese women have lower fertility rates, they have poorer prognosis with assisted reproduction. In fact in one study2, pregnancy rates in women with a BMI >35 kg/m2 were only half that in women with a BMI of 20-24.9 kg/m2.

 

Obesity in pregnancy

Obesity imposes a number of serious risks during pregnancy. In early pregnancy there is a higher risk of miscarriage. As the pregnancy progresses obese women have higher rates of hypertension (high blood pressure) and pre-eclampsia, higher rates of diabetes and a greater risk of venous thromboembolism (blood clots). For example, gestational diabetes (diabetes which starts during pregnancy) occurs in around 4% of all pregnancies, but in overweight women, the prevalence increases significantly to around 17%. 

During labour obese women are more likely to need caesarean section and are at greater risk of vaginal tears. They are also more prone to infection and bleeding following delivery. 

Not only the mother, but also the developing child is at risk. Children born to obese mothers have higher rates of congenital abnormalities, foetal distress and birth injury. 

It is also becoming clear that a woman’s nutritional status during pregnancy can have an impact on her children in later life. For example, children of obese women with diabetes were examined over a 16-year period and compared with the children of non-obese, non-diabetic women. In the children of non-obese, non-diabetic women the rate of diabetes was 2%, but among the children of obese, diabetic women it was almost 20%. In other words, children of obese women had about 10 times the risk of diabetes in adolescence. 

Children whose mothers had diabetes during pregnancy are also more likely to be obese themselves. In fact they are around 3.5 times more likely to be obese than the children of women who were non-diabetic during pregnancy.

Mature and ageing women

As women get older, one sees the emergence of obesity-related chronic diseases such as type-2 diabetes, hypertension (raised blood pressure) and cardiovascular disease. In the case of diabetes the good news is that even modest weight loss can have a dramatic impact in preventing the development of type 2 diabetes in the overweight individual. In the Diabetes Prevention Programme3 weight loss of just 5-7% of baseline weight (probably just 10-20 lbs) reduced the risk of developing diabetes by almost 60%!

There is also an increased risk for several of the major cancers, especially breast, cervix and ovary4.

 

Obesity and the older woman

Of concern in the elderly is that obesity imposes an increased risk of impaired mental function, including Alzheimer’s disease. Interestingly this association does not appear to be present in men.

Finally, it is also clear that obesity reduces life-expectancy. A report from the Framingham Heart Study showed that a 40-year old obese woman can expect to lose 7 years of life when compared with a normal weight woman at the same age. If the same woman smokes cigarettes she can expect to lose 13 years of life5.

Table 1: Overweight and obesity can have an adverse impact on health at each stage of a woman’s life cycle.  These are summarized here:

 

Stage of Life

Effects of Obesity

Adolescence and young adulthood

  • Psychosocial – low self-esteem, social stigmatization, depression and social isolation

  • Lower incomes compared with normal-weight women Increased risk of infertility

  • Increased risk for Polycystic Ovarian Syndrome (PCOS)

Obesity in pregnancy

  • Higher risk of miscarriage

  • Greater risk of hypertension (high-blood pressure) and pre-eclampisa

  • Greater risk of thromboembolism (blood clots)

  • Have 4 times the risk of gestational (pregnancy-induced) diabetes

  • Obese women are more likely to require caesarean section and are at greater risk of vaginal tears, infection and bleeding.

  • Children of obese diabetic mothers are more likely to be obese and diabetic themselves

Mature and ageing women

  • As obese women enter middle-age they are at a much greater risk of chronic disease, including hypertension, diabetes and heart problems.

  • There is also an increased risk for various cancers, especially breast, cervix and ovary

Obesity and the older woman

  • Increase risk of impaired mental function, including Alzheimer’s

  • Obese women will also lose average – 7 years of life compared with non-obese women. 

 

 

References 

1.     Ryan D.  Obesity in women: a life cycle of medical risk.  Int J of Obesity 2007; 31: S3-S

2.     Wang JX, Davies M, Norman RJ.  Body mass and probability of pregnancy during assisted reproduction treatment: retrospective study.  BMJ 2000; 321: 1320-1321

3.     Diabetes Prevention Program Research Group.  Reduction in the incidence of type 2 diabetes with lifestyle interventionN Engl J Med 2002; 346: 393-403

4.     Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ.  Overweight, obesity, and mortality from cancer in a prospectively studies cohort of US adults.  N Engl J Med 2003; 348: 1625-1638

5.     Peeters A, Barendregt JJ, Willekens F, et al.  The Netherlands Epidemiology and Demography and Compression of Morbidity Research Group.  Obesity in adulthood and its consequences for life-expectancy: a life –table analysis.  Ann Intern Med 2003; 138: 24-32

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