Copyright 2010 by Darden North, MD, All Rights Reserved.
Darden North, MD
Obesity and Women
Many men and women live in fear of getting cancer. The yearly reassurance of negative screening tests for cancer is the main reason some women visit their gynecologist. However, statistics tell us that death related to heart disease is six times more prevalent among women than that from cancer. Unfortunately, the more one weighs over recommended levels, the higher the risk of heart disease, leading obese women to have three times the risk of heart failure than women of normal weight. Add in high blood pressure and a sedentary lifestyle as associated conditions (not to mention the high blood sugar of diabetes) and the poor heart is under tremendous strain.
In addition to cardiovascular disease and diabetes, hormonal levels can be altered if a woman is overweight. Actually, 20 to 25 per cent of her total weight should be fat, helping to maintain normal estrogen levels. Estrogen is the hormone that controls a woman's menstrual cycle and most feminine characteristics including her shape. If the estrogen levels become too high or low, then menstrual cycles can become altered and fertility affected. Overweight women can produce too much estrogen as a result of hormone conversions in the abundant body fat and sometimes experience loss of scalp hair.
Since overweight women may experience irregular menstrual patterns, they may also suffer lower fertility rates. When they do conceive, overweight women have a higher incidence of high blood pressure and diabetes during pregnancy as well as higher rates of cesarean section births. Obese woman (particularly if they develop diabetes during pregnancy) can give birth to overly large babies called macrosomic infants, who may experience abnormal blood sugar levels at birth and have difficulty navigating the birth canal.
Over the last several years the term body mass index (BMI) has been used to determine an individual's healthy weight. A BMI compares one's height to weight with a range of 20 to 24 considered normal and 25 to 29.9 overweight, while obesity is 30 or higher. BMI calculators are easily available free on the Internet (just Google BMI), or your physician may have a pamphlet containing a Body Mass Index chart.
Body shape is another measure of appropriate weight. An “apple” shape resulting from excess abdominal fat carries a higher risk of heart disease more so than the accumulation of fatty tissue in the hips and thighs creating a “pear shape.” If a woman's waist is the same size or greater than the largest measurement around the hips taken over the buttocks, then she may be at a greater risk of both heart disease and diabetes.
What I have learned from many patients (and from my wife and female friends) is that the physician's laboratory scales are a dreaded part of the annual gynecology visit. (In fact, I've taken my own shoes off before being weighed by my internist!) Just as obsessions should be avoided over sex, spending money, clothes, sports, politics, and reading Darden North novels – maybe the novel thing is OK – both women and men should adopt a healthy approach to maintaining normal weight. Working toward that optimal BMI may help to lower and maintain normal cholesterol levels, prevent heart attack or stroke, and reduce the risk of gallstones. (Remember to ask your physician to monitor your cholesterol.) Individuals with a BMI over 24 also place themselves at higher surgical risks. Returning to the issue of concern over the development of cancer – uterine, breast, colon, and rectal cancer are more common in overweight women.
What we should all accept is that everyone cannot achieve an ideal BMI. We must all learn to exercise and reduce our portions at meals (Believe me, I struggle.) Without exercising, two-thirds of dieters can expect to regain the weight lost. Consumers should read food labels for fat and calorie content and discuss healthy diets with their doctor or nurse. Medication to lose weight should be taken only under the strict supervision of a healthcare provider and decisions to undergo surgery for weight reduction should not be made lightly.
No one should ever let weight or BMI values rule her life. Adopting a healthy lifestyle with moderate exercise, while avoiding fad diets, will make life much more enjoyable and beautiful.
----- “Women's Health -Weight Control: Eating Right and Keeping Fit” Educational pamphlet #AP064, published by the American College of Obstetrics and Gynecology
----- Eight combined years of medical school and ob/gyn residency plus 24-plus years of private practice in ob/gyn
Darden North is a board-certified obstetrician-gynecologist practicing at Jackson Healthcare for Women, PA, in Jackson, MS. He is also the author of three nationally-awarded mystery and medical thriller novels. His medical practice website is www.jhcfw.com and is author website is www.dardennorth.com .