Obesity and Women's Reproductive Health: What's the Big Deal?

Abstract

In 1997, the World Health Organization (WHO) formally identified obesity as a global epidemic; regrettably, the rate of obesity has continued to increase dramatically since then.1 Today, nearly 50% of US women of reproductive age and 17% of their children ages 2 to 19 years are overweight or obese.2,3 Obesity-related health conditions include heart disease, type 2 diabetes, certain types of cancer, and obstructive sleep apnea, with an estimated annual medical cost that exceeds $200 billion.4 Obesity is classified on the basis of body mass index (BMI), defined as weight in kilograms divided by height in meters squared (kg/m2). Table 1 illustrates WHO classifications for adult BMI.5 It is estimated that only 18% to 30% of physicians engage in weight loss discussions with their patients despite the continued high prevalence of obesity.6 Physicians cite lack of time and training in weight counseling, the need to place a greater priority on other health conditions, and lack of reimbursement or staffing as primary barriers to these discussions. Physicians may also question whether counseling will have a positive effect on patient outcomes, and may further feel that obesity is the responsibility of the patient, and not the physician. As obesity is the most common health care problem in women of reproductive age, implications relative to reproductive health—including preconception and obstetric complications such as gestational diabetes, hypertensive and thromboembolic disorders of pregnancy, and increased rates of cesarean delivery—often go unnoticed or are ignored secondary to lack of specific evidence-based guidelines.2,7 Obstetrician/gynecologists have a unique opportunity to intervene and effect change as the primary provider throughout some of the most notable periods in a woman’s life. Optimal management of obesity requires an integrated long-term approach and should begin before conception and continue through a woman’s postmenopausal years.