Insight: How Obesity Compromises Reproductive Health in Women
Obesity results from excessive accumulation of fat that exceeds the body’s skeletal and physical standards for age, sex and height. A BMI of >25 is overweight and >30 is obese. Though excessive calorie intake is important factor for the development of obesity, certain hormones regulated by genes are equally important factor for obesity. Excess calorie intake in relation to physical requirement causes obesity.
More women are obese (21%), compared to men (17%) , having greater health and socioeconomically implications. Excess fat harms women’s health by creating the imbalance in sex steroid hormones especially estrogens and androgern. Women suffer from obesity and co-morbid diseases more in comparison with men. Every age group of women has age specific diseases due to obesity.
Childhood and puberty (15-20yrs): obesity affects the ovarian function with an imbalance in estrogens and androgern, causing polycystic ovarian diseases(PCOS).It manifests with menstrual irregularities and hair growth in male pattern, called hirsutism, obese teens have low self esteem and poor self confidence, affecting their performance in school and studies.
Child bearing age group (21-30yrs): In this age group, obesity causes a major problem of infertility and bad obstetrics history. 15% of infertility problem are linked with obesity. Obesity causes irregular ovulation and poor quality of ovum. Obese women are less likely to respond to infertility drugs and need higher doses and prolonged treatment.
Even after conception an obese women faces increased risk of repeated abortions and a pregnancy complicated with diabetes, hypertension, thrombo-embolic events, respiratory disorders like asthma and sleep apnoea and various infections. Also obesity complicates both the vaginal and caesarean section deliveries by shoulder dystopia, post partum haemorrhage, uterine rupture and increased risk of anaesthesia.
Obesity related adverse outcomes on the foetus include neural tube defects which increases by 7% with every unit increases in BMI. There is a 3 fold increase risk of antepartum still birth in morbidly obese women. Also higher incidence of macrosomia, preterm birth and IUGR in PIH are seen. Not only this, but an obese woman passed on the abnormal metabolic molecules to the foetus leading to obesity in her children with early onset metabolic diseases thus affecting the future generation.
Premenopausal age group (>40yrs): Obesity in this age group leads to a poor quality of life , complicated with diabetes, high blood pressure and cholesterol, breathing problems and sleep apnoea, digestive disorders like acid reflux and gall stones. Increased weight leads to osteoarthritis of weight bearing joints like hip, knee and spine. Breast, uterine and ovarian cancers have higher incidence in obese women.
Obesity not only decreases the life span but leads to a very poor quality of life for affected ladies. Their social life is restricted and health compromised.
With rapid rise in obesity in all age groups, it is set to become a global epidemic. Life style changes are the need of the hour to combat this killer disease. Healthy diet and exercise can help in reversing it. For those who have advanced beyond, bariatric surgery offers the last ray of hope, not only to reduce weight but get rid of associated diseases and have a better reproductive outcome.
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