Special Topic on Obesity in Women: Comorbidities, Pregnancy, and Body Management
What are the common complications of obesity in women?
American researchers believe that a woman's body shape can determine her risk of developing endometrial cancer. Apple-shaped women have most of their fat located in their upper body, with thinner lower limbs and hips; those with larger hips and thighs are classified as pear-shaped. Apple-shaped women have an increased risk of endometrial cancer. If overweight or postmenopausal women supplement with estrogen without progesterone, their risk of endometrial cancer is further increased, mainly due to higher levels of free estrogen in apple-shaped women, thus increasing the risk of cancer. If apple-shaped women follow a weight loss plan to transform into a pear-shaped woman, their risk of cancer is halved. You can determine your body type using a measuring tape and simple calculations. The formula is: waist circumference/hip circumference ratio less than 0.74 indicates a pear-shaped body, and greater than 0.74 indicates an apple-shaped body. For example, a woman with a waist circumference of 61 cm and hip circumference of 91.5 cm has a ratio of 61/91.5 = 0.66, which is a standard pear-shaped body. Another woman with a waist circumference of 76.2 cm and hip circumference of 91.5 cm has a ratio of 76.2/91.5 = 0.83, which is a standard apple-shaped body. Isn't it easy to calculate?
Because obesity affects the endocrine system and metabolism, it is detrimental to growth and development. Obesity also weakens the immune system, making obese women more susceptible to gynecological diseases, such as ovarian insufficiency, uterine hypoplasia, endometrial cancer, infertility, vulvar and vaginal eczema, and sexual dysfunction. Ovarian insufficiency (uterine hypoplasia, dysfunctional uterine bleeding) has the highest incidence (approximately 20%), followed by uterine cancer (approximately 14%). Besides gynecological diseases, the clinically known "3F" syndrome (female, obese, middle-aged) – referring to cholecystitis and gallstones – is strongly associated with female obesity, as is the higher incidence of diabetes. Some believe that women who are particularly obese above the waist have a higher risk of breast cancer than other women. The Murphy Cancer Center at the University of South Florida found that women with a waist circumference significantly smaller than their hip circumference were more than six times more likely to develop breast cancer than other women. Dr. Norgette of Columbia University conducted a study on the relationship between colon cancer and obesity in 800 women (aged 25-84). He found 300 cases of precancerous adenomatous polyps. Further calculation of their obesity index revealed that obese women had twice the rate of precancerous lesions compared to women of normal weight. As the obesity index increased, the incidence of adenomatous polyps also increased.
Why is it necessary to measure the thickness of abdominal fat in obese women?
We know that obesity in women is mainly manifested in fat deposition in the trunk, while the limbs have less fat, exhibiting the characteristics of "abdominal obesity." Therefore, measuring abdominal fat thickness largely reflects the degree of obesity. Moreover, the adipose tissue in this area is much looser than in areas such as the chest, back, and buttocks, making measurement easier. On the other hand, women tend to lose weight more easily in the limbs than in the trunk. Therefore, to understand the effectiveness of weight loss, measuring abdominal fat thickness is a more accurate reflection of the treatment's effectiveness. While direct measurement of abdominal subcutaneous fat or measurement using a skinfold thickness meter is possible, ultrasound tomography can now be used for even more accurate fat measurement.
Researchers found that comparing subcutaneous fat thickness measured by ultrasound computed tomography (CT) with actual subcutaneous fat measurements after surgical incision of the abdominal wall, and exploring the relationship between the measured values, Broca's index, and age, revealed a correlation between ultrasound computed tomography and actual measurements. Specifically, the correlation coefficient (r) between Broca's index and abdominal subcutaneous fat thickness was found to be 0.7 in individuals under 45 years of age and 0.4 in individuals over 45 years of age. This indicates that Broca's index is associated with abdominal subcutaneous fat thickness in younger individuals under 45, while those over 45 years of age show subcutaneous fat deposits in areas other than the lower abdomen. Further research revealed that, regardless of whether the group was under 45 or over 45, the thickness of subcutaneous fat in the lower abdomen, navel, thighs, and subscapular region increased with increasing Broca's index.
**What are the types of obesity in women?**
Women generally have more subcutaneous fat tissue than men, especially in the breasts, abdomen, buttocks, and thighs. This abundant fat tissue in these areas contributes to the unique beauty of the female figure. The development of subcutaneous fat in women makes them more prone to obesity, which is related to genetic factors.
There are several different ways to classify obesity. Generally, obesity in women can be classified into the following types:
Band-like obesity – fat accumulation areas are mainly distributed on the back, lower abdomen, hips, buttocks and thighs, similar to the body shape of people with obesity-related infertility syndrome.
Greater trochanteric obesity – Fat is mainly distributed in the greater and lesser trochanters of the femur, breasts, abdomen, mons pubis, and other areas. Postmenopausal obesity often falls into this category.
Lower limb obesity – fat storage areas extend from the hips down to the ankles, sometimes limited to the legs and ankles, such as progressive lipodystrophy, resulting in extreme obesity in the lower body and extreme thinness in the upper body.
Upper limb obesity – fat is mainly distributed in the back, arms, breasts, neck, face and other areas. Obesity caused by adrenal cortical hyperplasia, tumors and pituitary basophilic tumors (Cushing's disease) belongs to this type.
Obesity in the buttocks-fat mainly accumulates in the buttocks, resulting in particularly large buttocks. This is a characteristic of certain ethnic groups and is considered a genetic condition. In some cases, it is accompanied by breast fat accumulation, resulting in macromastia (giant breasts).
**What should obese women pay attention to during pregnancy?**
Obesity has many adverse effects on pregnant women. Among these, the most important and direct effects include:
①Obesity can induce pregnancy-induced hypertension, as well as abnormal fetal position or post-term pregnancy.
②Obesity can easily lead to miscarriage, dystocia, and stillbirth.
③ Due to the large amount of fat accumulation in the abdomen, prenatal examinations are difficult, and the fetal position is difficult to fix, leading to difficult delivery; if a cesarean section is required, the procedure is also inconvenient.
Given this situation, obese women should pay attention to weight loss treatment before pregnancy, but should not continue weight loss treatment after becoming pregnant. Obese pregnant women need more monitoring, including regular prenatal checkups and self-monitoring of fetal movement changes. This involves placing your hand on the pregnant woman's abdomen to directly feel fetal movements once a day for one hour each time. If fetal movement is less than 4 hours for two consecutive days, it may indicate fetal distress, chronic fetal hypoxia, or placental insufficiency, requiring immediate medical attention. Some women who are not overweight during pregnancy become obese after becoming pregnant, indicating nutritional imbalance, excessive calorie intake, and insufficient protein intake. This causes a decrease in intravascular plasma osmotic pressure, leading to extracellular fluid retention and resulting in overweight. In this case, simply adjusting the pregnant woman's daily nutritional composition-neither excessively emphasizing dieting nor overeating-ensuring that animal protein accounts for 2/3 of the total diet, and reducing staple food intake, will not significantly affect the fetus even if weight gain is 1 kg. Women who have always been obese should prepare for a cesarean section during delivery to better cooperate with the doctor if a cesarean section is necessary. In addition, it is important to pay more attention to diet after childbirth to avoid gaining weight again.
What precautions should obese women take during surgery?
When obese women undergo general surgical procedures, they should take the opportunity to lose weight while actively cooperating with their doctors. In addition to the general surgical requirements, it's crucial to prevent infection, as excessive fat at the surgical site hinders wound healing. Furthermore, when weight loss surgery is necessary due to extreme obesity, the surgical protocol must be strictly followed. Those who do not meet the surgical indications should not undergo surgery, and even those who do should be carefully considered, as any surgery carries the risk of adverse reactions. Some weight loss surgeries are not entirely effective, and some patients may experience venous thrombosis and other complications; therefore, caution is essential.
Weight loss surgery should generally not be performed during a woman's menstrual period, pregnancy, or postpartum period; the choice of surgical method should also be carefully considered. Furthermore, frequent multiple surgeries should be avoided simply because a previous surgery yielded ideal results, as this is detrimental to the body's recovery.
For obese women, surgery may be necessary for various surgical conditions or simply because of obesity itself. Regardless of the reason for surgery, it is essential to consider the unique physiological characteristics of women and take appropriate precautions during the procedure.
**★How should obese women choose weight loss medication?**
For mild obesity, medication is generally not necessary; only for stubborn obesity should medication be considered.
Weight loss medications mainly include: appetite suppressants; energy expenditure enhancers; drugs that inhibit digestion and absorption; drugs that affect lipid metabolism; and other medications.
If your obesity is related to hyperapplying, you can use appetite suppressants for weight loss instead of directly using appetite suppressants. When obesity is extremely severe, you can take appetite suppressants in appropriate amounts under the guidance of a doctor, but never overdose.
If your obesity is related to rapid absorption, you can use foods that delay digestion, and then, under the guidance of a doctor, temporarily use a small amount of medication to inhibit digestion and absorption. Long-term use can lead to anorexia.
If your obesity is related to insufficient exercise, you can first try exercise therapy, and then consider using energy-boosting agents.
If your obesity is related to an underlying medical condition, the primary task is to treat the condition before considering medication.
**Can obese women take weight-loss medications during menstruation?**
Menstruation is a physiological phenomenon unique to women. Whether menstruation is normal or not is a "barometer" of women's health. Observing changes in menstruation can reveal the impact of obesity on endocrine function.
Generally speaking, mild obesity can significantly affect menstruation, while moderate to severe obesity can have some impact. Some medical conditions, such as obesity-related infertility syndrome, can also cause menstrual irregularities, and adjusting menstruation can be used to achieve weight loss.
Weight loss drugs should be taken outside of menstruation. If menstrual irregularities occur due to taking weight loss drugs, the drugs should be discontinued.
What are the physiological characteristics of changes in a woman's body shape?
A woman's body shape changes with age. Generally, the changes in body shape due to aging are that the limbs become thinner and the torso thicker, resulting in a robotic-like physique. This change is more pronounced in obese women than in non-obese women, and the weight loss caused by treated obesity, which is essentially a reduction in limb fat, makes the age-related changes even more significant in normal individuals.
The changes in a woman's body shape mainly occur after puberty. Before that, there is actually little difference in body shape between men and women, meaning that there is no obvious gender difference.
For women, subcutaneous fat deposition is a significant factor in shaping their unique body shape. Generally, from puberty to sexual maturity, a woman's body shape gradually takes shape. Afterward, on the one hand, adipose tissue undergoes vigorous metabolism; on the other hand, the distribution of fat throughout the body changes. With age, subcutaneous fat increases in the trunk, especially the central area, and decreases in the limbs, which is particularly noticeable in obese women. While fat is distributed throughout the body in young women, after menopause, obese women show significant fat deposition in the trunk.
**★How should obese women choose weight loss foods?**
There are numerous and varied weight-loss foods on the market. However, the vast majority of them are made from foods or seafood that delay digestion. Some manufacturers even add weight-loss drugs to their products to achieve weight loss, which can cause side effects for consumers. Instead of achieving their weight loss goals, these products can harm their health.
How to choose weight loss foods? We suggest that obese individuals consider the following aspects:
① First, look for the official logo of weight loss food with a batch number, rather than so-called weight loss food produced by some manufacturers without authorization.
② You can consult relevant professionals by using the promotional materials of weight loss foods.
③ You can investigate the manufacturer by phone or letter to confirm that the production is correct before taking the product.
④ Consider whether to choose weight loss products based on other people's personal experiences.
⑤ You can start by taking small amounts of approved weight loss products. If they are effective, you can continue to take them. If adverse reactions occur, you should stop immediately.
**Is a vegetarian diet good for women?**
Some people say, "Monks are generally not obese because they do not eat meat." Therefore, they advocate vegetarian food, but this is actually a prejudice.
We already know that some obesity is clearly related to genetics; even if someone becomes a monk, they may still become obese in middle age. The Song Dynasty poet Lu You described a fat monk in his quatrain "Huacheng Temple": "A fat monk with a large belly, panting as he goes to greet the monks. He walks quickly but cannot speak, and his sweat is not yet dry." Of course, some monks may also eat meat.
Advocating vegetarianism does not mean ignoring nutritious foods. Rather, it means that people with high blood lipids should regularly consume vegetarian foods, as this can help lower blood lipids and thus achieve weight loss.