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    Sign Out: Obesity: a weighty problem

    DR. Phelan
    Obesity has become epidemic in the United States. In the past 20 years, the percentage of overweight adults has grown from 47% to 65% and adult obesity has doubled from 15% to 30%. This epidemic disproportionately affects women. Health-care providers and members of the general public recognize that obesity has major health, social, and economic consequences. Why have obesity/overweight grown so rapidly and what role should the ob/gyn play in addressing this major health issue?

    The rapid emergence of obesity is due to a combination of genetic tendencies and what some refer to as a "toxic environment." If a woman ingests more calories than she expends, her weight will increase. Due to eons of evolution in a marginally subsistence environment, the human body has become very effective in storing excess energy for times of famine. Add that "genetic hard wiring" to the toxic environment of super-sized portions, high-fat/high-sugar foods, and decreased physical activity, and it is no surprise that obesity is becoming more prevalent. It has almost become the norm. I frequently hear residents refer to patients with a BMI of 35 or greater as "fluffy," not as having Type 2 obesity.

    The additional tragedy is that "treatments," although plentiful, are not very successful. At many street corners—literally—there are posters promising "lose 60 lb in 60 days" or "5 lb a week without exercise or diet." There is even soap that will supposedly "wash away fat." At any given time there are numerous popular diets or formalized weight loss programs, such as Atkins, South Beach, TOPS, and Weight Watchers. But one of the problems with the term "diet" is that it implies a temporary change of eating habits and not a behavioral life change. The result: patients "yo-yo" off and on diets with major weight shifts and recurrent feelings of failure. In general, people in the US are not willing to give up basic pleasures; many even justify certain foods as being part of a cultural heritage. The bottom line is that there is NO magic pill. Medications usually result, at best, in a 20- to 25-lb weight loss over a 6- to 12-month period. Unfortunately, this weight typically returns when the medication is stopped. Surgery, although more successful, has significant risks of morbidity and mortality.

    So what should an ob/gyn do, given this trend? The most successful way to treat obesity is to prevent it from occurring. Ob/gyns are in a particularly good position to monitor weight gain over a woman's life, especially during high-risk phases such as pregnancy and perimenopause. If at each annual visit, a woman were apprised of a 3- to 5-lb weight gain, she could make minor changes and likely lose it quickly. Instead, the physician often waits until the patient has gained 20 to 30 lb. Losing that kind of weight is a more daunting task. Excessive weight gain during pregnancy with failure to lose it postpartum is a major contributing factor to obesity. During perimenopause women tend to be less physically active, may have some situational depression/stress that is self-treated with comfort foods, and may dine out more as grown children move away from home. This change in lifestyle places a woman at increased risk to gain 4 to 5 lb, or even more, per year. The addition of only 100 to 200 excessive calories per day (an extra cola drink or glass of wine) can result in a steady but significant weight gain.

    Ob/gyns are on the front line for prevention or early intervention. It is a role that we should take seriously. By helping women learn awareness and control their weight through healthy life choices (not crash diets) we can help them avoid or minimize continued weight gain. In turn, we may have a positive impact on our patients' families. As a woman incorporates her healthy choices in the family's activities and meals, we may see positive changes not only in her health but also in the health of the next generation.

    Sharon T. Phelan, MD
    Dr. Phelan is a Professor in the Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque.


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