Q&A Topic: Obesity and Women’s Health
Mitchell S. Roslin, MD, FACS, FASMBS
Q. Are more American women obese today?
A. Obesity is having a BMI – a measure of your height and weight together – greater than 30. Today, 40 percent of women in the U.S. are obese and the rate is climbing.
Q. Why are women prone to obesity?
A. Obesity is actually not about calories in, calories out. It’s now recognized as an energy storage disease that’s hormonally based. When people eat simple carbohydrates, like pretzels or bread, that quickly break down to sugar, there’s a rapid rise in insulin, our body’s storage hormone, which works to keep our blood sugar level normal. When we consistently eat these foods, insulin resistance often develops: the body now produces excess insulin to keep sugar at a certain level. That’s a serious problem because insulin prevents fat breakdown, thereby promoting fat storage.
Another key factor in obesity is the brain hormone called leptin, which sends the message that our body has enough fat, and that we should eat less. High insulin makes this fat “thermostat” less efficient – it’s as if it’s broken. These mechanisms aren’t unique to women. But there’s a huge, complex interaction between women’s hormonally based reproductive cycles and insulin system, so subtle hormonal changes have a greater effect on women. This can pave the way for insulin resistance, leptin ineffectiveness, and excessive fat storage.
Q. Are obese women particularly at risk for certain diseases?
A. Yes. And many of these problems revolve around excessive production of insulin. Obese women have more difficulty conceiving due to problems ovulating, and are more likely to have abnormalities during pregnancy, such as high blood pressure. Obesity is the number one cause of female infertility in the U.S. It also increases the risk of irregular or painful periods, high-birth-weight babies, gestational diabetes, and miscarriages. Obese women have a greater risk of breast cancer, especially post-menopausal breast cancer. Those with cancer have a higher rate of mortality and reccurrence. Treatments may not be as effective, as drugs are typically tested on non-obese people. Obese women have higher levels of glucose and insulin, a perfect environment for the growth of cancer cells.
Q. What are the best remedies for obesity?
A. Weight-loss surgery can work because it resets the hormonal thermostat. However, the thermostat broke because a person ate the wrong foods. So there’s no substitute for eating the right foods – more protein and vegetables; in general, foods lower on the glycemic scale. There are also FDA-approved medications that help some people lose weight.
We now know that treatment for obesity should consist of many therapies. Beside surgery, I use medications, behavioral therapy, and special exercise machines that make it possible for anyone to run. Exercise greatly improves insulin resistance.
Most conditions I see are reversible with a change of eating style and weight loss. But without changing what you’re eating, nothing will work. That’s where obesity treatment is moving, and it’s also the role of weight-loss surgery: making it easier to change your eating.
Learn More about Dr. Roslin
Director, Bariatric Surgery
Northern Westchester Hospital
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