Obesity In Women

OBESITY IN WOMEN OF CHILDBEARING AGE: RISKS, PREVENTION, AND TREATMENT
Mary E. Cogswell, RN, DrPH, Geraldine S. Perry, RD, DrPH, Laura A. Schieve, PhD, and William H. Dietz, MD, PhD

This article reviews the health burden of obesity, its treatment and prevention, and potential barriers to care with special emphasis on adult women of childbearing age. From 1988 to 1994, 22% of nonpregnant women18 – 49 years old in the United States were overweight (body mass index [BMI] > 25–29.9), and 22% were obese (BMI > 30). Both conditions increase the risk of chronic disease and mortality, and among women of childbearing age, overweight and obesity also increase the risk of infertility and adverse pregnancy outcomes. The three main strategies for preventing obesity are weight maintenance, weightloss for overweight and obese persons, and physical activity for all. More than 44% of nonpregnant women of childbearing age are trying to lose weight, and more than 33% are trying to maintain weight, but less than 21% of women of childbearing age use the recommended combination of physical activity and caloric restriction to try to lose or maintain weight. Pregnant women should try to gain nomore than the recommended weight gain range for their prepregnancy BMI, yet about one third gain more weight. Although research has shown
From the Division of Nutrition and Physical Activity and the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia

that advice from physicians can havean impact on their patients’ eating habits and physical activity, many health professionals either provide no such advice or give inappropriate advice to women of childbearing age. Barriers may include inadequate reimbursement, time constraints, and lack of professional training. Frequent contact with women of childbearing age provides obstetricians and gynecologists and nurse specialists anopportunity to prevent and treat obesity successfully. (Prim Care Update Ob/Gyns 2001;8: 89 –105. © 2001 Elsevier Science Inc. All rights reserved.)

Twenty-two percent of male and female Americans aged 20 years are overweight (body mass index [BMI] 25.0 –29.9), and an additional 23% are obese (BMI 30).1 Both conditions increase the risk of chronic disease and premature mortality. In addition, amongwomen of childbearing age, overweight and obesity increase the risk of infertility and adverse outcomes of pregnancy. Thus, the fact that in the last few decades, the prevalence of overweight and obesity rose more among women of childbearing age than among older women or men is cause for alarm. Findings such as these have increased interest in research on obesity, its treatment, and itsprevention. Primary care providers can do a
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great deal to prevent morbidity and mortality due to obesity by evaluating all patients and treating overweight and obese patients and by offering appropriate counseling on diet and physical activity to all their patients.2 Studies suggest that people who report receiving advice from their physician about weight loss are more likely to try to lose weightthan are those who do not report such advice.3,4 In addition, those who are counseled to lose weight are more likely to report that they are eating fewer calories and less fat and that they are increasing their physical activity.4 Randomized controlled trials demonstrate that brief (5–10 minutes) physician counseling can increase physical activity.5 Unfortunately, most physicians do not counsel theirpatients about weight loss and physical activity. In 1996, 44% of obese women (BMI 30) in the United States who had had a routine checkup in the last 12 months recalled that their doctor, nurse, or another health professional advised them to lose weight.3 In 1995, 33% of adult women who saw a physician in the previous year for a medical checkup recalled their doctor recommending that they begin...