Approximately one-third of American adults are obese and 62% of American women are either overweight or obese. More than 15% of the US population face increased health risks because of obesity. These include hypertension, dyslipidemia (high total cholesterol or high levels of triglycerides), type 2 diabetes, coronary heart disease, stroke, gallbladder disease osteoarthritis, sleep apnea and respiratory problems and some types of cancers (endometrial, breast and colon).
Obesity is a state of excess body fat or excess storage of triglycerides in the adipose (fat) cells. Body mass index (BMI) is used to standardize obesity into categories. BMI is calculated as the ratio of weight divided by the height squared in metric units (kg/m2). If you would like to calculate your own BMI, you may use the Centers for Disease Control and Prevention (CDC) web site and determine which category you are in (http://www.cdc.gov/nccdphp/dnpa/bmi/index.htm).
Obesity and Polycystic Ovary Syndrome (PCOS):
Obesity along with other organ systems in the body may impact the reproductive system. Some patients with obesity have insulin resistance as well as high androgen levels (male hormones such as testosterone). In the presence of irregular ovulation (oligo or anovulation) and high androgenenic activity a diagnosis of polycystic ovary syndrome (PCOS) is established. Most patients with PCOS are obese and have insulin resistance at the tissue level and at an increased risk of developing major illnesses during their lifetime. Patients with PCOS have ovulatory dysfunction and most of the time present with irregular periods or no periods at all.
When the body weight increases, insulin levels tend to increase to compensate and result in major metabolic changes. One of these metabolic changes is an increase in the production of androgens (male hormones-testosterone) from the ovaries. Insulin acts on the cells that produce testosterone in the ovaries and increases the production and secretion. Insulin also decreases the protein that carries testosterone in the blood stream, allowing it to be released form its bound protein and exert its actions in its free form (more androgenic activity). Increased androgens within the ovary negatively impact follicle/egg development, affect its quality and eventually may prevent ovulation. Additionally, increased androgenic activity negatively impacts the lining of the uterus, the endometrium. Overall, obesity has a close association with PCOS and the diagnosis should be considered especially in patients with infertility, irregular cycles (irregular ovulation), increase in hair growth or evidence of increased androgens in the blood.
Management of Obesity:
The therapeutic approach to obesity is directed to the immediate issue of weight loss and the ongoing problem of maintenance of the loss. This includes establishment of achievable goals; behavioral modification; diet; an exercise program; drug therapy and surgical approach (bariatric surgery).
Although a patient may not be able to attain ideal body weight on the short run, even 10-15% decrease in weight can produce a clinically significant health benefit. To achieve a loss of 1-2 pounds per week, the patient should adopt a diet that consists of 500-1,000 fewer calories per day and is consistent with nutritional needs. Once the desired weight is achieved, it appears that individuals successful in maintaining this weight continue to consume low-calorie, low-fat diets. It is important to have a balanced diet when trying to lose weight by limiting fatty foods and increasing the amount of vegetables, fruits and other low calorie foods. A consultation with a nutritionist is recommended.
Exercise is often included in weight loss programs and regular exercise is one of the strongest predictors of long-term maintenance of weight loss. Simply changing lifestyle activity such as using stairs or walking more during daily activities can be very effective. It is recommended that a structured exercise program be planned and followed and in some circumstances a personal trainer may be beneficial for compliance. The best time to exercise is before meals or about two hours after meals.
Medical management of obesity involves taking medications to lose weight, but this type of approach needs to be combined with diet, exercise and lifestyle modifications to maximize the benefits. Although there have been a number of drugs in the market for weight loss, most have been abandoned due to their significant side effects or minimal benefit on the long run. Currently, a few drugs are approved for use for a limited period of time and these patients need to be followed by a health care professional to screen for serious side effects and also close monitoring.
Surgical approach (bariatric surgery) has proven to be effective in weight loss but has peri-surgical and long term postoperative risks. The most frequently observed problems are related to the immediate post-surgical period and some in the later months such as anemia, malabsorption, stomach ulcers and the need for additional surgery for aesthetic reasons.
Overall, obese person feels trapped. Obesity leads to characteristic behavioral modifications, including passive personality, frequent periods of depression, decreased self-respect, and a sense of being hopelessly overwhelmed by problems.
Dr. Bayrak encourages patients to lose weight, increase their activity to minimize the risk of developing major diseases and complications. It can be difficult to lose weight but the benefits are worth the effort. We recommend dietary and lifestyle changes, an exercise program, nutrition consultation and in certain selected cases medical and surgical therapy. Support from family, friends, support groups as well as health care professionals will optimize outcome. This issue is a life-long task but is well worth the effort.