The health burden of obesity in women: a call to action for OB-GYN HCPs

Obesity is a chronic, progressive, multifactorial disease with serious health implications. The most recent estimates from the US Centers for Disease Control and Prevention (CDC) indicate that more than 40% of adults have obesity (body mass index [BMI]≥30 kg/m2), while approximately 10% have severe obesity (BMI≥40 kg/m2).1 Obesity-related conditions, including dyslipidemia and type 2 diabetes, are key risk factors for the development of cardiovascular disease (CVD),2 which is the leading cause of death in the United States.3 In addition, obesity is associated with CVD independently of traditional cardiovascular (CV) risk factors,4 while abdominal obesity is an indicator of CVD risk independently of BMI.2,5 Obesity is also associated with multiple other cardiometabolic diseases, in addition to other functional and psychological comorbidities, and thus has a major impact on quality of life.6 Women experience a disproportionately high disease burden related to obesity. National Health and Nutrition Examination Survey (NHANES) data suggest that age-adjusted rates of obesity and severe obesity are higher among women than men, at 40.8% versus 36.5% and 9.8% versus 5.5%, respectively.7 Moreover, evidence indicates that women have a greater risk for developing obesity-related conditions than men.8 One study of 4,181 people found that women with class 1 (BMI 30 to <35 kg/m2) or class 2 (BMI 35 to <40 kg/m2) obesity had significantly impaired physical health functioning as measured by the Physical Component Summary scale of the Medical Outcomes Study Short Form (SF-36 PCS) after adjustment for sociodemographic factors and comorbidities, but among men this association was only seen with class 2 obesity.9 Another study of more than 10,000 people found that women lose more quality-adjusted life years (QALYs) due to obesity than men; QALYs lost with overweight versus BMI 23.0-25.0 kg/m2 were 1.8 million for women and 0.3 million for men, while QALYs lost with obesity were 3.4 million and 1.9 million, respectively.10 The increased disease burden of obesity in women has been attributed to several factors, including emotional and psychological well-being, health-related quality of life, and differences in comorbidity profiles.8 The elevated burden of obesity and its associated mortality risk in women emphasize the need to incorporate an understanding of sex differences into obesity management, including for screening, diagnosis, documentation, and treatment. Furthermore, obesity has a multisystemic impact on female physiology at different stages in life -- including during childbearing years and around the time of menopause -- and is associated with a range of health conditions specific to women.11-13 Consequently, management of obesity in women requires a considered approach that takes age and life stage into account.14 Many women in the United States consider their obstetrician/gynecologist (OB-GYN) to be their primary healthcare professional (HCP), particularly during their childbearing years.15,16 Therefore, OB-GYNs are uniquely positioned to educate women on the health risks associated with obesity and to provide compassionate, evidence-based care. This CME-certified Special Issue Supplement focuses on the impact of obesity on women’s health throughout life and how OB-GYNs can help to manage obesity and optimize women’s health outcomes. In the first article, we explore the relationship between obesity and health conditions affecting women, and the associations between obesity and female physiology at different stages of life. In the second article, we outline the importance of appropriate diagnosis and documentation of obesity in women’s health clinics, and discuss practical approaches to discussing obesity in a respectful way. In the third article, we focus on obesity management, highlighting the available options and providing guidance on treatment selection in different scenarios and at different times in life. Finally, we invite readers to put their knowledge into practice in our series of interactive videos. Each video will feature a different example of a woman living with obesity, and users will sit in the driver’s seat to make choices on the most appropriate approaches to care.