Dr Richa Sharma
Obesity is a major public health problem throughout the world and most difficult and frustrating disorders to manage successfully
Incidence-India in the forefront of an obesity epidemic. Statistics point to an increase in overweight or obese citizens by 20% between 1998 and 2005. Presently, one in 6 women and one in 5 men are overweight in India. Initiation and maintenance of reproductive functions are related to an optimal body weight in women. Underweight [body mass index (BMI) <18.5 kg/m2], as well as overweight (BMI ?25 kg/m2) and obesity (BMI ?30 kg/m2) are associated with an increased risk of anovulatory infertility
What is obesity?
Obesity means accumulation of excess fat, which may have many serious long-term consequences on health.Overweight is body weight in excess of ideal weight – includes all components of body composition (muscle, bone, water and fat)
BMI is a measure of your weight relative to your height (wt(Kg)/ht(m)2)
BMI < 27 = Normal weight
BMI 27 – 30 = Overweight
BMI 31 – 39 = Obese
BMI > 39 = Morbidly Obese
Obesity is said to be present when body mass index – BMI > 30.
Increase in incidence of obesity by 2.3 to 3.3 fold in last 15 years in adults and 2.5 fold in last 20 years in children
Causes of obesity – Multifactorial – females have more tendency to gain weight than males,pregnancy, emotions, environmental factors, genes,medications, eating disorders,endocrine factors
Affect on Fertility-
Most of obese women are not infertile .Infertility in obese women is due to ovulatory dysfunction.Fecundity is lower in obese ovulatory women as well.
In case of IVF,Such patients may need higher dosage of medicines to form eggs with increased cycle cancellation rates,low oocyte
Affect on pregnancy-Adverse pregnancy outcomes with increased risk of-
* Pregnancy loss and reduced LBR esp. with BMI >=30
* Pre-eclampsia
* Gestational diabetes mellitus
* Caesarean section rates
* Birth defects-due to undiagnosed diabetes; hyperglycemia; elevated insulin levels .
* “FETAL ORIGIN OF ADULT DISEASE”
Effect of obesity on male reproduction- Decreased count and motility of sperms-risk increases twice in overweight and thrice in obese.
Medical consequences-
Risk of CVS disease increases 4 fold for women with BMI more than 32kg/m2.IncreasedHTN,DM,Hypercholesterolemia,hyperinsulinemia, dyslipidaemia, respiratory dysfunction, Sleep apnoea, reflux esophagitis, osteoarthritis. Increased breast cancer, uterine cancer,ovarian cancer ,colon cancer, renal and esophagial cancer.
Preventive measures- Prevention is better than cure 1st line treatment is lifestyle modification-diet and exercise
Weight loss and Lifestyle modifications is the crux
Weight management can be by-Exercises Regularly
Monitors weight Regularly (Daily even)
Eats low fat and reduced-carbohydrate diet
Monitors fat intake periodically – Food diary
Takes medication on regular basis if required
Behavior Modification
Dietary therapy should be individualized to the persons.
10% reduction in body weight over a period of 4 – 6 months is reasonable
Conclusion–Young women better to reduce weight before pregnancy.With increasing age there is risk of declining fertility.Increasing age should be balanced with benefits of postponing pregnancy to reduce weight.Obesity decreases fecundity in ovulatory women.Increased risk of obstetric and neonatal complications.Adversely affects male fertility ;abnormal semen parameters.Lifestyle modifications in the form of diet and exercise is the lifeline to overcome this health issue
(The author is IVF Consultant Delhi NCR)
Follow our WhatsApp channel
