Weight Control For Women

Description: Excess body weight results in adverse medical, social, economic, and personal outcomes. Women’s healthcare providers are frequently the first point of care to identify, counsel, and assist women in achieving a more appropriate body weight.

Scope of the Problem: Obesity is the most common medical condition in women of reproductive age. Roughly 42% of women are obese or very obese. This proportion rises to almost 52% of non-Hispanic Black women. Women who are obese are at increased risk for multiple medical problems ranging from diabetes to heart disease, high blood pressure to depression, spontaneous pregnancy loss to recurrent abortion and stillbirth. Obese mothers are more likely to have pregnancies affected by neural tube defects (eg, spina bifida), hydrocephaly, and cardiovascular, orofacial, and limb reduction anomalies. Patients who are obese are at greater risk for complications of infection by the COVID-19 virus. Obesity is the second leading cause of preventable death behind tobacco use.

Objectives of Management: To assist women to safely achieve and maintain a healthy weight as a part of lifestyle interventions to optimize health.

Relevant Pathophysiology: Obesity is classified based on body mass index (BMI), defined as weight in kilograms divided by height in meters squared (kg/m ² ). The World Health Organization organizes BMI ranges into six categories to define underweight, normal weight, overweight (BMI 25–29.9, ≥85th percentile), and obesity, classes I (BMI 30–34.9, ≥95th percentile), II (BMI 35–39.9, ≥99th percentile), and III (BMI ≥40). Metabolic syndrome is the coexistence of risk factors for type 2 diabetes and cardiovascular disease, including abdominal obesity, hyperglycemia, dyslipidemia, and hypertension.

Strategies: Ultimately, weight loss is achieved by ingesting fewer calories per day than are consumed by the body. This is best achieved in a measured, controlled manner that maintains nutritional balance, activities suited to the individual, and realistic goals for weight and timeframe (generally weight loss of no more than 2 lb/week). With lifestyle measures alone, a weight loss of 5%–7% of body weight is typical but often difficult to maintain. Motivational interviewing has been used successfully to promote these goals. Behavioral modification strategies include self-monitoring, stimulus control, goal setting, and positive reinforcement. The US Preventive Services Task Force recommends that all adults aged 18 years and older with a BMI of ≥30 be offered intensive multicomponent behavior interventions for weight loss and weight loss maintenance.

Pharmacotherapy: Over-the-counter dietary supplements have not been proven to be effective, have been associated with significant side effects (including cardiovascular), and should not be recommended. Medications used to assist weight loss include anorectics, which alter the release and reuptake of neurotransmitters that suppress appetite, and drugs that decrease intestinal fat absorption by inhibiting pancreatic lipase (tetrahydrolipostatin [Orlistat]). The glucagon-like peptide-1 (GLP-1) receptor agonists liraglutide (Saxenda, Victoza) and semaglutide (Ozempic, Rybelsus) are approved for the treatment of obesity. The combination of phentermine-topiramate should not be used in reproductive-age women.

Surgical Management: Surgical options are generally reserved for patients in obesity class III (BMI ≥40 kg/m ² ) or who have comorbidities. Laparoscopic adjustable gastric banding, intragastric balloon systems, and more extensive procedures such as Roux-en-Y, sleeve gastrectomy, and biliopancreatic diversion may be indicated. These are best managed by a bariatric specialty team.

Patient Education: Reassurance; diet counseling and nutritional education (with referral, if possible)

American College of Obstetricians and Gynecologists Patient Education Pamphlet:

• Healthy Eating, 2020

• Obesity and Pregnancy, 2021

Centers for Disease Control and Prevention:

• Reproductive Health

• Weight Control: Eating Right and Keeping Fit, 2021

• Weight Gain During Pregnancy