How would you fix the obesity epidemic
Obesity - increasingly a problem for women?
When obesity becomes pathological: Obesity is becoming more and more of a global problem. Women are more often affected, although the level of suffering is even higher for them.
Obesity - in technical jargon obesity - is increasing dramatically worldwide. Since the 1980s alone, the number of those affected is said to have doubled. Austria is not excluded from this development either:
- A little less than half of the adult population is at least overweight.
- When it comes to overweight, men and women are roughly equal, but obesity affects noticeably more women.
- In 2014, according to the World Health Organization in Austria, 39% of men and 40% of women were overweight and 11% of men and 15% of women were obese.
- The increase in the number of overweight people mainly affects younger men, while obesity affects older women in particular.
- According to forecasts, 18% of men and more than 21% of women will be obese by 2025, with 6% and 9% of them particularly heavy.
Genes and the environment as important factors
Studies indicate that certain hereditary gene variants associated with a larger waistline are more likely to lead to manifest obesity in women. Other factors are epigenetics and genes that influence our appetite, the control of the organs and the energy balance.
In addition, obesity has a strong social and economic component: If healthy food is not available or affordable, if there are few attractive leisure activities that require exercise, or if unhealthy behavior is encouraged by family or friends, one speaks of an obesign (i.e. obesity-promoting) environment.
Menopause: an inevitable risk factor
Menopausal women are particularly often overweight, among other things due to the simultaneous drop in female sex hormones and the rise in appetite-increasing hormones. The loss of estrogen leads to a more “masculine” fat distribution, which unfortunately means more unhealthy abdominal fat that settles around the organs.
Abdominal obesity eventually develops into a pronounced metabolic syndrome in many of those affected, as increased cholesterol and blood pressure levels, as well as type 2 diabetes, are added gradually. This not only restricts the quality of life, but also increases the risk of cardiovascular diseases such as stroke and heart attack many times over.
Significantly reduced fertility
But an increase can also be observed in young women of childbearing age. If an affected person wants children, obesity can drastically reduce fertility. Almost half of all overweight and obese women have menstrual cycle disorders, sometimes due to too high a proportion of androgens (male sex hormones) and too little SHBG (sex hormone-binding globulin) in the blood. Even with artificial insemination using IVF, the success rate is lower than with people of normal weight.
Male fertility also suffers from being very overweight: Obese men very often have reduced sperm quality and / or sperm mobility.
A common disease that accompanies obesity is dysfunction of the sex glands. In women, this manifests itself as polycystic ovary syndrome (PCOS), in which the follicles in the ovary do not (or at least less often) mature into functional egg cells. Underdevelopment of the gonads and erectile dysfunction are common in men.
Weight loss through a healthier lifestyle or (if necessary) through gastric banding or gastric bypass often helps patients regain a regular cycle or improved fertility.
Pregnancy: complications more common
If obese women do become pregnant, complications are more common:
are about two to three times as common.
Responsible for this are probably insulin resistance caused by being overweight, oxidative stress, functional disorders of the placenta and so-called "lipotoxicity". As a result of the disturbed lipid metabolism, toxic substances are formed in the body.
Obese pregnant women often unintentionally pass on their weight problems to their offspring: macrosomes (i.e. particularly heavy) newborns already have more fat mass at birth and later an increased risk of obesity and metabolic diseases.
Why the number of obesity diseases is increasing
Biological factors (heredity, sex hormones) are only partially responsible for the increased occurrence of obesity. Often the social and cultural environment as well as lifestyle and environmental factors are decisive for the development. Here gender plays a role: obese women are more likely to have a rather low level of education and a lower income than men affected. Chronobiological disorders caused by sleep disorders or night and shift work also seem to have a stronger influence on women and more likely to favor weight gain. "Emotional eating" also plays a greater role in women than in men. Too little exercise and the consumption of high-calorie food and soft drinks affect both sexes, with women eating less red meat, but more often sweets. With the same eating and exercise behavior, women gain weight faster on average - this is due to gender-specific differences in metabolism.
Overall, women suffer from higher levels of suffering
Young obese women are particularly likely to be stigmatized by their surroundings because of their appearance. They are also more likely to experience psychological conditions such as anxiety and depression than obese men. The fact that the level of suffering is higher among women is also reflected in the number of participants in weight loss programs and clinical studies: around 80% are female. The gender statistics show similar figures for so-called bariatric operations, i.e. operations for long-term weight loss. Men often only seek medical help when physical complaints take over. These include:
Prevention work against the obesity epidemic
In order to curb this worrying development, it is not enough to educate adults about the risks. Experts have to start as early as possible and promote health awareness in children and adolescents. The aim must be to arouse joy in exercise and to make a healthy diet palatable to you. Exercise should be encouraged, especially among girls, while boys have more catching up to do in terms of nutrition.
The author: Alexandra Kautzky-Willer (Gender Medicine Unit, Endocrinology and Metabolism, KIM III, Medical University of Vienna, Head of the Institute for Gender Medicine in Gars am Kamp)
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Univ. Prof. Dr. Alexandra Kautzky-Willer
Katrin Derler, BA, Nicole Kolisch
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