This is a very simple and informative presentation about obesity in obstetrics and gynecology including the cause, classification, the effects of obesity on women from gynecologic and then obstetric point of view and then how we can manage these patients.

1. Obesity in
OBGYN
April 4th, 2023
Halder Jamal

2. • Burden of obesity globally
• Classification of obesity
• Effect of obesity on non-pregnant women
• Effects of obesity on pregnancy
• How to treat obesity
Objectives
By the end of this session, you need to be aware of the:

3. • More than 2 Billion adults are overweight and over 1 Billion
of global population are obese!!
• Half of humankind is expected to be overweight by 2030.
• More people suffer from obesity and die of it’s consequences
than underweight.
The Pandemic of Obesity
All the alarming bells should ring!

4. Our Narrow Slice

5. Overweight & Obesity
Defined as abnormal or excess fat accumulation
that poses a risk to the health.

6. 17 years, BMI: 33,
raised waist:hip ratio.
Central distribution
of body fat (android
pattern) is seen.
This pattern of
obesity predicts
insulin resistance

7. Globally, there has been:
• An increased intake of energy-dense foods that are high in fat
and sugars.
• An increase in physical inactivity due to the increasingly
sedentary nature of many forms of work, changing modes of
transportation, and increasing urbanization.
Etiology
The fundamental cause is an energy imbalance
between calories consumed and calories expended.

8. • Leptin from adipose tissue signals the brain to initiate the
sequence of pubertal changes (activation of HPO axis)
• Accelerated aromatization of adrenal and ovarian androgens
in adipose tissue increases the bioavailability of estrogens.
• Average age of puberty was 17 before 200 years, but now is 13.
Puberty
Body weight is the most important factor in timing of
puberty with critical weight being 47 Kg for menarche.
Thus obesity is an important risk factor of precocious
puberty:

9. • Obese women are at increased risk of ovulatory disorders (e.g
PCOS) and need longer time to conceive.
• Even in the absence of PCOS, obesity has been associated
with long and irregular cycles.
• Insulin resistance leads to increased androgens which are
aromatized to estrogens by fat → neuro-regulation of HPO
axis deteriorates → ovulatory disorder → subfertility.
• Induction of ovulation becomes more difficult with obesity
and the risk of miscarriages increases in both spontaneous
and induced ovulations.
Fertility
Subfertility & Miscarriages

10. Polyps & Fibroids
• The rising estrogen levels correlates with and
increased risk of estrogen dependent lesions
including endometrial polyps & fibroids (with
larger size & numbers).
• It is also an important factor in malignant
transformation of polyps to endometrial cancer,
and of breast cancer too.

11. • Increases the risk of female pelvic organ prolapse.
• Associated with stress incontinence of which the severity is
related to the duration of obesity.
Prolapse & Incontinence
The rising Intra-abdominal pressure puts considerable
weight on the pelvic organs:

12. • Mother: GDM, GHTN, chronic HTN, pre-eclampsia & difficult
US assessment.
• Fetus: miscarriages, IUFD, stillbirth, IUGR, anomalies (NTD),
post-maturity & macrosomia.
• Labour: uterine atony, prolonged labor, shoulder dystocia,
instrumental delivery, C/S (with difficult anesthesia & surgery).
• Puerperium: PPH, UTI, DVT, poor wound healing, lactation
failure.
Obstetrics
Pregnant women who are obese are considered high risk
because it complicates pregnancy in all the known ways:

13. • ↓ visceral adipose tissue → ↑ insulin sensitivity &

improvement
in lipid profile
• ↑ SHBG levels → ↓ free androgens
• ↓ ovarian volume → resumption of spontaneous ovulation
→ ↑ chance of spontaneous conception
• Regularization of menstrual cycles
• ↓ in urinary incontinence symptoms
• ↓ risk of comorbidities including obstetrics complications
Management
Obesity is a preventable & treatable disease.
Losing weight is associated with:

14. • Lifestyle: Combination of diet & exercise is superior to
either of them alone and should be advised for all patients.
• Medical: Orlistat, sibutramine…:
‣ BMI > 30
‣ BMI > 28 + comorbidities.
• Surgical: Bariatric surgeries:
‣ BMI > 40
‣ BMI > 35 + comorbidities.
‣ Failure of other measures
Management
Three lines of treatment for obesity:

15. WHO

16. Lose weight, pleaseeee
Thank you