Michelle*, a 42-year-old mother of two, has lived with overweight or obesity her entire life. Around third grade, Michelle said she remembers a change in her parents’ attitude toward her eating habits: they went from bribing or forcing her to eat to questioning whether she really needed seconds.
Her mother, although smaller than Michelle, was never happy with her own body, always dieting and complaining about her weight. When Michelle compared her relatively larger body to her mother’s, she found it even more problematic. Michelle went on her first diet and accompanied her mother to Weight Watchers around age 11.
“I started learning not to trust my body because I was always told what to do and what not to do,” Michelle said.
Obesity is a common medical condition.
An estimate 4 out of 10 women in the United States they have obesity. And the obesity rate is even higher. almost 6 out of 10 – among black women.
Historically, obesity has been defined by a body mass index (BMI) of at least 30. However, this simple height-weight relationship is not necessarily the best way to predict health complications of obesity. Hormones, genetics, psychology, and environmental factors can contribute to the health risks related to obesity. Although obesity was once thought to be a willpower problem, it is now understood that obesity is, in fact, a complex disease.
“Women are especially prone to obesity due to hormonal influences, such as puberty, birth control, infertility treatments and menopause,” said Holly F. Lofton, MD, director of the Medical Weight Management Program at the New York University Grossman School of Medicine and member of HealthyWomen’s Women’s Health Advisory Committee.
Lofton noted that obesity is associated with more than 200 conditions. Many of these affect women and people assigned female at birth much more than men and people assigned male at birth. These conditions include:
Obesity has also been linked to fatty liver disease, digestive problems, osteoarthritis, anxiety, and certain types of cancer. Obesity can pose risks to pregnant women, women trying to get pregnant, and babies born to women with obesity.
Changing treatment guidelines for obesity
Treatment guidelines for obesity typically begin with reducing calories and increasing exercise or activity. But obesity treatment must be more comprehensive than that, according to Lofton. AND studies have shown that people who use anti-obesity medications (AOMs) in combination with lifestyle changes, such as nutrition and exercise programs, tend to lose more weight than those who make lifestyle changes alone.
He American Gastroenterological Association strongly recommends medications in addition to lifestyle changes for adults with a BMI of at least 27 who also have weight-related conditions and for people with a BMI of 30 or higher without any other medical conditions.
“We’ve seen a shift in the types of medications prescribed for weight management,” Lofton said. “We are moving from treating obesity with appetite suppressants to combination therapies and hormonal therapies, which aim not only to regulate appetite but also to optimize brain, gut and brain signals. [fatty] fabric too.”
Current clinical guidelines recommend surgery for people with a BMI of 35 or higher who also have other medical conditions or people with a BMI of 40 or higher without other conditions. According to Lofton, these guidelines are being reviewed and may change to include people with lower BMIs.
“Just as in the case of hypertension, or even in cancer treatment, there is no single model for obesity as a disease,” he said. Given how complicated obesity is, Lofton said more research is needed to find even more treatment options.
Michelle’s experience illustrates the importance of new and varied treatments for obesity. She has tried countless diets, which worked, until they didn’t. Despite being active (walking, swimming, and doing water aerobics and strength training), Michelle said she usually regains weight and then some.
Recently, Michelle has not been able to lose weight, no matter how active she is or how few calories she eats. And her weight has started to affect her health. She lives with joint problems, high cholesterol, high blood pressure, acid reflux, prediabetes, and fatty liver disease. Because she has a family history of heart disease, Michelle eventually began taking medication to treat her obesity.
“I’m more on the cusp of all these terrible things that are happening, so I’m trying to get a handle on them now,” he said.
For Michelle, the medication seems to be working. After taking an OMA for the past four months, Michelle estimated that she had lost 25 pounds, or a little more than a pound per week. She said that she hasn’t dieted, but that she just feels less interested in food. Although she has experienced side effects such as nausea and fatigue, she has noticed that her irritable bowel syndrome (IBS) symptoms have disappeared and she feels less pain. Her blood pressure has improved and she is awaiting further liver function tests.
Barriers to access to obesity treatment
Despite evidence that AOMs and surgery work better than lifestyle changes alone, many women struggle to access comprehensive obesity treatment. Even with a diagnosis of obesity, there can be a wide variety of differences in coverage depending on the type of insurance you have. Many insurance companies require women to meet certain criteria before approving necessary treatment. For example, patients often must prove that they have other medical conditions that are a result of their obesity before their insurance company will pay for nutritional counseling. Anti-obesity medications are often not covered because many plans do not yet recognize the fact that obesity is a chronic disease. Because of that lack of recognition, they prohibit coverage of “weight loss” agents instead of recognizing AOMs as necessary medications that have been approved by the FDA to treat the disease of obesity. And most women also need approval from their insurance company before having surgery.
“As we pay more attention to obesity as a chronic disease, we still have a lot of work to do in the United States to increase access to care,” Lofton said.
According to Lofton, not everyone who needs medication or surgery can get it. In fact, people with greater need for obesity treatment may have more problems accessing it.
For women living with obesity, Lofton recommends partnering with your healthcare provider to review treatment options, which she says are constantly improving.
“It’s critical to remember that this is a chronic disease,” Lofton said. “It is present even when weight is considered normal or under control.” For women living with obesity, Lofton recommends partnering with her healthcare provider to review treatment options, which she says are constantly improving.
If you would like to talk to someone about how your weight may be affecting your overall health, you can find a obesity care provider through Obesity Action Coalition Obesity Care Providers research tool.
Help us increase access to obesity treatment >>
*Name has been changed for privacy reasons.
This educational resource was created with the support of Novo Nordisk, a member of HealthyWomen’s Corporate Advisory Board.
From the articles on your site
Related articles on the Web
