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Pharmacists should be prepared to offer informed counseling and ongoing support to the increasing numbers of American women who are obese and trying to lose weight.
This Preventable Condition Requires Counseling and Control
In 1996, only 16.7% of women were obese, but obesity’s prevalence increased more than 50% among women in the past decade, surpassing that of men. 1 In fact, from 2007 to 2008, female obesity prevalence climbed to 35.5% compared with 32.2% for men. 2 Female obesity rates are even higher among African American, lesbian, and sexually abused women. 3,4 Socio-cultural factors are also a significant factor when it comes to obesity in women. Educated women with middle or high incomes are less likely to be obese than women with less education and low incomes—a sociocultural relationship absent in obese men.
Multiple factors—genes, inadequate exercise, increased calorie intake, and behavioral lifestyle variables, such as eating out and automobile use—interact to predispose a person to obesity. Genetic factors may account for 50% of an individual’s weight. Despite obesity’s epidemic prevalence, clinicians fail to diagnose and treat 20% of obese patients (Table6). 3
Obesity-Related Medical Conditions
Obesity’s severe health impact makes obesity-related conditions the second leading cause of death. 3 Individuals who are obese at age 40 live 6 to 7 years less than their nonobese counterparts. Mortality is much higher in individuals who are severely obese at age 25. Their life expectancy is 13 years shorter than other individuals’. 7
Obesity also negatively impacts every major organ system. 3 Being overweight or obese increases the risk for numerous morbidities, including hypertension, type 2 diabetes, heart disease, stroke, sleep apnea, arthritis, gallbladder disease, cancer, infertility, and poor reproductive health. 1,8
In women, obesity increases risk for breast, uterine, cervical, and endometrial cancers; C-section; birth defects (especially neural tube defects and spina bifida); urinary stress incontinence; and decreased ovulation and pregnancy rates. 9-12 One study reports that obesity in pregnancy carries an increased risk for infections such as chorioamnionitis (infected membrane surrounding the fetus and amniotic fluid). Additionally, obese pregnant women have fewer CD8 cells, affecting the body’s ability to fight infections. 13
Effective counseling begins by recognizing that many patients appear motivated to lose weight. A total of 57% of women and 36.9% of men reported weight loss attempts in the preceding 12 months. 14 Unfortunately, some patients simply conclude that they can’t lose weight and passively accept their obesity. Patients often have unrealistic expectations and time frames. Pharmacists should inform patients that weight-loss guidelines recommend a goal of 1 to 2 lb a week. 8
Several medications (eg, atypical antipsychotics) promote weight gain. Pharmacists need to screen patients for medication-induced weight gain, and when alternatives exist, they should be recommended.
Use sensitive language, avoiding words like “fat” and even “obese.” A specialist recommends the following: “You seem to be a bit heavy for your height, which can lead to health problems.” Emphasize that losing weight is difficult, but it is possible and even small weight losses can make tremendous differences. For example, if a 200 lb person loses 10 to 15 lb, their risk for diabetes decreases more than 50%. 3
Note that visceral fat is especially alarming, as it carries a greater risk for health issues than evenly distributed weight. Women with waistlines greater than 35 in are at increased risk for obesityrelated comorbidities. Use the examples of body shape when counseling (describing weight in the hips as pear-shaped and
Patients should avoid fad diets, especially those that eliminate entire food groups. They may work in the short term, but the extra pounds return if old eating habits resume. Increasing exercise and decreasing food intake is the most effective strategy.
Additionally, patients must modify their diet, eliminating unhealthy food choices and selecting a more balanced and healthy diet. Refer patients to the US Department of Agriculture Web site (www. mypyaramid.gov) for guidelines on healthy eating.
Many obese patients balk at exercise, partly because their current lifestyle is sedentary and recommended exercise levels are too challenging. Encourage them to work toward that goal, even if it is only 5 minutes a day. Encourage patients to keep an exercise diary so they can track their progress.
No Magic Pill
Patients need to inform their doctor if they are considering weight-loss medication. The FDA had approved 2 medications for long-term treatment of obesity. Sibutramine was withdrawn from the market due to its increased risk for coronary problems, leaving orlistat as the sole FDA-approved agent. Orlistat is generally recommended for those with a body mass index (BMI) of 30 or higher or those with a BMI of 27 or higher and weightrelated health problems or health risks. 8 Medications are most effective if patients follow a healthy eating and physical activity plan.
Inform patients that there is no magic pill for weight loss, and that orlistat’s common side effects include diarrhea, cramping, gas, and leakage of oily stool. A low-fat diet may prevent or minimize these side effects. Orlistat may interfere with vitamin absorption and patients should talk to their doctor about the possible need for vitamin supplements.
Table 2. Recommended Guidelines for Physical Activity
•2 hours and 30 minutes of moderate-intensity aerobic physical activity or
1 hour and 15 minutes of vigorous-intensity aerobic physical activity or
a combination of moderate and vigorous-intensity aerobic physical activity
•Muscle-strengthening activities on 2 or more day
Source: Reference 8
Patients may inquire about surgical options. Note that weight-loss surgeries—also called bariatric surgeries—are effective. Eligible patients generally have a poor success rate for other weight-loss methods and have a BMI of 40 or higher or a BMI of 35 or higher with weightrelated health problems.
Two-thirds of Americans are overweight or obese and if left unchecked, some predict 75% of the population will be obese or overweight by 2015. 3,15 Female obesity is preventable—and health care professionals need to address it with the same aggressive efforts that are used for other preventable female disorders. PT
Guido R. Zanni, PhD Dr. Zanni is a psychologist and health systems consultant based in Alexandria, Virginia.
1. U.S. Department of Health and Human Services, Health Resources and Services Administration. Women’s health USA 2008. http://mchb.hrsa.gov/whusa08/hstat/hi/pages/215oo.html. Accessed May 1, 2011.
2. Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity
among US adults, 1999-2008. JAMA. 2010;303:235-241.
3. Fujioka K, Lebovitz HE. Why don’t we recognize obesity as a treatable disease? www.medscape.org/viewarticle/725826. Accessed April 27, 2011.
4. U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. Women’s health-obesity rates are higher among sexually abused and lesbian women. www.ahrq.gov/research/mar11/0311RA13.htm. Accessed May 1, 2011.
5. Hellmich N. Less education, income linked to obesity in women, not men. USA Today. www.usatoday.com/yourlife/fitness/2010-12-15-obesity14_ST_N.htm. Published December 14, 2010. Accessed May 1, 2011.
6. Centers for Disease Control and Prevention. Body Mass Index. www.cdc.gov/healthyweight/assessing/bmi/. Accessed November 8, 2010.
7. Villareal DT, Apovian CM, Kushner RF, Klein S; American Society for Nutrition;
NAASO, The Obesity Society. Obesity in older adults: technical review and
position statement of the American Society for Nutrition and NAASO, The Obesity Society. Obes Res. 2005;13:1849-1863.
8. U.S. Department of Health and Human Services, Office on Women’s Health. Overweight, obesity, and weight loss. www.womenshealth.gov/faq/overweight-weight-loss.cfm. Accessed April 27, 2011.
9. Huang Z et al. Dual effects of weight and weight gain on breast cancer risk. JAMA. 1997;278:1407-1411.
10. Ballard-Barbash R, Swanson CA. Body weight: estimation of risk for breast and endometrial cancers. Am J Clin Nutr. 1996;63(suppl):437S-441S.
11. Waller DK et al. Are obese women at higher risk for producing malformed offspring? Am J Obstet Gynecol. 1997;170:541-548.
12. Norman RJ, Clark AM. Obesity and reproductive disorders: a review.Reprod Fertil Dev. 1998;10:55-63.
13. Medical News Today. The risks of maternal obesity to future generations. www.medicalnewstoday.com/articles/223840.php. Published May 1, 2011. Accessed May 1, 2011.
14. Centers for Disease Control and Prevention. Quickstats: percentage of adults aged > 20 years who said they tried to lose weight during the preceding 12 months, by age group and sex--National Health and Nutrition Examination Survey, United States, 2005-2006. MMWR. 2008;57:1155.
15. Centers for Disease Control and Overweight. Obesity and overweight. www.cdc.gov/nchs/data/hestat/overweight/overweight_adult.htm. Accessed May 1, 2011.