Overweight is not about beauty!

The reason behind my writing this article was the annual forum “Mother and Child” that had taken place in Moscow recently. Usually, this conference extensively covers the issues of Obstetrics, Gynecology and Reproduction. This time, however, as I perceived it, the issues of overweight and obesity were looked into more thoroughly than usual, at different sessions and classes at that. It means that the problem of excessive weight runs through the domains of all specialists including gynecologists – doctors preparing women for pregnancy; fertility specialists - doctors bringing about this very pregnancy; obstetricians - doctors meeting a new life; and, most disagreeably, pediatricians – magicians trying their best to relieve a child of a burden of the mother’s unhealthiness.

So what is it exactly – an overweight woman dreaming of becoming a mother?

First of all, when can we say that a problem exists?

There is a globally accepted index – the body mass index (BMI) calculated as a ratio of weight (kg) to height (m) squared. If you google “BMI”, you will immediately get a result with a formula where you will only have to key in your data.

The results are assessed in the following way:

Or, to put it simpler:

We are interested in a group that stays within the range of 18.5 - 24.9. It is good enough if you find yourself within this range. It is, however, no reason to let your guard down. The BMI is a good index but somewhat crude. It is much more interesting to utilize another health marker – waist circumference (WC) or abdominal circumference (AC), whichever applies. It is thought that if a measuring band shows more than 80 cm, it is an alarming sign. Don’t be too lazy to check your waist circumference. But do not suck your stomach in and do not fast for a couple of days in advance. You may be surprised but 80 cm is not such a big value, and a good-looking belly can all of a sudden measure 85 cm. And this is a very important index. It means that the amount of abdominal fat is much larger than needed. Which means that the aromatase enzyme operates at an increased rate, that leptin secretion increases tenfold, that insulin resistance looms large and His Majesty Metabolic Syndrome comes knocking at your door.

So what do these terms mean for an ordinary person?

First of all, gloomy figures. For a woman not planning to get pregnant it means that she is at risk of ALL hyperplastic processes including uterine myomas, endometrial polyps and mammary gland fibroadenomas. Third-degree obesity was acknowledged as an independent risk factor for uterine cervix cancer. Overweight poses a risk of hypertonic and varicose diseases, diabetes mellitus et cetera.

It is a pity that the word RISK does not seem to impress our people, although as far as quite a number of the so-called socially significant diseases are concerned, the role of our lifestyle - that cannot be bought at a pharmacy and cannot be administered thrice a day in anticipation of a miraculous recovery - has been proven.

For a woman planning a pregnancy, the effects of obesity are much more evident.

It turns out that more than 50 % of women of reproductive age are overweight.

And the risk of infertility in such women is much higher – about 35%. It means that every one in three overweight women experiences difficulties with conception due to this reason ONLY. Secondly, even if pregnancy occurs, the risks of miscarriage, premature delivery, stillbirth and maternal mortality are significantly higher. It is much more often that such patients suffer from gestational diabetes, preeclampsia and thromboembolic complications. Doctors also have to turn to cesarean section and labor induction more often.

It would be a different matter if this were the end of it. Our women are resolute and are ready to go through such a difficult pregnancy to give birth to a child. The problem is that a newborn is often not very healthy as well. In the recent years, the number of children born with body weight of more than 4000g has significantly increased. Which means that since its very birth a baby has certain problems with immune and endocrine systems and will need to be observed by respective specialists. Overweight mothers significantly more often give birth to children with bronchial asthma. A great frequency of occurrence of congenital anomalies such as neural tube defects, congenital cardiac anomalies and umbilical hernias is proven as well. Hence, the “everything for the children” principle does not work out as well.

As far as the IVF programme in case of such patients is concerned, there are certain hardships as well. We have to employ many more agents to attain the growth of follicles. Very often, the growth of the endometrium and the growth of follicles become desynchronized, which brings about an unplanned embryonic cryoconservation. Ovarian puncture in an overweight woman is very much like a torture that both a patient and a doctor go through. To reach the ovary and try to obtain everything that has been grown with such a titanic effort, one has to make it through the abdominal fat with the help of the strongest doctor in the surgery. Such puncture is highly traumatizing and can end differently than planned. And the quality of obtained oocytes is far from what fertility specialists would be pleased with: more degenerative and immature oocytes, abnormal fertilization, a small number of embryos of good quality…

It is no use fiddling around changing the protocol, the agent, the embryonic culture media or the fertility specialist; or adding leech therapy, barotherapy or ozone therapy to the IVF programme.

You only need to LOSE WEIGHT. This is a cheap yet very unpopular procedure. Not even once in my practice have I heard an overweight woman say: “Yes, I do eat a lot and don’t move much”. It is more often that I hear about two pieces of dietetic veal a day or about hard work when a patient only manages to eat at night, or about stress, or about a nasty husband who does not like eating alone. There are quite a number of valid reasons to not take a step towards giving birth to a healthy son or daughter.

Coming to a doctor and delegating a problem – in this case, the achievement of pregnancy - to him/her, a patient makes a doctor responsible for its solution. Which is entirely correct. A doctor must have the knowledge and skills to try and find a maximally effective solution. There are, however, no responsibilities that would not be accompanied by rights. And since a doctor is responsible for a patient’s treatment, he/she must also have the right to demand cooperation: in this case, in losing excessive weight. Not to produce good statistics but so that the future child should not receive a distasteful gift for their first birthday.

We did not write anything about methods, diets or medication for weight management because this is a question of a union between a patient and an endocrinologist, or rather between a patient, a pan and running shoes – in less drastic cases. The aim of this article was that if you all of a sudden found yourself above the blue zone on the diagram or a measuring band showed inappropriate results, or if you noticed a patch of darkened skin on your inner-thighs or on the back of your neck, with the skin on your elbows somewhat dry, instead of trying to find the cause of infertility in sperm cell DNA fragmentation or in the carriage of certain HLA class II loci, you should focus on something that does not require a blood test to discover - something that can be easily seen in the mirror.