ABSTRACT: The obesity epidemic continues unabated. Among American women aged 20–39 years, 31.9% were obese in 2009–2010 1. Obese women are at risk of multiple medical comorbidities and pregnancy-related complications. Therefore, obstetrician–gynecologists should be familiar with current approaches to the prevention and management of obesity. Appreciation of the risks of obesity and associated diseases is essential. The etiology of obesity is multifactorial and includes genetic makeup, behavior and environment as they affect metabolism, physical activity, and dietary intake. Informal office counseling usually is the initial approach to managing weight. When this fails, structured weight loss programs that include diet modification, medications, exercise, and behavioral strategies may be used. However, because of the limited long-term effectiveness of these modalities, bariatric surgery is becoming a preferred option. Several surgical approaches are available. Obstetrician–gynecologists should be familiar with the advantages and disadvantages of each procedure, the importance of long-term management, and principles of pregnancy care in these individuals.
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- The Role of the Obstetrician–Gynecologist in Addressing Obesity
- Basic Science Update
- Screening
- Prevention
- Evaluation and Diagnosis
- Counseling: Establishing a Dialogue
- Management
- Considerations in Pregnancy
- Special Concerns for Older Women
- Complementary and Alternative Medicine
- Referral Guidelines
- Conclusions
- Future Directions in Research and Therapy
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Clinical Updates in Women's Health CareObesity Update
![Fig. 1. Prevalence of self-reported obesity among U.S. adults in 2011. Prevalence reflects methodologic changes in 2011, and these estimates should not be compared with those in previous years. (Modified from Self reported obesity among U.S. adults in 2011. Centers for Disease Control and Prevention. Atlanta [GA]: Centers for Disease Control and Prevention; 2012. Available at: http://www.cdc.gov/obesity/downloads/DNPAO_State_Obesity_Prevalence_Map_2011_508.pdf . Retrieved September 24, 2012.)](/-/media/project/acog/acogorg/clinical/images/clinical-updates/2013/01/obesity/cu054-20130100-fig1.png)
![Fig. 6. Obesity management and referral algorithm. Abbreviation: BMI indicates body mass index (calculated as weight in kilograms divided by height in meters squared). (Modified from National Heart, Lung, and Blood Institute, National Institutes of Health. The practical guide: identification, evaluation, and treatment of overweight and obesity in adults. Bethesda [MD]: NHLBI; 2000. Available at: http://www.nhlbi.nih.gov/guidelines/obesity/prctgd_c.pdf . Retrieved August 13, 2012.)](/-/media/project/acog/acogorg/clinical/images/clinical-updates/2013/01/obesity/cu054-20130100-fig6.png)
