Dr. Sumana Gurunath, Consultant Infertility & Reproductive Medicine, Department of Obstetrics & Gynecology, Cloudnine Group of Hospitals, Bengaluru
Globally overweight and obesity are emerging epidemics and a major public health concern along with the dual nutrition burden. While our country has been fraught with malnutrition for many centuries, rapid urbanization, industrialization, sedentary lifestyle, and consumption of energy-dense processed foods have seen a rapid surge in the prevalence of obesity. The pandemic has added to the obesity burden and as a result, the challenge of managing weight is another task. During the pandemic, fitness centers have been shut down, our activity may be decreasing, or we may be working from home and not moving as much.
The trends are alarming as the number of overweight – obese has more than doubled in the last two decades. Based on NFHS data, it was observed that the prevalence of overweight/obesity in women aged 30-39 years increased from 7.3% in 1998 to 27% in 2015. In men a similar increase was seen from 9.7% to 19.6% in the same time period.
Besides all this, did you know, obesity not only increases the risk of developing increased cholesterol, hypertension, diabetes and heart disease; but also has a negative impact on male and female fertility. It can impair reproduction in both men and women, leading onto infertility, can result in subsequent complications in pregnancy and in children born. Obesity is correctable and weight loss is achievable with disciple and lifestyle change. Awareness of these negative consequences and the health benefits of weight loss can motivate a person to overcome this reversible predicament.
Let us address some of the common myths surrounding weight:
- I weigh 65 kgs and I am not overweight: Obesity is defined by certain measurements such as BMI, waist circumference and waist hip ratio. BMI is a ratio of weight (kgs)/Height (m) 2. BMI between 25 – 29.9 is defined as overweight and > 30 is obese. Asians have been found to be more prone to heart disease at lower BMI and so the Asian definition for overweight is 23-24.9 and obese is >25. Waist circumference is a better indicator of central or abdominal obesity which is more dangerous. A value of >90 cms for men and >80 cms for women is high. Greater deposition of abdominal fat increases insulin resistance and has higher morbidity. Hence instead of just measuring one’s weight, calculation of these indices gives us a better perspective of the problem.
- I see so many women who are overweight but get pregnant. I should not have a problem: Many obese men and women are fertile. However, obese women are more likely to have irregular periods due to disturbed ovulation. Even in women with regular periods, obese women take longer to conceive compared to normal weight women. Obesity is also known to worsen the hormone imbalance in polycystic ovarian syndrome (PCOS). So, if you are having a problem conceiving, obesity is likely to worsen it.
- Obesity does not have any impact on success of infertility treatments: If you are obese, you are more likely to need higher doses of medications to induce ovulation, less likely to respond to oral agents and need more number of cycles of treatment to conceive. Several large studies on women undergoing IVF confirm that obesity reduces response to hormone stimulation (need higher doses of injections, increase in the duration of stimulation, increased cost), reduces the number of eggs retrieved, lowers egg quality and pregnancy rates of treatment. Studies have found a 2% decrease in live birth rate for every 1 unit increase in BMI. Obesity reduces the ability to conceive naturally and the success of fertility treatment.
- Being obese has nothing to do with low sperm counts: Not all obese men have infertility. But those who do may have erectile dysfunction, low sperm counts and motility. Obesity, especially abdominal obesity is associated with greater chance of having abnormal semen parameters and infertility. The peripheral fat brings about conversion of circulating male hormone or testosterone into the female hormone / estrogen. This lowers the testosterone levels in the body which is essential for sperm production and hence, impacts semen quality.
- I am going to have an uncomplicated and comfortable pregnancy. Weight has no effect on pregnancy and the baby: Obese women are more likely to develop complications in pregnancy. Obesity is associated with greater risk of miscarriage, developing gestational diabetes, hypertension, preterm delivery and stillbirth. Delivery can be more difficult and complicated requiring caesarean section or instrumental delivery. Babies born to obese mothers can have a mildly increased risk of abnormalities and are more likely to be obese themselves.
- To improve my fertility, I have to reach my ideal body weight: Improvement in fertility is observed even with a small weight loss of 5-10%. It is not mandatory to reach one’s ideal weight which may be an arduous task for many. This makes the goal easier and more attainable. Weight reduction regularises periods, resumes ovulation and facilitates early conception
- What is the best way to achieve weight loss and maintain it: Weight management is best realised through a combined lifestyle modification program involving dietary modification, physical activity and psychological, behavioural and stress management strategies. A consistent 500-750 Kcal/day reduction in usual dietary intake should result in a 3-4 kg loss per month. There is no evidence that any specific type of diet is better than the other. However, one must take into account food preference, flexibility and avoid diets that are unduly restrictive and nutritionally unbalanced. Recommendations for exercise include a minimum of 250 min/week of moderate intensity activities or 150 min/week of vigorous intensity and muscle strengthening activity for moderate weight loss. Sedentary, screen and sitting time must be minimised.
Role of processed foods
Processed food includes food that has undergone some change from its natural state. Any raw agricultural commodity that has been cooked, canned, chopped, heated, frozen, dried or changed in nutritional composition is “processed”. Foods are classified into unprocessed/minimally processed, processed culinary ingredients, processed and ultra-processed foods. Not all processed foods are harmful and it is important to recognise those that are unhealthy.
Unhealthy processed foods include those with added salt, sugar and trans- fat. Some highly processed foods go beyond these and add artificial flavours, colours and preservatives to promote shelf life, preserve texture and increase craving and palatability. Most of these lack nutrients, protein, and fibre and stimulate people to overeat. Some examples of unhealthy processed food include processed meat, sauce / ketchups, packaged bread and cakes, pre made sauces, breakfast cereals, colas and carbonated drinks, salad dressings, pizzas, sweets, biscuits, potato chips, ready to eat meals, etc.
Consumption of a healthy, balanced nutritionally adequate diet is of vital importance. Indian diet is notoriously known to be excessive in cereal without enough protein, fruits or vegetables. A study found that the mean energy intake from ultra-processed food in Delhi in adolescents was as high as 16%. The overall per capita sales of packaged and processed foods in India have nearly doubled from 2012 to 2018. Increased consumption of processed food has been associated with rising rates of obesity, diabetes, hypertension, cancer, heart disease, stroke and so on. From a fertility perspective, it is linked to lower fertility in both men and women, higher chance of irregular periods and lower success rates with fertility treatment.
As Michael Jordan once said “Obstacles don’t have to stop you. If you run into a wall, don’t turn around and give up. Figure out how to climb it, go through it, or work around it.” Weight loss is not just a diet, it’s a change in lifestyle. It needs tremendous discipline and self motivation. Remember, when you want to give up, remember why you started. That is our goal, our destination. Start today and hope for a healthy happier tomorrow.
