Obesity

Foreword

About the Editors

Contributors

Section 1: Epidemiology

1. Worldwide Epidemic of Obesity

Introduction

Definitions of Overweight and Obesity

The Extent of the Problem

Temporal Trends

Factors Associated with Overweight and Obesity

Disease Burden and Impact on Health and Economy

International Response to the Epidemic

Conclusions

References

2. Social and Ethnic Determinants of Obesity

Introduction

Ethnic Factors

Social Factors

Dietary Factors

Conclusion

References

3. Genetic and Molecular Basis of Obesity

Introduction

Hereditary Factors Influencing BMI

Genetic–Molecular Interaction of Obesity

Regulation of Energy Balance – Molecular Basis

Regulation of Food Energy Intake

The Role of Hypothalamus

The Role of Leptin

Melanocortin Signalling Pathway

Control of Energy Expenditure

Adipogenesis

Interactions Among Social, Environmental, Genetic and Behavioural Factors in Obesity

Conclusion

References

4. The Psychological Basis of Obesity

Introduction

Eating Behaviour

Early Attachment and Trauma

Emotion Regulation

Personality Traits

Depression and Anxiety

Cognitive Factors

Summary

Acknowledgements

References

5. Obesity in Adolescence

Introduction

Prevalence of Childhood Obesity: A Global Perspective

Obesity and the Pubertal Transition

Factors Affecting Childhood and Adolescent Obesity

Adolescent Obesity – Adverse Outcomes

Polycystic Ovarian Syndrome in Adolescence

Obstetric Outcomes in Obese Adolescents

Management Principles

Management of PCOS in Adolescence

Conclusion

References

Section 2: Obesity and Reproduction

6. Obesity and Contraception

Introduction

Risks of Obesity in Pregnancy

Classification of Obesity Based on Body Mass Index

Potential Concerns with Obesity and Contraception

Obesity and Contraceptive Efficacy

Conclusion

References

7. Sexual Health and Obesity

Introduction

Obesity and Sexual Behaviour

Obesity and Sexual Dysfunction

Obesity and Sexual Health Outcomes

Conclusion

References

8. Obesity in PCOS and Infertility

Introduction

Obesity and Infertility – Possible Mechanisms

Impact of Obesity on Infertility Treatment

References

9. Obesity and Recurrent Miscarriage

Introduction

Obesity and Miscarriage

Obesity and Recurrent Miscarriage

Metabolic Effects of Obesity on Ovary

Endometrial Changes in Obesity

Management

Conclusion

References

10. Obesity and Assisted Reproduction

Introduction

Prevalence of Obesity in the Assisted Reproduction Sector

Evidence of Reduced Fertility in Obese Women

Specific Issues Relating to Art

Rationale for the Use of Assisted Reproduction

Practical Management of Obese Women Undertaking Art

Clinical Procedures

Effect of Obesity on the Results of Art

Safety Issues for Mothers and Offspring

Ethical Issues Relevant to Access to Services

Conclusion

References

Section 3: Obesity and Male Reproduction

11. Obesity and Sexual Dysfunction in Men

Physiology of Sexual Function

Sexual Dysfunction and Obesity-Related Co-morbidities

Evaluation

Treatment

Summary

References

12. Male Obesity – Impact on Semen Quality

Background

Impact on Semen Quality

Aetiological Theories

Treatment

Conclusions

References

13. Obesity, Bariatric Surgery and Male Reproductive Function

Introduction

Bariatric Surgical Techniques

Pathophysiology of the Hypothalamic–Pituitary–Gonadal Axis in Obesity

Summary and Practical Considerations

References

Section 4: Pregnancy and Obesity

14. Maternal Obesity and Developmental Priming of Risk of Later Disease

Introduction

Epidemiological Observations on Maternal Obesity, Macrosomia and Neonatal Adiposity

Maternal Obesity and Childhood Obesity

Maternal Pregnancy Weight Gain and Childhood Obesity

Maternal Diabetes, GDM and Glucose Effects

Relationship Between Maternal Hyperglycaemia and Neonatal Adiposity

Maternal Hyperglycaemia and Childhood Obesity

GDM and Cardiometabolic Diseases in the Offspring

Maternal Insulin Resistance, Hyperinsulinaemia and Foetal Growth

Glucose Metabolism and Foetal Growth

Maternal Lipid Supply and Foetal Growth

Effects on Vascular Function

Animal Models Using Maternal Obesity

Neurohormonal Changes

Placenta, Foetal Priming and Foetal Development

Epigenetics as the Unifying Mechanism in Foetal Priming of NCD Risk

Implications for Public Health Intervention

Acknowledgements

References

15. Foetal Ultrasound in Obese Pregnancy

Introduction

Excess Foetal Risks Associated with Obesity

Ultrasound Assessment in Obesity

Conclusion

References

16. Obesity and Prolonged Pregnancy

Introduction

Prolonged Pregnancy

Conclusion

References

17. Obesity and Venous Thromboembolism

Introduction

Epidemiology, Prevalence and Trends

Possible Underlying Mechanisms

Prevention of VTE in Obese Women During Pregnancy

Investigation and Diagnosis of VTE in the Obese Pregnant Woman

Treatment of VTE in the Obese Pregnant Woman

Conclusion

References

18. Obesity and pre-eclampsia

Definitions

Blood Pressure Measurement

Urine Testing

Changing Incidence of Obesity

Does Obesity Predispose to Pre-Eclampsia?

Adipokines

Is ‘Pre-Eclampsia’ in the Obese Pregnant Women Really Underlying Chronic (Essential) Hypertension?

Final Considerations

References

19. Obesity, Insulin Resistance and Placental Dysfunction – Foetal Growth

Introduction

Obesity and the Endocrine Environment

Placenta and Insulin Resistance

Placental Size

Placental Transporter System

Placenta and Inflammatory Response

Prothrombotic State

Diabetes and the Placenta

The Intrauterine Growth-Restricted Foetus

Conclusions

References

Section 5: Obesity and Gestational Diabetes

20. Screening for Gestational Diabetes

Introduction

Overweight as a Risk Factor for GDM

Pathophysiology

Diagnosis of GDM

Treatment of GDM

Implications Related to GDM

References

21. Obesity and Metabolic Disorders During Pregnancy and Pregnancy Outcome

Introduction

Obesity and Gestational Diabetes

Impact of Obesity and/or Diabetes During Pregnancy on the Offspring

Interventions

Conclusions

References

22. Obesity, Polycystic Ovaries and Impaired Reproductive Outcome

Introduction

Obesity and Reproductive Health

Pathogenic Mechanisms

Polycystic Ovary Syndrome

Obesity in Pregnancy

Gestational Weight Gain in Obese Women

Guidelines for Management for Obese Women of Reproductive Age

Management of Obesity in Pregnancy

References

23. Pregnancy and Metabolic Syndrome of Obesity

Introduction

Lipid Metabolism and Fat Deposition in Lean Pregnancy

Lipid Metabolism and Fat Deposition in Obese Women

Glucose Metabolism in Lean and Obese Pregnancy

Adiposity, Obesity and IR: Potential Mechanisms

Amino Acid Metabolism in Lean and Obese Pregnancy

Pre-eclampsia, Obesity and Metabolic Syndrome of Pregnancy

Intervention Strategies in Maternal Obesity and Effects on Metabolism

Conclusion

References

Section 6: Obesity and Labour

24. Induction of Labour in Obese Women

Background

Indications for Induction of Labour

Women with a Previous Caesarean Section

Assessment Prior to Induction of Labour

Methods of Inducing Labour

Foetal Well-Being

Summary

References

25. Challenges of Intrapartum Care in Obese Women

Introduction

Preterm and Post-term Pregnancy

Induction of Labour

Place of Delivery

Equipment Required

Labour and Intrapartum Monitoring

Labour Dystocia

Caesarean Section in the Obese Woman

Macrosomia and Shoulder dystocia

Post-partum Care

Perinatal Morbidity

Risks in Subsequent Pregnancy

Conclusion

References

26. The Role of the Midwife During Pregnancy, Labour and Post-partum

The Role of the Midwife in Pregnancy

Specialist Clinics for Women with a BMI≥30kg/m2

The Role of the Midwife in Labour

The Role of the Midwife in the Post-partum Period

Conclusion

References

27. Anaesthetic Issues During Labour

Introduction

Conclusion

References

28. Maternal Obesity and the Risk of Stillbirth

Background

Epidemiology

Pathophysiology

Direct Risk Factors

Indirect Risk Factors

Management

References

29. Obesity, Diabetes, Placental Pathology and Foetal Malformations

Introduction

Obesity, Diabetes and the Umbilical Cord Coiling

Obesity, Diabetes and the Placenta

Obesity and Other Placental Changes

Obesity, Diabetes and Foetal Pathology

Conclusion

References

30. Post-Natal Care for the Recently Delivered Obese Women

Introduction

Background

Implications of Obesity for Planning of Post-Natal Care

Post-Natal Morbidity

Severe Maternal Morbidity as an Indicator of Quality of Maternity Care

Planning Post-Natal Care

Current Guidance to Inform the Content and Timing of Post-Natal Care

References

Section 7: Interventions to Improve Care of Women During Pregnancy

31. Anti-Obesity Drugs for Obese Women Planning Pregnancy

Introduction

Classification of Anti-Obesity Drugs

Drugs for Weight Reduction in Reproductive-Age Women: Pharmacology and Clinical Efficacy

Pharmacological Anti-Obesity Treatment in Women Contemplating Pregnancy

Concluding Remarks

References

32. Anti-Obesity Surgery for Women Planning Pregnancy?

Introduction and Background

The Global Obesity Epidemic

Obesity and Reproductive Function

The Effects of Obesity on Pregnancy

Bariatric Surgery: Overview and Indications

The Surgical Options

Pre-Operative Assessment for Bariatric Surgery

Special Considerations in a Post-Bariatric Patient

Role of Bariatric Surgery to Treat Obesity-Related Female Reproductive Abnormalities

Conclusion

References

33. Evidence-Based Approach to the Management of Obese Pregnant Women

Background

Pre-Pregnancy Weight Management

Weight Management Interventions in Pregnancy

Nutritional Supplementation for Obese Women in Pregnancy

Prophylaxis for Pre-eclampsia and Thromboembolism

Screening for Gestational Diabetes

Public Health Measures on Obesity

Recommendations for Clinical Practice

Recommendations for Research

References

34. Multimodal Framework for Reducing Obesity-Related Maternal Morbidity and Mortality

Introduction

Obesity in Women of Reproductive Age

Obesity-Related Maternal Mortality

Obesity-Related Maternal Morbidity

The Concept of a Multimodal Framework

Primary Prevention of Obesity-Related Maternal Mortality and Morbidity

Secondary Prevention of Obesity-Related Maternal Mortality and Morbidity

Tertiary Prevention of Obesity-Related Maternal Mortality and Morbidity

Conclusion

References

35. Developing Standards of Care for Obese Women During Pregnancy

Introduction

What Is a Standard in Health Care?

How to Develop Standards

What Measures Should be Used When Defining Standards of Care?

The Obesity Epidemic

Pre-Pregnancy Care

Early Pregnancy Care

Aspects of Care During Pregnancy

Post-Natal Care

Organisation

References

Section 8: Long-Term Impact of Obesity

36. Maternal Obesity – The Road to Diabetes and Cardiovascular Risk

Introduction

The Link Between Maternal Obesity and Offspring Obesity, Diabetes and Cardiovascular Risk – Hypotheses and Possible Mechanisms

Conclusions

References

37. Obesity and Female Malignancies

Introduction

Epidemiology

Mechanisms Relating Obesity to Female Malignancies Risks

Effect of Obesity on Management of Female Malignancies

Future Directions

References

38. Obesity and Menstrual Disorders

Obesity: The Problem

Obesity and Abnormal Uterine Bleeding

Polyps

Malignancy and Hyperplasia

Ovulatory Dysfunction

The Endometrium

Polycystic Ovary Syndrome

Obesity in the Absence of PCOS

Summary

Acknowledgements

References

39. Developing HRT Prescribing in Obese Women

Introduction

Effect of Menopause on Metabolic Factors

Managing Menopausal Symptoms in Obese Women

Alternatives to HRT

Conclusion

References

40. Incontinence and Prolapse in the Obese Woman

Introduction

Incidence and Prevalence

Normal Bladder Function and Causes of Incontinence in Women

Obesity and Urinary Incontinence

Obesity and Faecal Incontinence

Obesity and Prolapse

Weight Loss and the Effects Upon Continence and Prolapse

Continence and Prolapse Surgery in the Obese Woman

Conclusion

References

41. Laparoscopic Surgery in Obese Women

Introduction

Conclusion

References

Section 9: The Future Research and Health Service Planning

42. Obese Women and Quality of Life

Quality of Life

Obesity and Quality of Life

Physical Functioning

Psychological Functioning

Social Functioning

Body Image

Obesity and Quality of the Childbearing Experience

Conclusion

References

43. Understanding Eating Behaviour and Lifestyle Issues in Women – Implications for Obesity Development and Prevention

Introduction

Current Diet and Lifestyle Issues

Socio-Cultural Influences on Eating and Lifestyle Behaviours

Individual-level Influences

Conclusion

Acknowledgements

References

44. Planning for the Future: Maternity Services in 2035

Planning for the Future: Maternity Services in 2035

Projected Prevalence of Obesity in 2035

Key Health Burdens of Obesity in Pregnancy

Current Model of Care

Future Model of Care

How Can We Deliver this Care?

Research Needed to Inform Future Planning

Summary

References

45. Providing Infertility Services for Obese Women

Introduction

What Is the Current Situation?

Evidence for BMI Restriction to Fertility Services and Not Providing Service

What Is the Need?

What Are the Potential Barriers?

What Can We Offer?

Maintenance of Weight Loss

Cost-Effectiveness of Weight-Loss Strategies

How Can We Improve the Services and Promote Weight Loss?

Conclusions

References

46. Summary and Research Recommendations

Introduction

Research Agenda

References