2005 Annual Meeting Monday Highlights: Weight and Women's Health Issues

- Obese Women Delay Gynecologic Cancer Screening -
- Weight Loss Helps Obese Women Feel More Sexually Attractive -
- Pregnancy Outcomes Following Weight Loss Surgery -

Vancouver, British Columbia - October 17, 2005 Three new studies presented today at the 2005 Annual Scientific Meeting of NAASO, The Obesity Society, offer new insight on the dangers of excess weight as well as the benefits of weight loss unique to women's health. While direct health consequences of overweight and obesity are well established, one study reveals that excess weight erects barriers to preventive health screenings. The two other studies add to the growing body of research about the positive impact taking off excess weight can have on many different areas of a woman's life.

African American and White Obese Women Delay or Avoid Routine Gynecological Cancer Screening (60-OR; 3:45 p.m. PT)

Faced with a history of negative experiences at the doctor's office, many obese women delay preventive medical visits, including those for gynecological cancer screening. Being overweight increases a woman's chance of developing breast, ovarian, cervical and uterine cancer. For example, obese women have a one and a half-fold relative risk for endometrial cancer and a two-fold relative risk for postmenopausal breast cancer.

Through research that included a survey of 498 overweight and obese women (BMI ranged from 25 to 122) and 129 health care providers, researchers from the University of California at Berkeley found that obese women are more likely than non-obese women to delay Pap tests, pelvic exams and mammograms, even though they are "moderately" or "very concerned" about cancer. Women who have repeatedly tried to lose weight (five or more times) were the most likely to delay cancer screening. Additionally, 90 percent of the women had insurance coverage for cancer screening services, suggesting the delay was unrelated to cost or access to services. The study is believed to be the first to gain insight into the perspectives of obese women concerning access to healthcare. "Since obesity rates are on the rise, delaying or avoiding cancer screening is a tremendous concern for large women that could result in many more cancers going undetected," said Nancy Amy, Ph.D., associate professor of nutrition at the University of California at Berkeley, who led the study. "Cancer screenings are vital to women's health. Interviewing and finding a doctor they trust who will treat them with respect is one way to help ensure overweight and obese women get these potentially life-saving tests."

Women surveyed felt their weight was a barrier to receiving appropriate health care. According to Dr. Amy, many of these women shy away from health care visits due in part to humiliating visits in the past. From finding waiting room chairs too small for them, not having a gown that fits or inappropriately sized exam tables, speculums or blood pressure cuffs, these women do not feel welcome in the medical office.

The women surveyed also reported that physicians tend to focus on large women's weight, regardless of the nature of the visit. With increasing awareness of the obesity epidemic and its health consequences, Dr. Amy suggests that physicians may feel compelled to address issues of weight under the current medical paradigm.

Medical professionals indicated they too face barriers to caring for very large women. Physicians surveyed reported that difficult and more time-consuming exams, lack of training in dealing with large patients and unsatisfactory access to referrals or resources for those patients are barriers to providing care to this population.

More evidence-based medicine about care for obese people and inclusion of obese people in clinical trials were suggested strategies to overcome these barriers.

Changes in Sexual Quality of Life in Individuals Undergoing Weight Loss Treatment - A 2-Year Longitudinal Study (59-OR; 3:30 p.m. PT) Feelings of sexual attractiveness, along with five other key indicators of sexual quality of life, significantly improved for obese women and men who lost weight over a two-year period. In one of the longest and few studies to examine the impact of weight loss on sexual quality of life, the researchers conclude that sexual quality of life improves with intentional weight loss. Prior studies have demonstrated that obese people have high rates of difficulty with sexual quality of life, and obese women experience higher rates of difficulty with sexual quality of life than do obese men. In the current study, Martin Binks, Ph.D. and colleagues examined the impact of weight loss on sexual quality of life (SQOL) in 187 obese adults (161 of whom were women) participating in an open-label, non-controlled clinical trial of a weight loss medication. The Impact of Weight on Quality of Life questionnaire was used to assess six areas of sexual quality of life: feeling sexually unattractive, lack of sexual desire, reluctance to be seen undressed, difficulty with sexual performance, avoidance of sexual encounters and lack of enjoyment of sexual activity.

At the start of the study, approximately two-thirds of participants reported feeling sexually unattractive at least "sometimes." On each of the six SQOL domains examined, the prevalence of participants who reported difficulty at least "sometimes" ranged from 19 to 67 percent. Additionally, the obese women in the study were twice as likely as the obese men to report having difficulty being seen without clothing and were five times more likely to report not enjoying sexual activity.

After two years, the patients lost an average of about 13 percent of their body weight. Maximum improvement in SQOL was seen after approximately three months (approximately 11% weight loss) and remained relatively stable thereafter in all six domains for both women and men. Overall, these changes were consistent with improvements in BMI. "There is tremendous social pressure in our society to be thin, so it is not surprising that the majority of women and men in our study felt sexually unattractive," commented Martin Binks, Ph.D., director, behavioral health at Duke Diet and Fitness Center in Durham, NC. "Sexual quality of life is an important, but frequently overlooked aspect of overall quality of life for men and women; however, women face particular challenges in our society."

Outcomes of 100 Consecutive Births in Women Following Laparoscopic Adjustable Gastric Band Surgery (57-OR; 4:45 p.m. PT) Babies born to severely obese women after weight loss surgery with laparoscopic adjustable gastric band surgery (LAGB) are just as healthy as babies born in the community and are healthier than babies born to obese women, including births in the same women prior to surgery. "Our study provides evidence that significant weight loss is not harmful to the fetus in terms of its growth and development," said John Dixon, Ph.D., associate professor and head of clinical research, Australian Centre for Obesity Research and Education in Melbourne, Australia. "Women who are considering whether they will undergo weight loss surgery for their own health should also factor in the potential benefit to their baby if they think they will have children in the future."

Previous research has shown that obese women have high-risk pregnancies and their newborns do not fare as well as non-obese women. Dr. Dixon and his team studied the pregnancy outcomes of the first 100 births in their bariatric practice. Seventy-nine of the women underwent LAGB, a surgical weight loss method commonly referred to as "lap band." Results were compared to outcomes in obese controls and the general community as well as prior pregnancies in 54 of the women before the surgery.

The women gained an average of 20.7 pounds, compared to 33.2 pounds when the same women were pregnant prior to weight loss surgery. Mean birth weight of 7.48 pounds was similar to birth weight pre-band and in the community. Maternal complications were reduced after the band surgery. Incidence of pregnancy-induced hypertension (11%) and gestational diabetes (6%) were similar to those in the general community (12% and 5.5% respectively), lower than other obese pregnant women (35% and 9.4%) and lower than these women's prior pregnancies (42% and 11%.)

The incidence of negative birth outcomes including stillbirth, fetal abnormalities, pre-term deliveries and low or high birth weight were consistent with community outcomes and better than those in severely obese women. The team attributes the improved outcomes to weight loss, monitoring during pregnancy, band adjustments and nutritional support that may minimize the risk to the developing fetus of growth and development abnormalities.

NAASO, The Obesity Society, is a leading scientific society dedicated to the study of obesity. NAASO is committed to encouraging research on the causes, treatment and prevention of obesity as well as to keeping the scientific community and public informed of new advances in the field. For more information about NAASO and obesity, visit www.naaso.org or call (301) 563-6526.