The doctor clarified the difference between obesity and excess weight

— Bekhan Bayalovich, how do you understand that a person is obese?

— The diagnosis of obesity is based on body mass index (BMI). You can calculate this indicator yourself using an online calculator or the formula: weight in kilograms divided by height in meters. If the BMI is greater than 30, then the person is obese. A BMI between 25 and 30 is considered overweight. It, like obesity, worsens the quality of life, but is a correctable condition. You can get rid of excess weight by adjusting your diet and exercising. But with obesity, this will no longer work – about 90% of obese people who lose weight through diets and exercise return to their original weight, sometimes even with a plus.

— Why is female obesity dangerous?

— It is generally accepted that it is easier for obese women to bear a child and, accordingly, become pregnant. But this is not true at all. First of all, obesity affects the entire musculoskeletal system; additional weight from the fetus has a negative impact on the spine and various joints – they are subject to excessive stress and wear occurs. Pregnancy can be dangerous because it will lead to rapid wear and tear of the body, which is already struggling with the consequences of excess kilograms.

In obese women, the level of the male sex hormone androgen increases in the blood. This is due to leptin, a hormone produced by fat. Increased androgen content leads to reproductive dysfunction – ovulation becomes irregular, and because of this it is difficult to predict the time of conception.

If excess fat is concentrated in the abdominal area, this is a direct indicator of insulin resistance. In this condition, the body is forced to produce more insulin to maintain normal blood sugar levels. But the cells still do not receive the required level of glucose. This leads to the development of type 2 diabetes. In addition, insulin resistance also leads to a decrease in the level of globulin, a protein responsible for regulating the sex hormones androgens and estrogens, which becomes one of the causes of infertility or problems with conception.

Research shows that obese women are less likely to conceive within one year of stopping contraceptives (66% vs. 81.4% of normal-weight women). There is also a difference in the probability of conception depending on the BMI indicator: for a woman with a BMI of 35, the probability of becoming pregnant within a year is 26% lower, and for a woman with a BMI of 40, it is 43% lower compared to women with a BMI from 21 to 292.

— How does obesity affect the restoration of fertility?

— Obesity not only negatively affects fertility, but also impedes its restoration. One study published in the Journal of Reproductive Science found that women with a higher body mass index and more belly fat were less likely to become pregnant when using assisted reproductive technologies, including hormonal treatments. Another study found that overweight and obese women who tried egg growth-stimulating drugs required higher doses. However, even this did not guarantee a positive outcome.

Obesity also affects the success of the IVF procedure. Excess weight complicates the procedure for artificial insemination, since during IVF women undergo hormonal therapy to fertilize the largest number of eggs. If a woman has hormonal imbalances due to obesity, then she will have to undergo more and more cycles, which will not be without complications. In the case of IVF, the doctor may give a recommendation – to postpone planning the procedure and lose a certain weight.

— How does obesity affect the course of pregnancy and the child itself?

— Obesity also affects blood pressure and wound healing. If you have a caesarean section, an obese woman has a higher risk of developing complications after surgery than a woman with a normal weight. However, other risks for the mother during pregnancy include deterioration of the kidneys and cardiovascular system, the development of high blood pressure, sleep apnea and type 2 diabetes.

The fetus is at risk of stillbirth and congenital anomalies. A child born to an obese woman is at risk of developing obesity and cardiovascular disease in the future.

— How to prepare for pregnancy with excess weight?

— If the expectant mother is overweight, but not obese, then you can get rid of excess kilograms on your own using conservative methods.

Usually we are faced with the following belief: strong weight gain during pregnancy is the norm. This is wrong. During pregnancy, a woman can gain up to 15 kilograms, this is due to the development of the fetus, increased weight of the uterus, swelling and the presence of amniotic fluid. When your weight goes up rapidly, it may be something to do with your diet. The mother’s diet should be complete, healthy and balanced. Of course, taste preferences may also change during different trimesters of pregnancy. There is no need to give up your favorite foods that you especially want. But it is important to limit the consumption of unhealthy foods from this list: fast food, flour, sweets, extra salty, fried. The responsibility of the expectant mother is to monitor her health and the condition of the unborn child, which also determines nutrition.

That is why it is important to eat right and not give up physical activity (their type should be determined in consultation with your doctor).

The main thing to remember:

• It is recommended to adhere to a diet consisting of 5 food groups: vegetables and legumes; fruits; whole grain breads and cereals; milk, yogurt, cheese; lean meat, poultry, fish, eggs, seeds and nuts.

• It is worth limiting the uncontrolled number of snacks, limiting yourself to three main meals and two snacks, while controlling the amount of food consumed. If you find it difficult to stick to portion sizes at first, you can purchase or use smaller dishes to avoid overeating.

• Replacing carbonated and sweet drinks with water will help qualitatively improve the condition of the body and reduce weight by removing swelling.

• Alcohol also promotes weight gain and can negatively affect the health of the expectant mother and fetus. It is recommended to abstain from alcohol both before and during pregnancy.

• Regular walks in the fresh air, playing sports (any that suits you and is agreed with your doctor) will help restore metabolism and reduce weight.

• Psychological health is no less important than physical health: if you are overeating and eating too much food, you should consult a psychotherapist, as such eating behavior can be unhealthy and indicate stress and depression.

— How to deal with infertility with diagnosed obesity and is it possible?

— Yes, it is possible to restore fertility if you are diagnosed with obesity. As part of pregnancy planning, it is necessary to take care in advance of the issue of treating the root cause – obesity. A responsible approach includes both the help of specialists and positive changes in lifestyle – avoiding high-calorie, highly processed foods and increasing physical activity. An integrated approach will help increase the chance of getting pregnant and reduce the risks of pregnancy.

A team of specialists is working on the treatment of obesity, which includes a therapist, psychotherapist, bariatric surgeon, endocrinologist and nutritionist. It is thanks to the teamwork of professionals that it is possible to approach the treatment of the disease in a comprehensive manner and not only lose weight, but also get rid of concomitant diseases – type 2 diabetes, infertility and others. In addition, comprehensive treatment will help change the patient’s eating habits and lifestyle.

It is important to remember that obesity is a serious disease and lifestyle changes alone are not enough. The medical community agrees that the most effective method today for weight loss in obesity is bariatric surgery. This is a minimally invasive operation that allows you to change the anatomy of the stomach or intestines using small punctures, creating a feeling of fullness in a person from small portions of food, which helps both reduce weight and solve the problem of overeating.

During the first year and a half after the intervention, the patient’s body weight decreases by 60–70%. At the same time, bariatric surgery prevents relapses of weight gain, providing long-term results. You should think about bariatric surgery at least a year before planning a pregnancy, since in the first six months after the operation pregnancy is extremely undesirable, because the woman’s body is being rehabilitated, and nutritional deficiencies may also occur. Taking vitamins and a diet containing all the necessary microelements recommended by your doctor will help restore the balance of substances faster.

HELP “MK”

Today, 62% of adult Russians are overweight, and approximately 25% can be diagnosed as obese. Doctors say that this is a chronic, relapsing disease, which is dangerous in itself, and is also a risk factor for the development of concomitant diseases: type 2 diabetes, cardiovascular diseases, including stroke and heart attack, joint problems and infertility. According to the Deputy Head of the Ministry of Health of the Russian Federation, Evgeniy Kotov, today every third Russian woman between 18 and 35 years old has problems in the reproductive sphere. At the same time, according to a study by the Society of Bariatric Surgeons, obesity predominantly affects women aged 40 years without pronounced bad habits.