2012 Dialogue presentation by Catherine Spong, MD – Branch Chief, National Institute of Child Health & Human Development

1. Catherine Y Spong, MD
Associate Director Extramural Research
Eunice Kennedy Shriver National Institute of Child Health &
Human Development (NICHD)
National Institutes of Health (NIH)

2. Ihave no conflict of interest related to this
presentation
Ihave no relevant financial relationships
with any commercial interest relative to
the subject of this lecture

4. Obesity: excess of body fat
Common Methods
 Body Mass Index
 Body circumference:
◦ Waist <85cm or < 35” for women)
 Waist to hip ratio: >.91

5. Online BMI calculator: www.nhlbisupport.com/bmi
Weight (Kg)
Body Mass Index:
(BMI) Height (m)2
• Overweight BMI >25 – 29.9
• Obese BMI >30
obesity class I BMI 30 -34.9
obesity class II BMI 35 -39.9
obesity class III BMI >40
WHO 2000 and NIH

6.  Obesity is the fastest-growing cause of disease
and death in USA
 Over 60% U.S. adult women are overweight
 Over 1/3 of overweight adult women are obese
 The World Bank has estimated the cost of
obesity in the U.S. at 12% of the National Health
Care budget

7.  30% of reproductive age women are obese
 Additional 25% are overweight
 There has been a 70% increase in the proportion of
women who are obese at the beginning of
pregnancy
IOM 2009
Flegal 2010 JAMA 303:233-41
Kulte et al J Am Board Fam Med 2011;24:75-85

8.  34 million Americans are overweight
 Increase from 1 in 8 (1991) to 1 in 5 (1998) are
obese
 Women are generally at increased risk
 Racial distribution (women):
◦ 45% Black
◦ 35% Hispanic
◦ 25% White
◦ 45% American Indian

9. (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%

10. (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%

11. (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%

12. (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%

13. (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%

14. (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

15. Obesity Trends* Among U.S. Adults
BRFSS, 2002
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

16. (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

17. (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

18. (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

19. (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

20. (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

21. (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

22. (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

23. (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

25.  Hypertension  Degenerative Joint
 Type II Diabetes Disease
 Gout
 Hyperlipidemia
 Gallstones and Kidney
 Coronary Heart Disease
Stones
 Cancer:
 Gastric Reflux
◦ Endometrial  Sleep apnea
◦ Breast  Increased surgical risks
◦ Colon  Depression

26.  Gynecologic Implications
◦ Infertility
◦ Menstrual Irregularities
◦ Ovulation problems
◦ Reproductive Cancers
◦ Metabolic Syndrome

27. Jai & Lubetkin, Am J Prev Med
2010;38(2):138 –144.

28.  Weight reduction of 5-7 % associated with:
◦ Lower blood pressure
◦ Improved cholesterol
◦ Lower risk of developing diabetes
Treatment must involve
- Multidisciplinary, culturally appropriate
approach as for most chronic diseases
- Focus on prevention especially at critical points
such as childhood, pregnancy and menopause

29.  Obesity rates are rising, reaching concerning
levels in women and children
 Impact on women’s health is dramatic
◦ reproductive
◦ long-term
 Role
of technology and lifestyle
 Complex as a health issue
◦ Solutions require diverse perspectives

30. The goal: healthy mothers, healthy children, healthy families…