Obesity and Women's Health: An Evidence-Based Review

Article Figures & Data

Table 2.

Effects of Obesity on Low Back Pain (LBP)

Authors	Assessment of Obesity	Results	Effect^* (OR [RR])
Brown et al (20)	BMI >30	Increased incidence of LBP	1.26 (1.08–1.48)
Shiri et al (21)	BMI >35 in women aged 24–39 years	Increased incidence of LBP	1.2 (0.8–1.8)
Tsuritani et al (22)	BMI >24 vs BMI = 20–24 in women >40 years old	Increased incidence of LBP and disability	1.46 (0.78–2.47)^†
			1.29 (0.74–2.25)^‡
	BMI >26 vs BMI = 20–24 in women >40 years old	Increased incidence of LBP and disability	1.22 (0.58–2.57)^†
			2.44 (1.24–4.81)^‡
Guh et al (9)	BMI >30	Increased incidence of chronic LBP	2.81 (2.27–3.48)

* All odds ratios (OR) and relative risk (RR) are compared to women with body mass index (BMI) <25, unless otherwise noted.
† Back pain.
‡ Disability.

Table 3.

Effects of Obesity on Knee Osteoarthritis

Authors	Assessment of Obesity	Results	Effect^* (OR [RR])
Abbate et al (30)	BMI: heaviest quartile vs lowest quartile	Increased diagnosis of knee OA	5.27 (3.05–9.13)
	Weight: heaviest quartile vs lowest quartile	Increased diagnosis of knee OA	5.28 (3.05–9.16)
Grotle et al (31)	BMI >30	Increased diagnosis of new knee OA within 10 years	2.81 (1.32–5.96)
Holmberg et al (32)	BMI increase from 23 to 25	Increased radiograph diagnosis of knee OA	1.6 (0.9–3.1)
Liu et al (33)	BMI >30 vs BMI <22.5	Increased rates of knee replacement	10.51 (7.85–14.08)
Patterson et al (12)	BMI >35	Increased rates of knee replacement	11.7

* All odds ratio (OR) and relative risk (RR) are compared to women with body mass index (BMI) <25, unless otherwise noted.
OA, osteoarthritis.

Table 4.

Manufacturer's Labeling: Weight-Based Precautions for Hormonal Contraception

Contraceptive	Precautions
Triphasic oral contraceptive (eg, Ortho Tri Cyclen, Ortho-McNeil-Janssen Pharmaceuticals, Inc., Raritan, NJ)	Increased body weight and surface area are associated with decreased hormone concentration (overweight is not listed as a precaution).
Monophasic Oral Contraceptive (eg, Loestrin 24 Fe, Warner Chilcott, Rockaway, NJ)	No weight-specific comments.
Progesterone-only contraceptive (eg, Ortho Micronor, Ortho-McNeil-Janssen Pharmaceuticals, Inc., Raritan, NJ)	No weight-specific comments.
Transdermal contraceptive (eg, Ortho Evra, Ortho-McNeil-Janssen Pharmaceuticals, Inc., Raritan, NJ)	Consider decreased effectiveness >90 kg (this is listed as a precaution).
Intravaginal ring (eg, Nuva ring, Schering-Plough Corp., Kenilworth, NJ)	No weight-specific comments.
Implantable progesterone (eg, Implanon, Schering-Plough Corp., Kenilworth, NJ)	Effectiveness not defined because women with >130% of ideal body weight were not studied. However, the hormonal concentration is inversely related to body weight and thus may be less effective in overweight patients.
Injectable progesterone (eg, Depo-provera, Pfizer, Inc., New York, NY)	No weight-specific comments.
Hormonal intrauterine device (eg, Mirena, Bayer HealthCare Pharmaceuticals, Montville, NJ)	No weight-specific comments.

Table 5.

Effects of obesity on pregnancy outcomes

Condition	Type of Study	Effect^*
GDM (53)	Meta-analysis	OR, 2.14 (1.82–2.53)^†
		OR, 3.56 (3.05–4.21)^‡
		OR, 8.56 (5.07–16.04)^§
PIH (54)	Meta-analysis	OR, 2.5 (2.1–3.0)^‡
		OR, 3.2 (2.6–4.0)^§
C-section (55)	Population-based cohort study	RR, 2.6 (2.04–2.51)^‡
		RR, 3.38 (2.49–4.57)
Pre-eclampsia (53)	Meta-analysis	OR, 1.6 (1.1–2.25)^‡
		OR, 3.3 (2.4–4.5)^§
Preeclampsia (56)	Retrospective cohort study	OR, 7.2 (4.7–11.2)^§
Induction of labor (56)	Retrospective cohort study	OR, 1.8 (1.3–2.5)^§
Postpartum hemorrhage (56)	Population-based cohort study	OR, 1.5 (1.3–1.7)^‖
Preterm delivery (<33 weeks) (56)	Population-based cohort study	OR, 2.0 (1.3–2.9)^‖
Stillbirth (57)	Systematic review and meta-anaylsis	OR, 1.47^†
		RR, 2.07^‖
Stillbirth (58)	Population-based cohort study	OR, 2.8 (1.5–5.3)^‖
Neonatal death (58)	Population-based cohort study	OR, 2.6 (1.2–5.8)^‖

* All odds ratio (OR) and relative risk (RR) are compared to normal weight pregnant women (body mass index [BMI] 18–25). Values in parentheses indicate 95% CI.
† BMI 25–30.
‡ BMI 30–35.
§ BMI >35.
‖ BMI >30. GDM, gestational diabetes mellitus. PIH, pregnancy-induced hypertension.