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Review ArticleClinical Review

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

Teresa Kulie, Andrew Slattengren, Jackie Redmer, Helen Counts, Anne Eglash and Sarina Schrager
The Journal of the American Board of Family Medicine January 2011, 24 (1) 75-85; DOI: https://doi.org/10.3122/jabfm.2011.01.100076
Teresa Kulie
MD
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Andrew Slattengren
DO
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Jackie Redmer
MD, MPH
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Helen Counts
MD
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Anne Eglash
MD
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Sarina Schrager
MD, MS
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    Table 1.

    Classification of Obesity Based on Body Mass Index (BMI)3

    ClassificationBMI
    Underweight<18.5
    Normal Weight18.5–24.9
    Overweight25.0–29.9
    Obese
        Class I30.0–34.9
        Class II35–39.9
        Class III*>40
    • * Morbid obesity or extreme obesity.

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    Table 2.

    Effects of Obesity on Low Back Pain (LBP)

    AuthorsAssessment of ObesityResultsEffect* (OR [RR])
    Brown et al (20)BMI >30Increased incidence of LBP1.26 (1.08–1.48)
    Shiri et al (21)BMI >35 in women aged 24–39 yearsIncreased incidence of LBP1.2 (0.8–1.8)
    Tsuritani et al (22)BMI >24 vs BMI = 20–24 in women >40 years oldIncreased incidence of LBP and disability1.46 (0.78–2.47)†
    1.29 (0.74–2.25)‡
    BMI >26 vs BMI = 20–24 in women >40 years oldIncreased incidence of LBP and disability1.22 (0.58–2.57)†
    2.44 (1.24–4.81)‡
    Guh et al (9)BMI >30Increased incidence of chronic LBP2.81 (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.

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    Table 3.

    Effects of Obesity on Knee Osteoarthritis

    AuthorsAssessment of ObesityResultsEffect* (OR [RR])
    Abbate et al (30)BMI: heaviest quartile vs lowest quartileIncreased diagnosis of knee OA5.27 (3.05–9.13)
    Weight: heaviest quartile vs lowest quartileIncreased diagnosis of knee OA5.28 (3.05–9.16)
    Grotle et al (31)BMI >30Increased diagnosis of new knee OA within 10 years2.81 (1.32–5.96)
    Holmberg et al (32)BMI increase from 23 to 25Increased radiograph diagnosis of knee OA1.6 (0.9–3.1)
    Liu et al (33)BMI >30 vs BMI <22.5Increased rates of knee replacement10.51 (7.85–14.08)
    Patterson et al (12)BMI >35Increased rates of knee replacement11.7
    • * All odds ratio (OR) and relative risk (RR) are compared to women with body mass index (BMI) <25, unless otherwise noted.

    • OA, osteoarthritis.

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    Table 4.

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

    ContraceptivePrecautions
    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.
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    Table 5.

    Effects of obesity on pregnancy outcomes

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

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The Journal of the American Board of Family Medicine: 24 (1)
The Journal of the American Board of Family Medicine
Vol. 24, Issue 1
January-February 2011
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Obesity and Women's Health: An Evidence-Based Review
Teresa Kulie, Andrew Slattengren, Jackie Redmer, Helen Counts, Anne Eglash, Sarina Schrager
The Journal of the American Board of Family Medicine Jan 2011, 24 (1) 75-85; DOI: 10.3122/jabfm.2011.01.100076

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Obesity and Women's Health: An Evidence-Based Review
Teresa Kulie, Andrew Slattengren, Jackie Redmer, Helen Counts, Anne Eglash, Sarina Schrager
The Journal of the American Board of Family Medicine Jan 2011, 24 (1) 75-85; DOI: 10.3122/jabfm.2011.01.100076
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  • Article
    • Abstract
    • Obesity and Type 2 Diabetes Mellitus
    • Obesity and Coronary Artery Disease
    • Obesity and Musculoskeletal Pain
    • Obesity and Infertility (Including Polycystic Ovary Syndrome)
    • Obesity and Pregnancy
    • Obesity and Breastfeeding
    • Obesity and Depression
    • Obesity and Cancer in Women
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