Summary
Obesity is a worldwide epidemic with a complex multifactorial aetiology. The commonest cause is an excess of calories that are not balanced by increased energy expenditure. Although genetic and biological pathways may contribute to the development of obesity, behavioural, psychological, and environmental factors are now the prevailing risk factors.
As discussed, female obesity is more prevalent than male obesity and this is significantly increased at the higher classes of obesity (II and III). This places an unprecedented burden on the speciality of obstetrics and gynaecology. The prevailing evidence indicates that female obesity is associated with increased risks in all aspects of a woman's life; during adolescence, reproductive years, and post-reproductive years. Obese pregnant women are at an increased risk of gestational diabetes, thromboembolism, preeclampsia, operative delivery, and postpartum haemorrhage. Her child's health will bear the burden of their exposure in the obese in utero environment with an increased risk of shoulder dystocia, obesity, diabetes, and developmental delay. There is therefore an urgent need for effective screening policies in early pregnancy and these should identify high-risk pregnancies in order to then have a focused care plan in place.Women who are obese are at an increased risk of gynaecological morbidity such as menstrual dysfunction, infertility, miscarriage, and urogynaecological disorders. Of concern is the increased risk of gynaecological cancers such as endometrial cancer, postmenopausal breast cancer, and, to a lesser degree, ovarian cancer in obese women. Their body habitus influences the choice of management options thereafter. Morbidly obese women are at an increased risk of surgical and postsurgical complications and therefore medical options have to be heavily considered, for example, in the management of endometrial cancer. The developments in minimal access surgical techniques are now allowing an increasing number of more complex gynaecological procedures to be undertaken laparoscopically for women with complex comorbidities and obesity.
Obesity is a considerable burden on an individual and on healthcare systems. It has had a significant impact in the practice of obstetrics and gynaecology. Its far-reaching sequelae mean that urgent action is required to educate the public with regard to healthy eating and lifestyle habits. It requires governments to acknowledge the current evidence and adjust policymaking accordingly, including regulation of advertising by the food industry, particularly towards children.