Binge eating disorder and food addiction occurrences among adult Jordanian women with obesity

@#Introduction: The aim of the study was to estimate the occurrences of binge eating disorder (BED) and food addiction (FA) in Jordanian women with obesity and to explore their relationships with selected potential risk factors for obesity. Methods: A descriptive case series design that involved a total of 842 women with obesity was conducted. The occurrences of BED and FA were evaluated using the Questionnaire on Eating and Weight Patterns-5 (QEWP-5) and Yale Food Addiction Scale 2.0 (YFAS 2.0). Results: The overlapping of BED and FA (BED+FA) was the most frequent category constituting 53.7%. The second highest category was BED comprising 25.0%, followed by FA comprising 9.0%. Body mass index (BMI) and waist circumference (WC) were significantly higher in the BED+FA group as compared to all other groups. The FA group (41.3%) had significantly the lowest level of sleeping hours. BED (58.0%) and BED+FA (66.1%) groups were significantly higher in consuming more than three snacks per day. BED and/or FA-free group had significantly higher level of water intake of >5 cups/day. Conclusions: The frequencies of BED and FA were relatively high among obese Jordanian women. The study demonstrated an overlap between BED and FA, highlighting its associations with increased BMI and WC in a selected sample of obese women. The study suggested that BED, FA, and the overlapping of both conditions were associated with greater tendencies towards an unhealthy pattern of eating practices, fluid intake, and sleeping habits.

Qualidade de vida em mulheres com peso normal, sobrepeso e obesidade: uma perspectiva subjetiva e individual / Caldad de vida en mujeres con peso normal, sobrepeo y obesidad: una perspectiva individual y subjetiva / Quality of life of women with normal weight, overweight andobesity: an individual and subjective perspective

O objetivo deste estudo foi avaliar a qualidade de vida em mulheres com peso normal, sobrepeso e obesidade, em duas faixas etárias. Foram avaliadas 50 mulheres, distribuídas em dois grupos de diferentes faixas etárias (31?45 anos e 46?60 anos). Todas responderam uma ficha de identificação para caracterização sóciodemográfica e clínica, seguida da avaliação da massa corporal e estatura, para o cálculo do Índice de Massa Corporal e classificação do estado nutricional. A qualidade de vida foi avaliada por meio do Questionário de Qualidade de Vida. O primeiro grupo foi formado por sete mulheres com peso normal, sete com sobrepeso e onze obesas. O segundo grupo era composto por nove mulheres com peso normal, nove com sobrepeso e sete obesas. De modo geral, as participantes demonstraram uma boa qualidade de vida. Entretanto, o segundo grupo apresentou diferença significativa nos domínios Capacidade Funcional e Vitalidade, indicando que as obesas apresentaram prejuízo nas atividades físicas ou de vida diária e maior sensação de cansaço quando comparadas às mulheres com sobrepeso. Considera-se que a qualidade de vida seja uma percepção subjetiva e individual, pouco afetada pela obesidade.Contudo, não se descarta que a obesidade representa um fator de risco à saúde das mulheres.

Este estudio evaluó la calidad de vida en mujeres con peso normal, sobrepeso y obesidad en diferentes edades. Se evaluaron 50 mujeres, divididas en dos grupos (31?45 años y 46?60 años). Los sujetos respondieron una hoja de identificación de datos socio-demográficos y clínicos, siguiente de la evaluación del peso corporal y la altura para calcular el Índice de Masa Corporal y la clasificación del estado nutricional. Se evaluó la calidad de vida mediante el cuestionario de calidad de vida. El primer grupo se compone de siete mujeres con peso normal, siete con sobrepeso y once obesas. El segundo grupo era compuesto por nueve mujeres con peso normal, nueve con sobrepeso y siete obesas. De manera general, las participantes demostraron una buena calidad de vida. Sin embargo, el segundo grupo mostró diferencias en la capacidad funcional y vitalidad, lo que indica que las mujeres obesas mostraron deterioro en la actividad física o la vida diaria y un mayor sentido defatiga en comparación con las mujeres con sobrepeso. Se considera que la calidad de vida es subjetiva y la percepción individual se ve poco afectada por la obesidad. Sin embargo, no se descartó que la obesidad es un factor de riesgo para la salud de las mujeres.

The aim of this study was to evaluate the quality of life in of women with normal weight, overweight and obesity in two age groups. We evaluated 50 women, divided into two groups of different age brackets (31?45 years and 46?60 years). All the participants answered an identification form for socio-demographic and clinical aspects, followed by the evaluation of body weight and height to calculate the Body Mass Index and nutritional status classification. The quality of life was assessed by using the Quality of Life Questionnaire. The first group was composed of seven women with normal weight, seven with overweight and eleven obese participants. The second group ? G2 ? contained nine women with normal weight, nine with overweight and seven with obesity. Generally speaking, the participants evidenced a good quality of life. However, the second group showed significant difference in the Functional Capacity and Vitality, indicating that obese women showed impairment in physical activities or in daily life and a greater sense of fatigue when compared to women with overweight. Finally, the quality of life is a subjective and individual perception little affected by obesity. However, it is not implausible that obesity is a risk factor for women?s health.

Effects of High Temperature Aerobic Training on Body and Mind Health of Obese Young and Middle-aged Women / 中国康复理论与实践

@#Objective To explore the effects of high temperature aerobic training on body and mind health of obese young and middle- aged women. Methods 50 obesity middle-aged and young females from the yoga clubs were included. Their physical component, physiological functional components were compared before and after 1-year high temperature aerobic training. Results All the related parameters of exercise improved significantly (P<0.05), as well as the psychological status. Conclusion Yoga, as a representative of the high temperature aerobic training, can not only effectively improve the body physique, reduce lipid-lowering weight, but also improve the physiological function and psychological adjustment

Fatores associados à combinação do índice de massa corporal e circunferência da cintura em mulheres / Body mass index and waist circumference combination in women and associated factors / Factores asociados a la combinación del índice de masa corporal y circunferencia de la cintura en mujeres

Neste estudo, teve-se como objetivo testar associação entre fatores socioeconômicos, de estilo de vida, reprodutivos e clínicos, bem como a presença simultânea de obesidade central e global, em mulheres. Foi usado o delineamento de estudo caso-controle para verificar a associação entre as variáveis independentes e a dependente, por meio de regressão logística multivariada, e a força de associação foi estimada por meio dos Odds Ratio e seus intervalos de confiança. Permaneceram significantes para esse tipo de obesidade: idade (OR 3,772 - faixa etária 30-39 anos; OR 15,769 - faixa etária 50-65 anos), baixa renda (OR 2,422), baixa escolaridade (OR 2,937), menarca com 12 anos ou mais, confere efeito protetor (OR 0,409; IC95% 0,214-0,784), alta paridade (OR 6,795; IC95%3,137-14,717), obesidade materna (OR 2,867; IC95%1,623-5,065) e hipertensão diastólica (OR 5,251; IC95% 2,132-12,933). A baixa escolaridade, baixa renda e alta paridade foram significativamente associadas à condição de obesidade centralizada e global no grupo de mulheres estudadas.

Relationships between social-economics factors, lifestyle, reproductive and hypertension with central obesity and global overweight in women were studied by case-control study. Odds Ratio and confidence interval of 95% was estimated by logistic regression. Adjusted analysis shown: age (OR =3.772 - ages 30-39, OR= 15.769 ages-50-65), low income (OR= 2.422), low schooling (OR= 2.937), menarche at 12 (OR 0.409: IC95% 0.214-0.784), high parity (OR 6.795; IC95% 3.137-14.717), mother overweight (OR 2.867; IC95% 1.623-5.065) and diastolic hypertension (OR 5.251; IC95% 2.132-12.933), were associated to global obesity. Women with less schooling and income and high parity were significantly associated to high waist circumference and high body mass index

El objeto del presente estudio fue comprobar la asociación entre factores socio-económicos, de estilo de vida,reproductivos y clínicos y la presencia simultánea de obesidad central y global en mujeres. Se aplicó el estudio de caso - control para verificar la asociación entre las variables independientes y la dependiente, con regresión logística multivariada. La fuerza de asociación fue estimada por medio de odds ratio y sus intervalos de confianza. Permanecieron significantes para este tipo de obesidad: edad (OR= 3,772 - rango de edad 30-39 años, OR 15,769 - rango de edad 50-65 años), bajos ingresos (OR = 2,422), baja escolaridad (OR= 2,937), menarquia a los 12 años o más confiere efecto protector (OR=0,409: IC95% 0,214-0,784), alta paridad (OR 6,795; IC95% 3,137-14,717), obesidad materna (OR= 2,867; IC95% 1,623-% 5,065) e hipertensión diastólica (OR= 5,251; IC95% 2,132-12,933). Baja escolaridad, bajos ingresos y alta paridad son los factores que más se asociaron a la obesidad central y global en el grupo de mujeres objeto de estudio.

Risk factors for coronary heart disease in women.

In the United States, coronary heart disease (CHD) is the leading cause of death in both women and men. Although advances in medical diagnosis and treatment of CHD have contributed significantly to the recent decline in CHD mortality, preventive measures--both lifestyle changes and improvements in the medical management of coronary risk factors--have been estimated to account for the majority of the secular decrease in heart disease mortality. Most of the modifiable risk factors for CHD and strategies for prevention of CHD are similar for both men and women. As reviewed in this article, however, the magnitude of the effect of some factors differs between men and women, and there are some risk factors as well as preventive interventions that are unique to women.

PIP: This article discusses the risk factors for coronary heart disease (CHD)--the leading cause of death in the US--in women. Studies have shown that cigarette smoking more than doubles CHD incidence and increases CHD mortality by 70%. A cohort study among more than 121,000 female nurses in the US revealed that the risk of CHD was 6 times greater in heavy smokers than nonsmokers. The level of blood cholesterol is also a strong risk factor for CHD: levels of high-density lipoprotein (HDL) cholesterol are inversely associated with the risk of CHD. Thus, lowering low-density lipoprotein (LDL) and increasing HDL cholesterol levels reduce CHD risk in both men and women. Hypertension is a risk factor which responds well to pharmacologic treatment, and increasing levels of physical activity were proven to decrease CHD risk in numerous studies. Meanwhile, obesity, which is prevalent in the US, worsens other coronary risk factors such as hypertension, diabetes, and hypercholesterolemia. A study showed that overweight women (body mass index values 29) are at 3 times the risk for CHD as those with body mass index values less than 21. Diabetes mellitus is another CHD risk factor which is stronger in women than in men, and CHD death rates are 3-7 times greater among diabetic than nondiabetic women. Other studies revealed that women who consumed alcohol in moderation (10-15 g of alcohol per day) had a 40% lower risk of CHD compared with nondrinkers. There is a significant relationship between combined oral contraceptive and cigarette use and increased risk of CHD. Estrogen replacement therapy, low-dose aspirin, and antioxidant vitamins have been proven in studies to reduce the risk of CHD in women.

Perception of body weight and self-reported eating and exercise behaviour among obese and non-obese women in Saudi Arabia.

A case control study was conducted to examine the theorized differences for eating and exercise behaviour among the obese and non-obese women from an urban health center in Saudi Arabia. Perceptions regarding actual and ideal body size were also determined. The obese were significantly more likely to eat under emotional conditions of stress and anger, in secrecy, and indulge in binge eating (P < 0.05). Frequent snacking and drinking of regular soda drinks was also more common in this group compared to the controls (P < 0.05). A weak association was observed for nibbling at food without being aware and preference of sweet foods compared to savoury ones by the obese (P < 0.1). A large group of the study population (75%) were either not exercising at all or doing so infrequently--a feature expected in the middle and lower social class group of women in this region. A sizable proportion of women either overestimated (28.6%) or underestimated (28.9%) their actual body weight with increasing education significantly related to overestimation of weight and vice versa (P < 0.05). A change in the concept of an ideal body image from the overweight female to that of the slim figure was also observed with advancing education. To control and prevent obesity in this region, it is suggested that health education related to an awareness of a healthy body size and appropriate eating and exercise behaviour should be given through primary health centers, other health facilities and schools.

PIP: To facilitate the design of weight control programs in Saudi Arabia, where female obesity is widespread, eating and exercise behaviors and perceptions of ideal body weight were compared in 74 obese and 70 nonobese women (mean age, 29 years) recruited from a primary health care clinic in Al-Khobar. Questionnaire items on eating antecedents indicated that excessive eating was often a response to negative emotions or boredom, suggesting a need for stress management and relaxation training in weight control programs. Obese women were less likely than their nonobese counterparts to eat at fixed times during the day. Although obese women were more likely to skip main meals in an attempt to lose weight, this resulted in extensive snacking on sweet foods. 75% of women were not exercising at all or infrequently. 29% of women of normal weight and 28.1% of mildly or moderately obese women overestimated their actual weight category. On the other hand, 36.8% of mildly/moderately obese women and 23.5% of severely obese women considered themselves to be of normal weight. Overall, 30.6% of study participants designated "a little overweight" as the ideal female body size. Women with higher educational attainment (and thus, exposure to Western concepts of beauty) were more likely to favor slimness as an ideal. The adoption of healthy eating and exercise patterns early in life through school-based programs would represent a major step in the prevention of female obesity in Saudi Arabia.

Adolescent age at first pregnancy and subsequent obesity.

Adolescent pregnancy has been associated with subsequent obesity. This paper examines the patterns of obesity for second and third pregnancies among women who had their first singleton pregnancy as teenagers. We used maternally-linked data from 1978 to 1990 among 43,160 Missouri resident women. Age, parity, interpregnancy interval and prior body mass index were significantly associated with subsequent obesity among adolescents. Race, marital status and smoking had significant interactions with age. Among older women, being African-American and never having married was associated with an increased probability of obesity, and smoking had a greater effect on obesity at higher maternal age. Race and marital status did not have significant effects on obesity among younger women. The most important predictor of obesity was prior body mass index. Body mass index before the first pregnancy had a greater effect on subsequent obesity if the intervening interpregnancy weight gains were large. Excessive weight gain during pregnancy presents the health care provider with a dilemma. An increase in birthweight associated with high prenatal weight gains may diminish the risk of infant mortality and morbidity in an index pregnancy, but subsequent obesity may increase perinatal mortality rates, the rates of obstetric problems and neural tube defects.

PIP: This study examines the prevalence of obesity among American women who had an adolescent pregnancy in Missouri. Data were obtained from a maternally-linked longitudinal data set for the period 1978-90. The sample includes 103,262 births for first through fifth order singleton pregnancies linked to 43,160 Missouri mothers with a first pregnancy before the age of 20 years. Findings indicate that all women had at least two pregnancies. 31% had three pregnancies, 7% had four pregnancies, and 1% had five pregnancies. 8% were aged under 15 years at the first pregnancy, 35% were aged 16-17 years, and 57% were aged 18-19 years. A significantly higher number of higher birth order women had their first pregnancy when aged under 16 years. African American women were more likely to have their first pregnancy under 15 years of age, while White women were more likely to have their first pregnancy at 19 years. Medical risk factors decreased with age and increased with birth order. Cigarette smoking increased with age and with each pregnancy for all women. White women smoked more at every age and birth order. The rates of women in a subsample on Medicaid and food stamps decreased with age and increased with birth order. Rates of obesity increased with birth order. Rates increased from 3.8% for the first pregnancy to 16% for the fourth pregnancy. Women who were underweight at their first pregnancy had only a 0.5% increase in the rate of obesity from the first to second pregnancy, but overweight women had a 44.9% increase, and obese women had a 21% decrease in the rate of obesity. From the second to the fifth pregnancy, underweight women's rates of obesity are identified. Prior to the second and third pregnancy, the significant predictors of obesity were body mass index before the first pregnancy, interpregnancy weight gain, interpregnancy interval, race, medical risk factors, marital status, and smoking.

An empathetic look at overweight.

PIP: The author contends that neither behavioral nor psychological factors are responsible for obesity or overweight, but that physiological and nutritional factors are. Obesity and overweight are relevant to natural family planning because they contribute to various problems of the female reproductive system. Body fat stores estrogen, and excess body fat increases estrogen levels which creates various problems. For example, elevated estrogen levels may contribute to endometrium build-up, resulting in heavy, prolonged bleeding during menstruation or in midcycle. They may kick off a reaction, causing suppressed ovulation, premenstrual spotting, and menstrual cramps. Other possible effects of high estrogen levels are fibroid tumors, breast cancer, endometrial cancer, ovarian cancer, and amenorrhea. The consistent pressure of excess body fat on the uterus can result in uterine prolapse. Overweight may also be a symptom of a reproductive problem, e.g., ovarian failure. Hypoglycemia, including reactive hypoglycemia, caused by a diet high in sugar and white flour, plays a key role in overweight. Excessive insulin secretion in reactive hypoglycemic cases maintains high glucose levels, and the body stores the excess glucose in fat cells. Thus, a diet low in sugary foods and high in fiber-rich complex carbohydrates is the most successful way to lose weight. However, vitamins and minerals needed to maintain blood sugar levels must supplement this diet to be successful. These vitamins and minerals include the B vitamins, magnesium, and, perhaps, chromium. Iodine, vitamins A and E, zinc, and selenium help the thyroid gland operate optimally, so as to avoid excess blood sugar levels. Vitamin E, lecithin, and evening primrose oil assist the body in using fat better. Regular exercise is also important to burn excess fat. Aspartame (Nutrasweet) exacerbates hypoglycemia and is usually found in refined foods and non-foods.^ieng

A community study of gynecological and related morbidities in rural Egypt.

This study assesses the prevalence of gynecological and related morbidity conditions in a rural Egyptian community. A medical examination was conducted on a sample of 509 ever-married, nonpregnant women. For gynecological morbidities, genital prolapse was diagnosed in 56 percent, reproductive tract infections in 52 percent, and abnormal cervical cell changes in 11 percent of the women. For related morbidities, anemia was present in 63 percent of the women, followed by obesity (43 percent), hypertension (18 percent), and urinary tract infection (14 percent). Regression analysis of risk factors demonstrated the contribution of social conditions and medical factors to these diseases. Reproductive tract infections were shown to occur more frequently with uterovaginal prolapse, IUD use, presence of husband (regular sexual activity), and unhygienic behavior. Genital prolapse increased with age and number of deliveries. Age, recent pregnancy, education, socioeconomic class, and workload showed significant associations with related morbidity conditions. This evidence challenges national health programs to go beyond safe motherhood, child survival, and family planning in its services to women, and to consider the social context of health as well.

PIP: The prevalence of gynecological and related morbidity in a rural Egyptian community was assessed as part of the Program of Research and Technical Consultation in Family Resources. Child Survival, and Reproductive Health. A medical examination was conducted on a sample of 509 ever-married, nonpregnant women from November 1989 to July 1990. A logistic regression using Generalized Linear Interactive Modeling was performed for each type of morbidity. For gynecological morbidities, genital prolapse was diagnosed in 56%, reproductive tract infections in 52%, and abnormal cervical cell changes in 11% of the women. For related morbidities, anemia was present in 63% of the women, followed by obesity (43%), hypertension (19%), and urinary tract infection (14%). Most of the women were suffering from at least 1 morbidity, with only 3% free of all the morbidity conditions considered. Gynecological morbidity, together with urinary tract infection and syphilis, showed that 35% of the women had 1 morbidity, 34% had 2, and 17% had 3 or more morbidities. Regression analysis of risk factors demonstrated that social conditions and medical factors contributed to these diseases. Reproductive tract infections occurred more frequently with uterovaginal prolapse, IUD use, presence of husband (regular sexual activity), and unhygienic behavior. Genital prolapse increased with age and number of deliveries. Age, recent pregnancy, education, socioeconomic class, and workload revealed significant associations with related morbidity conditions. The risk of anemia was significantly related to age and to a pregnancy within the previous 2 years. With every increase of 1 year of age, the risk of hypertension increased by 9%. For every increase of 1 year of age, the risk of obesity increased by 7%. Women with the highest level of education had a 3 times greater risk of urinary tract infection than did uneducated women, while women of low-middle socioeconomic status had almost 4 times the risk of women in the lowest class.

Risk factors for spontaneous abortion and its recurrence.

Pregnancy histories of women interviewed as normal population controls during 1974-1981 in four case-control studies in the US and Canada were examined to identify risk factors for the occurrence of miscarriage. In total, 2,068 ever-gravid women aged 20-79 years at interview (mean age, 50.3 years) described 6,282 pregnancies, including 805 miscarriages. The roles of previous pregnancy history, age at pregnancy, and other factors were evaluated using relative risk binomial regression methods (similar to logistic regression). Risk of miscarriage during a given pregnancy was found to increase directly with the number of previous miscarriages (the risk was closely approximated by (1 + number of prior miscarriages)1.01), but appeared to be unrelated to the order of miscarriages within all previous pregnancies. Maternal age was also highly related to risk after controlling for gravidity and previous miscarriages, with doubled risk (compared with age 20 years) seen for pregnancies in women older than age 40 years. Risk of miscarriage did not appear to be associated with years since previous pregnancy, height, weight or obesity, use of oral contraceptives within one year before pregnancy, or duration of oral contraceptive use. A slight increase in risk was seen for women who had ever regularly smoked cigarettes (relative risk = 1.14, 95 per cent confidence limits = 1.00, 1.30). Thus, the levels of risk of miscarriage found in this analysis are similar to those of previous studies, and the analytic methods suggest how age, obstetric history, and other factors can be simultaneously examined for associations with such risk.

PIP: Data from 4 case-control studies conducted in the US and Canada in 1974-81 were examined to identify risk factors for spontaneous abortion. The 2068 women aged 20-79 years at interview whose histories were investigated reported 6282 pregnancies, including 805 spontaneous abortions. Relative risk binomial regression methods were used to evaluate the roles of factors such as previous pregnancy history and age at pregnancy. The risk of miscarriage during a given pregnancy was found to increase directly with the number of previous miscarriages, but was unrelated to the order of miscarriages within all previous pregnancies. Age at pregnancy was also a risk factor. With adjustment for gravidity and number of previous spontaneous abortions, the relative risk of miscarriage remained near unity through age 30 years, after which it increased to 2.0 at age 40 years and 3.0 at age 45 years. The risk of spontaneous abortion was not associated with years since previous pregnancy, height, weight or obesity, use of oral contraceptives (OCs) within the year before pregnancy, or duration of OC use. There was a slightly increased risk (1.4) of spontaneous abortion among women who had ever regularly smoked cigarettes. The findings of this analysis are consistent with those of previous investigations and suggest that age at pregnancy and number of prior miscarriages are important variables in predicting the occurrence of spontaneous abortion.

Cholesterol, lipoproteins, and coronary heart disease in women.

In the United States, coronary heart disease is the major cause of death and disability in women and in men. Despite this, little is known about the risk factors, including cholesterol and lipoprotein concentrations, for coronary disease in women. In this paper we review the determinants of cholesterol and lipoprotein concentrations in women, assess whether values for total cholesterol and lipoproteins (HDL and LDL) are associated with the occurrence of coronary heart disease in women, and evaluate the evidence that suggests that modifying the concentrations of lipids in women is associated with changing the risk of coronary disease. Besides genetic determinants, dietary cholesterol, dietary fat, total caloric intake, alcohol consumption, cigarette smoking, and physical activity are known to influence concentrations of lipids in women. Some of the strongest determinants of cholesterol and lipoprotein concentrations in women are sex hormones, including estrogen and progestin. Exogenous use of both of these hormones markedly influences HDL and LDL cholesterol; additional evidence suggests that endogenous sex hormones also influence lipid and lipoprotein concentrations. The few studies that have examined the association of total cholesterol with coronary heart disease occurrence and mortality in women have consistently shown that (a) women have much lower rates of coronary heart disease than men at the same values for cholesterol, and (b) clearly elevated risk for coronary heart disease in women is evident only at relatively high values of total cholesterol (i.e., greater than 260 mg/dL). There also appears to be an age effect, with total cholesterol concentrations being more predictive in older than in younger women.

PIP: Based on 9 prospective studies and other clinical data the author reviews the role of lipids and lipoproteins as predictors of coronary disease and analyses the determinants of cholesterol and lipoprotein concentrations in women. 1 of the studies showed that women with cholesterol concentrations of more than 295 mg/dl had rates of myocardial infarction 60% lower than men with concentrations smaller than 204 mg/dl. The rate of coronary disease in women with cholesterol concentrations exceeding 265 mg/dl was 3 times higher than in those with the lowest cholesterol concentration. In 2 American studies an increase of 10 mg/dl in HDL was associated with a 42-50 % reduction of coronary risk in women. However, LDL did not prove to be powerful in predicting cardiovascular disease in women. In connection with the determinants of lipid levels it was found that only 2% of hypercholesteremia was associated with major gene effects. In women with type II hyperlipoproteinemia total serum and LDL cholesterol levels were reduced by 9% and HDL levels by 10% as a result of an isocaloric diet with low cholesterol intake. In a study obesity was significantly and negatively correlated (P0.0001) with HDL concentrations. Drinkers had HDL cholesterol concentrations 6 to 18% greater than nondrinkers. all formulations of oral contraceptives were found to increase LDL cholesterol concentrations.

[The obese woman: pregnancy and contraception]. / La femme obese; la grossesse et la contraception.

PIP: Obesity is a risk factor for women in both pregnancy and contraception. Obesity per se does not cause sterility, but problems in gonadotropic function can arise during periods of rapid weight gain in bulimic episodes. Dysovulation is more common in such cases than amenorrhea. In established obesity, anovulation may occur, as demonstrated by the temperature curve and hormonal levels, but it is usually due to other factors such as ovarian polycystic syndrome or Cushing's syndrome. The main problems of obesity during pregnancy are carbohydrate metabolic disorders and hypertension. In 1 study, hypertension was found in 42.4% of pregnancies of obese women vs. 5.84% in controls; 22% of cases were severe, with blood pressure over 160/100. Carbohydrate metabolic difficulties were found in 11.8% of obese subjects vs. 1.2% of controls. The main consequence of maternal obesity on the child is macrosomy; occurring in 21.3% of births vs. 5.8% in controls. 5.1% of births to obese women are postmature vs. .7% in controls. The rate of cesareans for obese women is high. Improved fetal prognosis in pregnancies of obese women requires increased clinical surveillance for signs of hypertension or excessive weight gain and laboratory monitoring of glucose metabolism every month or even every 2 weeks. A sonogram should be done to detect macrosomy. A careful diet of 1200-1500 calories per day is recommended. 40% should be protein and 30% lipid. Rapid-absorption sugars should be excluded. Oral contraceptives appear to cause weight gain because estrogen stimulates the appetite and progestins have an anabolizing action. If weight gain exceeds 3 kg, a low dose pill and a restrictive diet should be recommended. OCs should be terminated if weight gain continues, and anomalies of glucose or lipid metabolism should be ruled out. Obesity constitutes a relative contraindication for use of combined OCs. Combined OCs may aggravate the obesity. Obesity on the other hand is a risk factor for cardiovascular accidents in OC users. IUDs are preferred for multiparous obese women. Nulliparas and multiparas with absolute contraindications to IUDs can use low-dose OCs if there are no other cardiovascular risk factors, no weight gain, and blood pressure and lipid and glucose metabolism are checked every 6 months. If these conditions cannot be met, the use of condoms or spermicides is recommended.^ieng