Focus on Women
Seminar Explores Obesity Research, Stigma

By Abhijit Ghosh

"We need to fight obesity, not fat people," declared Dr. Marlene Schwartz of the Yale Center for Eating and Weight Disorders at a recent seminar on obesity in women's health sponsored by the Office of Research on Women's Health. Four speakers discussed their research findings.

Schwartz led an interactive exercise by having the audience complete a quick test of weight bias. The results reflected, according to Schwartz, internalized attitudes influencing how a person treats others. Such bias has wide-ranging impact, including health providers, teachers and the community. Schwartz said the origin of such bias can be traced to cultural values; we tend to place a high value on thinness and reinforce messages such as, "If only you work hard enough," from the diet and beauty industries.

Schwartz showed explicit bias from health care providers who viewed obese patients as non-compliant and lacking self-control.

Dr. Marlene Schwartz Dr. Robert Kuczmarski of the Division of Digestive Diseases and Nutrition, NIDDK, discussed the special needs and concerns of women in the context of the increasing prevalence of obesity in the U.S. Many prevalence estimates have been made using the Body Mass Index (BMI) — a calculation that measures weight in relation to height and is closely associated with degree of body fat. In general, a person with a BMI of 18.5 to 24.9 is considered of healthy weight; a person with a BMI of 25 to 29.9 is considered overweight, and a person with a BMI of 30 or more is considered obese. The location of excess fat is also important, especially for women. According to Kuczmarski, carrying extra weight at the waist brings a higher risk of health complications than extra weight on the hips and thighs.

Dr. Robert Kuczmarski The basic mechanism of becoming overweight or obese is a result of energy imbalance — either too much energy intake and/or too little energy expenditure, Kuczmarski explained. Current research indicates that with 70 percent of women employed, they are finding little time for exercise. This leads to an increasingly sedentary lifestyle with accompanying energy imbalance. He suggested that small weight loss (10-15 percent of body weight) may reduce obesity-related co-morbidities such as type 2 diabetes, irregular menses and pregnancy complications.

Dr. S. Bryn Austin Dr. S. Bryn Austin of the division of adolescent medicine at Boston's Children's Hospital discussed research combining obesity prevention and eating disorders prevention initiatives in adolescent girls. In the Planet Health Study, the primary conclusion was that girls in the intervention group were less than half as likely as girls in the control group to adopt disordered weight-control behavior. Austin suggested a classroom initiative focusing on nutrition, physical activity and reduced television viewing.

Dr. Lewis Kuller Dr. Lewis Kuller of the University of Pittsburgh emphasized the role of waist circumference as an indicator of health problems. As women age between 40 and 55, they generally gain 1-2 pounds per year. According to Kuller, this change may be partially due to estrogen deficiency. Weight gain from premenopause through postmenopause is common and heightens risk of illness. An elevated BMI for postmenopausal women is a major risk factor for uterine and breast cancer, Kuller said.