Women and the Battle of the Bulge

Women and the Battle of the Bulge
By Myriam Z. Allende-vigo, MD,MBA, FACP, FACE

Why is it so hard for women to win the battle of the bulge? Is it stress, female hormones, food cravings, or is it in the genes? Or, is it a combination of some or of all these factors? The truth is that most womenin the U.S. (and many men as well, so no smugness here!!) are either overweight or obese and must fight the battle of the bulge lifelong.

FIRST, WHAT IS CONSIDERED BEING OVER WEIGHT AND WHAT IS CONSIDERED BEING OBESE?

Surprisingly, this is not as easy a question as it might seem. Experts continue to debate whether weight alone can define this (but 100 pounds might be too much if your height is three feet—hardly too much if your height is 10 feet), or whether we should use a measure of your waist (called waist circumference). Also hotly debated in recent years is whether we should use the BMI (body mass index), a measurement of the relationship between how tall you are and how much you weigh, to determine obesity. By agreement between experts, if your BMI is over 25, you are considered overweight, but if more than 30, then this is considered obese. A note of caution: for some individuals of different ethnicities, these criteria just do not hold, so check with your healthcare professional to review your personal data.

SECOND, WHY FIGHT THE BATTLE OF THE BULGE?

Sadly, much of the stigma of being overweight comes from the condition being viewed negatively in our society. Top performers, models, artists and athletes are pictured as being thin. Successful women are pictured as thin persons. And there is considerable data that overweight or obese people are discriminated against, not receiving merit promotions in their job and earning less than their thinner colleagues. Even personal goals of appearance do not favor being overweight. Excessive accumulation of fat around the waistline, arms, thighs and legs just doesn't look good—and there are many industries built around hiding this, trying to eliminate this cosmetically, surgically and through other means! But besides looks, the excess weight overweight women carry conveys a clear threat to a good health status and even one’s longevity.

Although not all overweight women will have poor health, they tend to be less physically active and generally report that they have less energy and more fatigue. The contrast between desired appearance and the figure staring back at you from the mirror may bring out depression and mood changes. And, yes, overweight women are more prone to develop diabetes, hypertension, heart disease, gallstones, arthritis and gout.

Obese women also may have polycystic ovaries, which can affect their ability to conceive and carry a pregnancy to completion. If an overweight woman gets pregnant, her chances of developing hypertension or high blood sugar while pregnant are much higher than a woman who is at a healthy weight. Obesity has also been linked to some types of cancer, such as colon, breast and uterus.

THIRD, SO WHY IS IT SO HARD TO LOSE WEIGHT

Sorry, but there’s no clear answer from the experts! This may have to do with the regulation of the satiety (feeling full from food) center in your brain and may be the way your body burns up the calories eaten. It certainly has to do with the amount of food you eat and the physical activity you perform, which might be different for each of us, adding to the frustration of why a certain amount of calories can be eaten by one person and weight remains at a healthy level, but the next person gains on the same calorie amount.

And there are many contributors to influence our eating. Much attention has been directed recently to the importance of getting enough sleep. Research shows that when sleep is shortened, which in present- day society is a frequent occurrence, there is increased intake of calorie-dense foods, which over time will lead to weight gain...in women as well as in men.

Additionally, we are only beginning to learn about the effects of stress on eating behavior. Although for some people (both women and men), acute stress can reduce appetite, there is a sizable population that turns to food for comfort, particularly women. Studies show that the particular foods people choose to eat, or overeat, when stressed are often foods that they normally avoid for weight control or health reasons, almost suggesting that stress can cause a loss of the control a person usually has to prevent themselves from eating what they know as fattening, unhealthy foods. So under stress, people tend to reach for snack foods. Added to this is the finding that eating such snacks has no effect on how much is eaten in a subsequent meal when in a stressful condition. So, there is clearly an increase in overall total caloric intake. Thus, someone who has stress frequently (and who doesn’t?) can wind up overeating highly caloric snack foods, often frequently, in an attempt to make themselves feel better. And women in particular are prone to eating in stressful situations, perhaps as an effect of being “mom,” who provides the hot chocolate for you when you have had a bad day. This becomes a rewarding behavior for mom, as she feels better that you feel better, but it’s not so good for her weight if she joins you.

SO WHAT CAN WOMEN DO TO WIN THE BATTLE OF THE BULGE?

It is important to stay physically active. The unfortunate and often typical lifestyle of constant sitting is no healthy. Ask for a standing workstation where you work—or at least one where you can stand some of the time. Very recent research suggests that just changing from sitting to standing can have a positive health impact. Use your breaks not to catch up or continue working at your computer, but get up and walk around. Walk the perimeter of your building at work or walk around the block if at home. Walk the stairs rather than the escalator. If you’re in an airport waiting for a flight, walk up and down the concourse. Try packing your grocery bags half full, so you have to make more trips from the car to the kitchen. Wear your iPod or plug into your portable music device when dusting or vacuuming and dance to the music. It’s great if you have the time for a sports club, but there are many ways to get the same activity in without club fees or the extra effort of having to travel to get your physical activity.

Be choosy with your food choices. That cookie or cupcake might look tempting, but think of the calories that come with it. Favor fruits and vegetables over chips and crackers. Make some dips for the veggies: mix herbs with yogurt or with low-fat mayonnaise if you or your family would like additional flavor. Chose lean meats, poultry and fish which can be a great source of low-fat protein.

And finally, choose a target healthy weight. Discuss what this might be with your health care team and keep that target in mind as you shop for groceries, go out to eat, and choose whether to use stairs or the escalator. When it’s all said and done, you are in charge of your health!

Dr. Myriam Z. Allende-Vigo Is Endocrine Section Director of the Department of Medicine at the University of Puerto Rico Medical Sciences Campus. She has lectured and researched in the fields of diabetes mellitus, lipid disorders and osteoporosis. Dr. Allende is a past president of the Puerto Rican Society of Endocrinology and Diabetology (SPED) and is the recipient of the 2006 American Association of Clinical Endocrinology Outstanding Endocrinologist Award.