Obesity and Reproduction

Wendy S. Vitek, MD

Obesity, defined as a body mass index (BMI) greater than 30 kg/m², is a highly prevalent chronic disease that increases health risks in nearly every body system, including the reproductive system. Obesity rates in the United States have tripled over the past 60 years and severe obesity has risen 10-fold. Similar trends in the prevalence of obesity are observed in counties that adopt a Western diet and lifestyle, fueled by industrialized foods, sedentary behaviors, inadequate sleep, and chronic stress due to structural inequality. While obesity is multifactorial, the rise in obesity coincides with the rise in ultra-processed foods, a likely culprit driving the global obesity epidemic. Ultra-processed foods are industrial foods composed of manufactured, calorically dense ingredients that are self-stable, convenient, low cost, and appealing to food cravings. Nearly 60% of the diet consumed by U.S. adults is composed of ultra-processed foods, possibly the highest consumption of any country. The Western diet and lifestyle have been linked to both female and male infertility and the negative impact of ultra-processed foods on fertility is starting to emerge in the literature.

While the solution to combating obesity likely lies in food policy and public health initiatives, clinicians are increasingly faced with the challenge of treating women and men with obesity who experience infertility and recurrent pregnancy loss. This issue of Seminars in Reproductive Medicine provides a comprehensive update on how obesity impacts all aspects of reproduction and infertility treatment in women and men from the perspectives of academic clinicians in Reproductive Endocrinology and Infertility, Urology and Medical Endocrinology. First, Dr. Adam Evans provides a framework for recognizing and addressing weight stigma in women with obesity who seek reproductive health care. Next, Dr. Scott Gabrielsen, Dr. Carl Ceraolo, and Dr. Amanda Rubano walk us through a thought-provoking review of the literature that questions whether or not obesity truly impacts male fertility and the physiologic mechanisms by which obesity may alter male reproduction. The following three articles focus on obesity and female fertility. Dr. Christina Boots and Samantha McLean explore how excess weight and miscarriage are correlated and the limitations of the observational evidence. They provide a framework for providing compassionate and patient-centered approach to addressing obesity in women with miscarriage as weight loss does not clearly improve reproductive outcomes. Dr. Samantha Schon, Dr. Emily Ferrell, and Dr. Abira A. Choudhry provide a concise review of the impact of obesity on IVF outcomes and how to plan IVF care in women with obesity accordingly. Dr. Stephanie Estes and Dr. Ciara Marshall provide an in-depth review of the surgical challenges of providing safe ambulatory reproductive surgery and offer tips for avoiding musculoskeletal strain and injuries in the surgeon when operating of patients with larger bodies. Finally, Dr. Alyse Goldberg, Dr. Samin Dolatabadi, Dr. Heidi Dutton, and Dr. Jamie L. Behham explore the application and safety of anti-obesity medications in the preconception period in women with obesity and infertility, a timely review given the meteoric rise in the use of GLP-1 agonists among reproductive-age women.

Given that obesity rates, and the severity of obesity, are projected to increase, clinicians in reproductive medicine must adapt to provide inclusive infertility care for women and men with obesity. Obesity is not the result of an individual patient's failure to regulate their diet and activity through willpower, but a failure to create an environment that supports optimal diet and lifestyle in the face of seismic societal and technological changes that have made an obesogenic lifestyle the norm. Blaming and shaming patients with obesity and infertility is not the answer. Nor is advising patients to try harder to lose weight through restrictive dieting and over-exercising as the data do not support the efficacy of these approaches to improve reproductive outcomes. The authors in this issue provide a roadmap to delivering respectful, safe, and effective infertility care for our patients with obesity - if we are willing to see them as more than a BMI number.

Publikationsverlauf

Artikel online veröffentlicht:
10. Januar 2024