Tag Archives: Obesity

Bariatric Surgery Before Pregnancy Benefits Moms, Babies

picture-35Women who get pregnant after having weight-loss surgery have a lower risk of maternal and newborn complications than pregnant women who are obese, according to U.S. researchers who analyzed 75 studies.

Data from those studies showed that bariatric surgery in the United States increased by 800 percent between 1998 and 2005 (from 12,480 to 113,500). Women accounted for 83 percent of procedures among patients ages 18 to 45. Between 2003 and 2005, more than 50,000 women in this age group had inpatient bariatric surgery each year, which accounted for 49 percent of all bariatric surgeries.

The review authors found that pregnant women who’d had bariatric surgery had lower maternal complication rates than obese women, including gestational diabetes (0 percent vs. 22.1 percent) and preeclampsia (0 percent vs. 3.1 percent). In addition, maternal weight gain was reduced in women who’d had bariatric surgery.picture-25

Newborn outcomes among women who’d had laparoscopic adjustable band surgery were similar or better than outcomes among obese women: premature delivery, 7.7 percent vs. 7.1 percent; low birth weight, 7.7 percent vs. 10.6 percent; overly large body (macrosomia), 7.7 percent vs. 14.6 percent.

The findings were published in the Nov. 19 issue of the Journal of the American Medical Association.

“Research is needed to better delineate the extent to which surgery and subsequent weight loss improve fertility and pregnancy outcomes,” the review authors wrote. “Optimizing success for contraception and producing healthy neonates following surgery will require a multidisciplinary effort by surgeons, primary care physicians, reproductive fertility specialists, obstetricians, and patients.”

Having bariatric surgery during childbearing years may change a woman’s fertility following weight loss, alter nutritional requirements during pregnancy, or impact contraception, the researchers noted.

Complications of Bariatric surgery:

Early complications of these operations can include bleeding, infection, leaks from the site where the intestines are sewn together, and blood clots in the legs that can progress to the lungs and heart.

Examples of complications that may occur later include malnutrition, especially in patients who do not take their prescribed vitamins and minerals. In some cases, if the malnutrition is not addressed promptly, diseases such as pellagra, beri beri, and kwashiorkor may occur along with permanent damage to the nervous system. Other late complications include strictures (narrowing of the sites where the intestine is joined) and hernias.

Two kinds of hernias may occur after a patient has bariatric surgery. An incisional hernia is a weakness that sticks out from the abdominal wall’s fascia (connective tissue) and may cause a blockage in the bowel. An internal hernia occurs when the small bowel is displaced into pockets in the lining of the abdomen. These pockets are created when the intestines are sewn together. Internal hernias are considered more dangerous than incisional ones and need prompt attention to avoid serious complications.

Research indicates that about 10 percent of patients who undergo bariatric surgery may have unsatisfactory weight loss or regain much of the weight that they lost. Some behaviors such as frequent snacking on high-calorie foods or lack of exercise can contribute to inadequate weight loss. Technical problems that may occur with the operation, like a stretched pouch or separated stitches, may also contribute to inadequate weight loss.

Some patients may also require emotional support to help them through the postoperative changes in body image and personal relationships.


Bariatric surgery may be the next step for people who remain severely obese after trying nonsurgical approaches, especially if they have an obesity-related disease. Surgery to produce weight loss is a serious undertaking. Anyone thinking about undergoing this type of operation should understand what it involves. Answers to the following questions may help you decide whether weight-loss surgery is right for you.

Is surgery for you?

Are you:

– Unlikely to lose weight or keep it off over the long-term with     nonsurgical measures?

– Well informed about the surgical procedure and the effects of treatment?

-Determined to lose weight and improve your health?

– Aware of how your life may change after the operation (adjustment to the side effects of the operation, including the need to chew food well and inability to eat large meals)?

– Aware of the potential risk for serious complications, dietary restrictions, and occasional failures?

– Committed to lifelong healthy eating and physical activity habits, medical follow-up, and vitamin/mineral supplementation?

Remember: There are no guarantees for any method, including surgery, to produce and maintain weight loss. Success is possible only with maximum cooperation and commitment to behavioral change and medical follow-up—and this cooperation and commitment must be carried out for the rest of your life.



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Fat mums 43 per cent more likely to miscarry

Overweight women are at greater risk of miscarrying a genetically normalpicture-131
baby in the early stages of pregnancy than women who maintain a healthy
weight, according to a new study by scientists at the Stanford University
School of Medicine in California, US. The researchers, presenting at the
annual American Society for Reproductive Medicine (ASRM) conference,
suggested that this indicates that a mother’s weight can affect the outcome
of an otherwise healthy pregnancy.
The UK’s National Health Service (NHS) estimates that around a quarter
of all pregnancies in the UK end in miscarriage. The majority of these occur
in the first 12 weeks of pregnancy, but can occur up to 24 weeks. The cause
of miscarriage is not always known, but it is thought that between 50 and 70
per cent occur as a result of chromosomal abnormalities (genetic defects) in
the fetus. The California researchers tested DNA from 204 fetuses miscarried
in the first eight weeks of pregnancy. They compared the rate of chromosomal
abnormalities in the fetuses from women with a normal body mass index (BMI)
with the rate of abnormalities in fetuses from women with a BMI that
classified them as overweight or obese. They found that 53 per cent of
babies lost by overweight women had no chromosomal abnormalities compared to
just 37 per cent of babies lost by women of a more healthy BMI.
Dr Inna Landres, who led the research team, said that these findings
indicate that ‘obesity predisposes women to miscarry normal babies.’ The
reason for this is not yet understood, but Dr Landres suggested that one
explanation could be altered levels of hormones such as oestrogen and
androgens seen in overweight women. She emphasised: ‘It’s important to
identify elevated BMI as a risk factor for miscarriage and counsel those
women who are affected on the importance of lifestyle modification.’
An individual’s BMI is calculated by dividing their weight in kilograms
by their height in metres squared. A BMI of 18 to 25 is considered normal,
whilst over 25 is classed as overweight and over 30 as obese. All the women
in the current study were attending an academic centre for fertility
counselling and had their BMI calculated before conception.
Dr Mark Hamilton, chairman of the British Fertility Society (BFS), said:
‘It is recognised that women who are overweight are at a greater risk of
miscarriage. It has not been defined if that risk is related to genetic
problems for the embryos or the obesity itself is linked to implantation
mechanisms. This study will aid our understanding of the known association
with being overweight and reproductive loss.’

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Insulin resistance : a root cause of PCOS

Are you one of the millions of women with Polycystic Ovarian Syndrome who, no matter what they’ve tried, has failed to better manage or reverse the symptoms of this condition? It may not be due to lack of willpower. Instead, you could be Insulin Resistant, a root cause of PCOS. Scientists at the National Institutes of Health, Stanford University and other research centers have clearly identified the existence and effects of Insulin Resistance, a biochemical condition that can cause excessive weight gain and Polycystic Ovarian Syndrome.



Polycystic Ovarian Syndrome is a hormonal imbalance linked to the way the body processes insulin after it has been produced by the pancreas to regulate blood sugar (glucose). Insulin Resistance, an underlying cause of PCOS, has many factors that contribute to its presence in the body. In essence, our environment and lifestyles have evolved too rapidly for our bodies to keep pace. We are still genetically “wired” to thrive on the entrenched habits of our ancestors, who consumed different, nutrient-rich foods and a diet low in carbohydrates and who sustained greater levels of movement and exercise. Some people may also have a genetic predisposition to Insulin Resistance, while others develop the condition through high stress and unhealthy lifestyles.


Over time, the above factors have damaged the complex ability of the body’s cells to properly utilize insulin to convert glucose to energy. This process creates Insulin Resistance.

Insulin Resistance vastly reduces the insulin sensitivity of cells, which impairs the processing of glucose through the cell wall for conversion to energy. As a result, glucose remains in the blood stream, causing elevated levels of blood sugar, which are sent to the liver. Once there, the sugar is converted into fat and stored via the blood stream throughout the body. This process can lead to weight gain and obesity, key factors in creating PCOS, which is also referred to as Polycystic Ovarian Disease or PCOD.



Insulin Resistance can also cause PCOS is by raising insulin levels in the blood stream. Unhealthy lifestyles and genetic conditions can lead to the pancreas overproducing insulin. This excess insulin stimulates the ovaries to produce large amounts of the male hormone testosterone, which may prevent the ovaries from releasing an egg each month, thus causing infertility. High levels of insulin also increase the conversion of androgens (male hormones) to estrogens (female hormones), upsetting a delicate balance between the two and having a direct effect on weight gain and the formation of cystic follicles or ovarian cysts.




The symptoms of Polycystic Ovarian Syndrome vary widely from woman to woman. In addition to polycystic ovaries, they can also include: irregular or completely absent periods, Hirsutism (excessive facial or body hair), Alopecia (male pattern hair loss), obesity, acne, skin tags (raisin-like growths on the skin), Acanthosis Nigricans (brown skin patches), exhaustion or lack of mental alertness and decreased sex drive. Because the symptoms vary so widely and not all women display all the symptoms, doctors very often misdiagnose PCOS. This became an issue of critical concern after a study in 2000 found that women suffering from PCOS have a higher risk of coronary heart disease.

Researchers discovered a link between Polycystic Ovarian Syndrome and other metabolic conditions such as obesity, high blood pressure and high levels of LDL “bad” cholesterol, all of which are risk factors for coronary heart disease.

Studies have also shown an increased link between PCOS and atherosclerosis, which occurs when fatty deposits called plaque cling to the interior walls of the arteries, leading to blockages that can cause heart attacks or stroke. Not only do PCOS sufferers have higher rates of plaque buildup but those over 45 have thicker deposits of plaque.

Another report indicated that up to 40% of women with Polycystic Ovarian Syndrome have either impaired glucose tolerance or Type 2 Diabetes by the age of 40.

All these findings substantially raise the bar on the seriousness of PCOS, making it even more important that doctors correctly diagnose the condition and instruct their patients about Insulin Resistance.

Posted by : Goral Gandhi, MSc,

                   Laboratory Director,

                   Rotunda – Center for Human Reproduction (Pvt) Ltd


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Brain ‘master switch’ controls reproduction, weight

Recent studies describe a genetic “switch” in the brain that is regulated by the hormone leptin and appears to link reproductive function and body weight. Scientists are closer to understanding the links between body weight and fertility after finding a genetic “master switch” that influences both.

 Although the switch was characterized in the brains of mice, lead study author Marc Montminy from the Clayton Foundation Laboratories for Peptide Biology in La Jolla, San Diego, California, USA, noted that, “because this gene is crucial to the daisy chain of signals that run between body fat and the brain, it likely plays a pivotal role in how much we, as humans, eat and whether we have offspring.”

 Montminy and colleagues discovered the gene, known as TORC1, while studying appetite-regulating hormones such as leptin that carry information from fat tissues to the brain.

The investigators studied mice lacking TORC1 and found that these animals rapidly became obese after birth and were usually infertile.

Further study showed that TORC1 responds to leptin by up-regulating the Cocaine and Amphetamine Regulated Transcript gene (CART), which suppresses appetite, and turning on the KISS1 gene, which is essential for normal reproductive function.

 In the absence of leptin, therefore, appetite is not adequately suppressed and reproductive functioning is abnormal, the researchers explain.

 They conclude that, since TORC1 is kinase regulated, it should make a good target for therapeutic intervention to treat both obesity and infertility.

Posted by : Goral Gandhi, MSc,

                   Laboratory Director,

                   Rotunda – Center for Human Reproduction (Pvt) Ltd

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Male Infertility and Obesity

Recent studies have found a link between male fertility problems and obesity. In fact, being overweight or obese is one of the central causes of male infertility and more specifically, of sperm health problems. But how exactly does a man’s weight affect his fertility and what types of male fertility problems does being obese cause?

A study found that men with a higher body mass index (BMI) had a significantly higher risk of being infertile compared with men considered to be normal weight. In fact, the study found that an increase of just 20 lbs. could increase the chance of male infertility by approximately 10%.

BMI is a tool that measures weight proportionate to height and helps to calculate an individual’s body fat. Individuals with a lot of muscle sometimes have higher BMIs due to the fact that muscle tissue weighs more than fat tissue.

 A BMI of 18.5 to 24.9 is considered to be normal for adults while a BMI of more than 25 is considered to be overweight. Obesity is defined as having a body mass index of more than 30 while morbid obesity is characterized by a BMI of 40 or higher.

 A separate study found that a link between obesity and sperm health. The study compared male BMI to DNA fragmentation in sperm. As BMI, so too did the fragmentation of sperm DNA in the participants. Deteriorated sperm quality increased significantly as BMI passed 25 and was acute in participants whose BMI was over 30. Fragmented sperm DNA is linked to reduced fertility as well as an increased risk of miscarriage.

 In addition, obesity can have a number of other effects on male fertility:

    * low sperm count and concentration

    * hormonal imbalance

    * increased scrotal temperature

    * decreased libido

 As such, it is important to maintain good overall health in order to reduce the risk of male fertility problems and in order to maintain good reproductive health. Following a healthy diet and exercising regularly are important steps in reducing weight can help to achieve a healthy weight as well as improve sperm health. Talk to your doctor about starting a healthy exercise regimen and for advice on healthy eating in order to make important lifestyle changes that can help to increase your fertility.


 Sperm Health:

 Sperm health is vital to increasing a couple’s chances of getting pregnant. While certain genetic conditions might affect a man’s sperm health, there are a variety of factors, ranging from environmental to lifestyle, that also influence male fertility. As such, men can follow simple sperm health tips in order to increase fertility so as to improve their partner’s chances of getting pregnant.

Sperm Health Tips that Can Help Improve Male Fertility

The following tips can help to alleviate male fertility problems so as to improve a couple’s chances of getting pregnant:

   * don’t smoke. Smoking is linked to sperm health problems. While smoking has not been linked to a lowered sperm count, it does cause damage to sperm DNA, which results in an increased risk of birth defects in a man’s children. Because it takes three months for sperm to fully form, it is imperative to quit smoking at least three months prior to trying to get pregnant in order to reduce the risk of birth abnormalities

    * . don’t do drugs. Drug use also negatively influences sperm health. For example, marijuana increases the number of abnormal sperm produced, as well as lowers overall sperm count.

    * limit your alcohol intake. Reducing your alcohol consumption to no more than two drinks a day is also important to male fertility. In fact, excessive drinking can lead to impotence.

    * try herbal solutions. Herbal remedies, such as green tea and gingko, are excellent male infertility solutions. Gingko helps to improve sperm healthy by promoting blood circulation to the capillaries while green tea helps to improve overall health, including reproductive health.

    * maintain a healthy weight. Because being either overweight or underweight can influence sperm health, maintaining a healthy weight is crucial in order to increase male fertility. A BMI of less than 20 or of more than 25 can reduce a man’s sperm count by 22%. Your BMI can be calculated by dividing your weight in kilograms by your height in meters squared. Following a healthy diet that is low in saturated and trans fats and that is high in folic acid, zinc, vitamins A, C and E is essential to staying healthy. Exercise can also help to maintain good weight.

    * get sun exposure. A healthy amount of sun exposure is linked to increased levels of testosterone, which in turn is connected to healthy sperm production. In addition, sun exposure is linked to lower levels of melatonin, which are known to negatively impact male fertility.

    * don’t overdo it. Studies have shown that ejaculating more than twice a day can have a negative effect on male fertility. This is because it takes some time for sperm levels to rise again following ejaculation. Nonetheless, it is important to have intercourse with your partner on a regular basis because sperm that is not ejaculated becomes old and less fertile, thereby reducing the chances of getting pregnant.

    * avoid heat. Overheating of the testicles can reduce sperm health. It is important for men to avoid wearing tightly fitting pants and undergarments, as well as to avoid hot baths and hot tubs. Also, placing a laptop on a table or desk as opposed to directly on the body also reduces the risk of sperm health damage.

    * reduce stress. Stress is a major contributing factor to sperm health problems. In fact, 15% of men experience decreased libido because of stress, while 5% of men experience impotence because of it. Practicing relaxation methods such as Pilates can help to minimize stress, as does participating in regular exercise.


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