We are in the middle of a global obesity epidemic. While the US leads the way, you can see evidence of the trend around the world, from Mexico to China, and from India to Saudi Arabia and the UK, and the number of obese people in these countries continues to increase. In eastern Taiwan, 50 percent of the population is obese, with a slightly higher percentage among Aborigines, and there are more obese females than males. This phenomenon has already started having an effect on health and fertility.
During her lifetime, a woman will only ovulate around 400 times, whereas a man will release thousands of sperm on each ejaculation. Obesity has a far greater influence on female fertility than on male fertility. When a woman is overweight, she will find it more difficult to find a partner compared with her overweight male counterpart. Many overweight women resort to surgical procedures to lose weight, but these involve risks, are prohibitively expensive for many and have side effects.
Obesity carries consequences in all stages of life, from conception to death. The prelude begins from when the ova are first formed. As we have learned from studies of artificial insemination, implantation rates, pregnancy rates and live birth rates differ greatly between overweight women and those of normal body weight.
Overweight women have a higher risk of miscarriage in the early stages of pregnancy, with an increased chance of repeat miscarriages thereafter. There is also a heightened risk of a range of complications during the pregnancy and an increased incidence of dysplasia in the fetus. Finally, overweight women are more likely to require additional medical care during their pregnancy.
The children of overweight mothers are often overweight themselves, and the proportion of overweight children in the nation has already reached 20 percent. Type-II diabetes, also known as adult-onset diabetes because it normally strikes adults, is now the most common form of diabetes seen in the nation’s children. There are six times more children with Type II than there are with juvenile diabetes. Obesity is the main cause of the diabetes epidemic in children and teenagers.
When parents need to work nights and part-time jobs in order to supplement the household income, they do not have the time to prepare fresh vegetables for their children, feeding them instead with fast food, sugar-laden drinks, high-sugar processed foods and carbohydrate-heavy meals and snacks because of their convenience.
In most households there is little understanding of how unhealthy excessive sugar can be: The average family does not understand that a large amount of sugar has already been put into processed foods or take-out lunchboxes, that when these sugars are metabolized in the liver they are transformed into fats, and that the deleterious effects of sugars converted to fat are actually more serious than the impact of smoking or drinking alcohol.
Precocious puberty is often seen in overweight girls, but they also often have irregular menstrual cycles compared with other girls, for whom the onset of menstruation arrives around the ages of 11 or 12. However, some overweight girls do not get their first periods until after the age of 15 or 16, when they are in the second or third year of high school. These girls sometimes also have increased body hair due to increased levels of the male hormones, while others develop diabetes.
Thirty years ago, polycystic ovary syndrome (PCOS) was a rare condition only really seen in gynecological reference books. Nowadays, it is very common in children. The symptoms of PCOS include many cysts of roughly the same size appearing in the ovaries. Many who get this condition are overweight, have above average body hair, hair loss on their heads, irregular ovulation, irregular periods, infertility and increased insulin resistance.
Pregnancy is dangerous for an extremely overweight woman and her fetus alike, and puts the mother at greater risk of gestational diabetes mellitus,
pre-eclampsia, prolonged pregnancy, the need for Caesarean sections, postpartum hemorrhaging, pelvic inflammation disease, urinary tract infection and wound infections. In addition, overweight mothers are more likely to give birth to oversized or stillborn babies. In general, a systolic blood pressure in gestational hypertension of 180 is alarming, but with overweight pregnancies it can reach 230, a worrying phenomenon that obstetricians and anesthesiologists working in eastern Taiwan are nowadays seeing quite often.
The renowned physician William Osler said: “The natural man has only two primal passions, to get and to beget.” Two preoccupations: procuring and procreating. The Chinese philosopher Confucius (孔子) meant something similar when he said, “eating and sex are human nature (食色性也). These sentiments are both more eloquent, and ring more true, than the values of modern society that places importance on status and wealth. Osler was born in the mid-19th century, at a time when the world population stood at 1.2 billion. It is now over 7 billion, and is expected to break the 9 billion mark by the middle of this century.
What can we expect of this century, with rising population and growing obesity?
Chiang Sheng is an attending physician in the Department of Obstetrics and Gynecology at Mackay Memorial Hospital.
Translated by Paul Cooper
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