Many women ‘unaware they have a weight problem’

When a woman asks: “Does my bum look big in this?” she has some insight that her derriere may appear larger than desirable.

But ask a woman if she thinks she is overweight and you may be surprised by the answer you get.

When US researchers asked 2,000 women this question, many were unable to give a correct answer.

A quarter of those who were overweight were unaware that they had a weight problem and perceived their size to be “average”, even though they clearly were not.

In fact 1,000 of the women in the survey were found to be clinically obese or overweight.

Like this latest work in Obstetrics and Gynecology journal, UK researchers have also found many Brits have a skewed perception of what is fat.
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Everybody is getting heavier and, as a result, people think ‘I’m not so heavy – look at her’ and then fail to realise they themselves have a problem”
Tam Fry
National Obesity Forum
Obese the new “norm”

A YouGov poll of 2,000, carried out last year with Slimming World, found three in four obese people in the UK were unaware of their weight problem.

This survey found only 7% of people believed their weight was significant enough for them to be classified as obese, despite over a quarter of those interviewed fitting into this category.

Experts say part of the problem is that obesity is becoming normalised by society.

With two-thirds of UK adults now overweight or obese, the average size is no longer average.

Tam Fry of the National Obesity Forum says obesity is now so common-placed that we no longer see it.

“Everybody is getting heavier and, as a result, people think ‘I’m not so heavy – look at her’ and then fail to realise they themselves have a problem.”

Dr Shahrad Taheri, lead clinician in obesity at Birmingham’s Heartlands Hospital, says it is the environment that we live in that makes it hard for people to both recognise and tackle weight issues.

Our love of convenience – fast food, motorised transport and sofa-based hobbies – is making obesity inevitable.

And as clothes are being supersized to fit our plumper bodies, we may not be alerted to our growing girth.

And, typically, when obesity is covered in the media, it is the extreme cases of massively overweight people stuck in their houses that grab the headlines. Hardly an accurate barometer.

Dr Taheri said: “Our environment is designed to trick us into eating fast food and doing little exercise.

“In the UK we have the biggest obesity problem in Europe, yet we continue to have this difficulty with perception.

“It may be easy to spot those people who are very overweight, but it’s the middle of the road people that are missed.

“Experience shows that even many parents are not aware when their children have a weight problem.”

But this blinkered perspective is dangerous say the US experts who carried out the latest survey.
Society’s problem

The team from the Center for Interdisciplinary Research in Women’s Health found people who failed to realise they were overweight were far less likely to concern themselves with adopting lifestyle changes to maintain a healthy weight.

Lead researcher Dr Abbey Berenson said: “These patients are at risk for cardiovascular disease, type 2 diabetes and other serious problems.”

Dr Tony Goldstone, an obesity expert at London’s Hammersmith Hospital, explains what fat is

Official statistics suggest an obese person dies on average nine years earlier than somebody of normal weight, while a very obese person’s life is cut short by an average of 13 years.

Tam Fry believes GPs should take charge and do more weighing of their patients.

“If people themselves can see that they have a weight problem then the medical profession has to be much more observant.”

But Dr Jacquie Lavin, head of nutrition at Slimming World, said it should be up to individuals themselves to take responsibility.

“If people take responsibility themselves they are more likely to succeed in keeping weight off.

“It is easy enough to jump on a set of scales and work out your own BMI.”

She believes it is important to get back to a time where a healthy weight is again the “norm”.

“As a society, we need to offer more opportunities for people to be more active and to make healthier food choices.

“The figures suggest we seem to be making some headway with tackling childhood obesity. But for adults, we are certainly not over the worst of it yet.”

Women seeking birth control get unneeded pelvic exams

Many doctors and other health care workers require that women have pelvic exams before they can get prescriptions for birth control pills, despite guidelines saying that the step is unnecessary, a new study finds.

In a survey of 1,200 U.S. doctors and advanced practice nurses, researchers found that one-third said they always required women to have a pelvic exam before they would write a prescription for birth control pills.

An even higher percentage — 44 percent — said they “usually” required one, according to findings published in the journal Obstetrics & Gynecology.

The number of practitioners requiring a pelvic exam is disappointingly high, researchers say, considering the fact that the World Health Organization and the American College of Obstetricians and Gynecologists (ACOG) advise that birth control pills can safely be prescribed without the exam.

“We were surprised, and we were certainly hoping that the numbers would be lower,” Dr. George F. Sawaya, one of the researchers on the study, told Reuters Health.

Unnecessary hurdle
The key problem with mandatory pelvic exams is that it puts up an unnecessary hurdle to women seeking effective birth control, according to Sawaya and his colleagues at the University of California, San Francisco.

Women have to wait until their provider can fit the exam into his or her schedule; some may be turned off by the requirement altogether and opt for less-reliable forms of contraception, like condoms.

Birth control pills are the most popular form of reversible contraception in the U.S., used by 28 percent of women using contraceptives, the authors note.

“In my view, we should have as few barriers as possible to women trying to get effective birth control,” Sawaya said.

Dr. Andrew M. Kaunitz, an ob-gyn not involved in the study, agreed.

Pelvic exams, which can find potential signs of sexually transmitted infections, ovarian cysts, cancer or other disorders, are an important part of women’s routine healthcare, said Kaunitz, a professor and associate chairman of obstetrics and gynecology at the University of Florida College of Medicine-Jacksonville.

“But pelvic exams should not be linked to oral contraception in a mandated fashion,” he told Reuters Health.

There is no established medical need for women to have the exam before receiving a prescription for birth control pills, Sawaya said. It’s just that, traditionally, pelvic exams have been coupled with contraceptive prescriptions; in many cases, it may have simply been convenient for women to have a pelvic exam as part of their routine healthcare at the same time they were seeking a birth-control prescription.

“The two just became linked,” Kaunitz agreed. But while there is nothing wrong with that, he said, “women also deserve the option of un-linking those two services.”

The current findings are based on a survey sent to a national sample of 1,196 ob-gyns, family doctors and advanced-practice nurses specializing in either women’s health or family medicine.

Overall, 29 percent of ob-gyns and 33 percent of family doctors said they always required a pelvic exam for women seeking birth control pills. In addition, half of ob-gyns and about 45 percent of family doctors said they usually required the exam.

Nurses least likely to require exams
Advanced-practice nurses specializing in women’s health were the least likely to require a pelvic exam, with 16 percent saying they always did so. In contrast, nurses specializing in family medicine were more likely than all other providers to always require a pelvic exam; 45 percent said they did.

The reasons for the high rates are not clear from the study. But simple tradition could be at work, according to both Sawaya and Kaunitz. “I think old habits die hard,” Kaunitz said.

He also pointed out that among all providers in the study, those working in private practice were twice as likely as those in community and family-planning clinics to require a pelvic exam — suggesting that the clinic providers are more aware of current guidelines.

It’s also possible that some doctors require a pelvic exam in order to get the insurance reimbursement, Sawaya and his colleagues note in their report.

Medicare pays doctors about $75 for a screening pelvic exam and, depending on geography, private insurers may pay more. Contraceptive counseling, on the other hand, may not always fall into a clearly defined reimbursement category, the authors note.

“In the absence of adequate financial incentives for contraceptive counseling as an important clinical activity in its own right,” the researchers write, “providers are incentivized to conduct a physical exam with a well-reimbursed billing code.

Exams raise risks of more unnecessary tests
Along with added costs, unneeded pelvic exams also open women up to the possibility of having an abnormal finding that, upon further testing, turns out to be nothing. “Any (test) we do with an asymptomatic person has a chance of resulting in a false-positive,” Sawaya pointed out.

As for how often women should have a routine pelvic exam in the absence of any problems, there is no specific guideline. There are guidelines, however, for how often women should get a Pap test to screen for cervical cancer, which is often done in conjunction with a pelvic exam.

According to ACOG, women should begin having Pap tests at age 21, with screening repeated every two years until age 30. Women age 30 and older who have had three consecutive negative Pap tests can be screened every three years.

For women who are only seeking a birth control prescription and are told they need to schedule a pelvic exam, Sawaya suggested they ask their provider why the exam is necessary.

But he said the real message of the survey results is for practitioners, who, based on these findings, need better awareness of current guidelines on birth control prescription.

Women’s Preventive Services Needed in Health Insurance

The process of implementing the new health care law continued last week as a panel of independent experts meet to begin to develop evidence-based preventive health guidelines for women that will be used to determine what preventive services will be covered in all new health insurance plans and provided with no cost-sharing.

Under a part of the new health care law that went into effect in September, all new insurance plans are required to cover certain preventive measures like mammograms, pap smears, smoking cessation therapy and folic acid and provide them to patients at no cost. To supplement these new rules, the Institute of Medicine has been tasked with addressing serious gaps in the definition of preventive care for women and ensuring that this landmark protection meets the full range of women’s health needs. This week the Institute of Medicine’s panel of women’s health experts is holding its first meeting to begin the process of making preventive care more accessible and affordable for women.

As a part of this meeting, I testified before the panel and discussed general barriers to care that women face and recommended five services that the panel should be sure to include in their final recommendations to Department of Health and Human Services (HHS).

Women seeking affordable health care face significant and unique barriers. Women generally make less than men. With women making on average just 78 cents for every dollar a man earns, women have less money to spend on their health care. It is then not hard to imagine why more women than men have faced economic hardship due to health care needs. Women are also more likely to delay or avoid seeking care, including preventive care, due to cost. Evidence also suggests that even moderate co-pays can cause individuals, especially those with low and moderate incomes, to forgo needed preventive care.

As NWLC has shown, before the Affordable Care Act, the individual insurance market routinely failed women, making access to affordable health care even more challenging. Women obtaining identical plans to men oftentimes pay higher premiums. To add insult to injury, maternity care is rarely included in basic individual plans, and as a result women must purchase a supplemental policy to cover pregnancy. These riders can be prohibitively expensive. Women who obtain coverage through an employer are partially protected from these barriers due to federal and state employment discrimination laws, but cost and coverage challenges continue to exist.

The National Women’s Law Center also proposed five additional services to be included in the final list:

Family Planning Counseling and All FDA- Approved Prescription Contraceptive Drugs and Devices- Nearly all American women use contraceptives during their reproductive years. Family planning counseling and supplies allow women to control the spacing, timing and number of births, which leads to improved health and mortality outcomes for women and their children. The ability to plan a pregnancy can prevent a range of pregnancy related complications that can endanger a woman’s health, and allows women to the take the necessary steps to ensure her own health is adequate to undergo pregnancy and childbirth.

A wealth of information supports the recommendation that reversible and permanent forms of contraception be covered by health insurance.

A consensus study by a panel convened by the IOM in 1995 to address unintended pregnancy recommended that financial barriers to contraception be reduced by “increasing the proportion of all health insurance policies that cover contraceptive services and supplies…with no copayments or other cost-sharing requirements, as for other selected preventive health services.”

The Centers for Disease Control and Prevention named family planning one of the ten most important public health achievements of the 20th century because of its contribution to “the better health of infants, children, and women.”

Contraceptive use is one of the cornerstones of Healthy People 2010, the nation’s agenda for promoting health and preventing disease.

The National Business Group on Health, a non-profit organization representing large employers’ perspectives on national health policy issues, conducted a comprehensive review of available evidence and recommends a clinical preventive service benefit design that includes all FDA-approved prescription contraceptive methods at no cost-sharing.

Including family planning counseling and supplies in the final recommendations would also build on key federal protections in place for millions of women. For almost 40 years, Medicaid has covered family planning services and supplies and provided them without co-payments for millions of low-income women.

Because the only FDA-approved prescription contraceptives available today are for women, and pregnancy is a condition unique to women, the panel has the opportunity to rectify a long-standing inequity for women. Failure to cover contraceptives forces women to bear higher out-of-pocket health costs, totaling approximately $9,000 over her lifetime. Nearly ten years ago, the Equal Employment Opportunity Commission issued an interpretation of the federal civil rights law that prohibits discrimination in employment, stating that it is sex discrimination for employer-sponsored health insurance plans to provide coverage of other prescription drugs and preventive services, but fail to provide coverage of contraception.

Screening for Intimate Partner Violence- Three women are murdered each day by their husbands or boyfriends, and two million injuries result from domestic violence each year. We should be using every tool at our disposal to identify and help victims of intimate partner violence and we believe routine behavioral assessment for intimate partner violence could help reduce these numbers.

Screening for Cervical Cancer- Cervical cancer was once the leading cause of cancer death for American women, but screening and early intervention has greatly reduced the number of deaths each year. It has been a several years since the United States Preventive Service Task Force (USPSTF) has updated its recommendations. We urge the panel to review relevant evidence to ensure women are receiving the appropriate care.

Breast Pump Equipment- Studies have shown that breastfeeding provides important long-term health benefits for mothers. Lactation supplies, including breast pumps, are critical for mothers to sustain breastfeeding and receive the preventive health benefits that lactation affords.

Physician-Recommended Preventive Services- Many of the services that are provided in a routine preventive visit are included among USPSTF recommendations, yet the Task Force does not recommend the actual visit itself, and women are often charged co-payments at the time of service. We urge the panel to consider covering all well-woman and preconception care visits. When a doctor recommends a preventive health visit, a woman’s decision about whether to comply should not turn on her ability to afford the care.

A number of organizations, including the U.S. Conference of Catholic Bishops, decried the possibility that contraception may be included among the preventive health services covered, but this extreme position is without merit and harmful to women. Sound science should trump ideology, and we’re confident that the Institute of Medicine panelists will not let the religious views of some interfere with their expert review of the scientific and medical evidence and the needs of American women.

Overcoming Disparity – Women’s health damaged by increased city living

Today’s urban cities are suffering from a dramatic rise in a disproportionate health crisis coming from its poorest citizens, finds WHO (World Health Organisation)/UN-HABITAT report, Hidden Cities – Unmasking and Overcoming Health Inequities in Urban Settings. Women suffering under poverty are especially sensitive to impacts of urbanisation as statistics show women in densely populated areas have a 1.5 times higher rate of HIV/Aids than men. Women in cities also face higher dangers of contracting Aids, a figure almost twice as high as their rural sisters.

On the edge of the global economic shakedown, as numerous cities and urban areas suffer from rising population, women who suffer from poverty experience greater encounters with overcrowded substandard housing, infectious diseases, food and water safety issues, inadequate sanitation and increasing solid waste disposal problems.

“In 2010, more than half (the world’s population) live in cities, and by 2050, 7 out of every 10 people will live in urban areas,” outlines the new report. “Most of this explosive growth is occurring in developing countries, where municipalities and other government authorities are often overwhelmed by the rapid population boom.”

With the transfer of both men and women from rural to urban regions steadily increasing at a rate of 60 million per year, globalisation is reaching a tight squeeze creating a real possibility that massive problems in overcrowding will overshadow our next century. Urban city dwellers will most assuredly face failures with services and infrastructure creating dire consequences that may outlive generations.

For the very first time in history, a majority of the world’s populations are living in cities. And this figure is rising. Ultimately, the problems of urbanisation will affect the life and health of rich and poor alike, but the poorest populations will suffer much more from inequities.

Developing nations, spurred by increasing problems of climate change, are also growing the world’s largest slums, as the rural poor break with generations of steady work in agricultural endeavors to move to cities under mythological promises of better employment.

“Urban poverty has become highly feminised,” says the new WHO/UN-HABITAT report. Women, who have worked in farming agri-industries, find that upon their arrival to urban areas they are often quickly and sharply excluded from jobs, denied training programs and placed in situations that bring ongoing and demeaning exclusions.

While cities offer rural women new experiences and opportunities to create larger support networks, they also face heightened struggles toward empowerment. With urban environments come increased dangers of violence to women due to domestic and economic struggles at home. Rape too is an ominous urban threat.

“In many cities, the urban poor face challenges in accessing health services due to their inability to pay out-of-pocket expenses for services,” says the 2010 report on urban health inequities from WHO/UN-HABITAT. “This is in contrast to rural settings, where the main access issue facing residents is that health facilities are far from their homes and communities.”

In Bangladesh, surprisingly the number of women who have diabetes increases as the nation becomes more developed and more urbanised as wealthier women, 45yrs and older, outnumber poor women who have the disease. But care, for those with less money who do suffer from diabetes, is markedly unequal.

“Many urban dwellers at some point will face a dire choice: either to go without essential treatment, or to seek treatment and go into poverty,” continues the WHO/UN-HABITAT report.

Health equity, for urban and non urban women, is an issue that relates across the board stating that all woman must have fair and equal access to health management and programs.

“Opportunities to put health at the heart of the urban policy agenda exists, and it is time for all sectors to work together toward innovative and effective solutions that mitigate health risks and increase health benefits,” says Margaret Chan, director of WHO.

“Of the many risks to health that are linked to rapid urbanization, none is more compelling than urban poverty,” adds Inga Björk-Klevby, assistant secretary general of the UN and officer in charge of UN-HABITAT.

“These unfair health gaps are growing in spite of unprecedented global wealth, knowledge and health awareness,” continues the UN assistant secretary general.

Hazards: Work Stress Raises Women’s Heart Risk, Study Says

Women who are stressed at work are more likely than other working women to have a heart attack or other forms of heart disease, a new study suggests.

The findings, presented Monday at an American Heart Association meeting in Chicago, were based on data from 17,415 otherwise healthy middle-aged women who took part in the Women’s Health Study, sponsored by the National Heart, Lung and Blood Institute.

The researchers found that women who reported high job strain faced a 40 percent increase in cardiovascular disease over all, and an 88 percent increase in risk for heart attacks alone. (“Strain” was defined as demanding work with little decision-making authority or ability to use one’s creativity and skills.)

Women who were worried about losing a job did not experience an increase in heart ailments, but they were more likely than women with high job security to be overweight or to have high blood pressure or high cholesterol, all risk factors for heart disease.

Earlier studies on chronic job stress and heart disease in women have had mixed results, though studies of mostly male subjects have found a clear association between the two, said the study’s senior author, Dr. Michelle A. Albert, a cardiologist at Brigham and Women’s Hospital in Boston and an associate professor at Harvard Medical School.

“You can’t get rid of stress, but you can manage it,” Dr. Albert said, adding that she recommends getting more exercise and maintaining contacts with friends and family. In addition, she said, “try to keep work at work.”

“If you have to work when you’re home, since we are all living in an electronic age,” she went on, “limit your time on e-mail. Otherwise you never leave work.”

Hormone therapy may prevent – or contribute to – dementia risk

Hormone therapy appears to affect the brain differently depending on the age of the woman when she receives it, researchers reported Thursday.

Hormone-replacement therapy for women has been the subject of considerable debate. Studies have shown both pros and cons. But hormone use has declined in the last decade because a major study on the issue, the Women’s Health Initiative, found that the risks of taking hormones appeared to outweigh significantly the benefits in older postmenopausal women. Among the findings was that beginning hormone therapy in women ages 65 and older led to a twofold higher risk of dementia.

Questions remain about the affect of hormones if taken at a younger age — among perimenopausal (the phase before menopause when hormones decline and fluctuate) or menopausal women in their early 50s. The new study, published in the Annals of Neurology, supports the idea that hormones can affect dementia risk differently depending on the age of the woman when she takes them.

Kaiser Permanente researchers examined data from members in Northern California from 1964 to 1973, among women 40 to 55 years old. The study examined whether hormones were used at midlife — defined in this study by the average age of 48.7 — or in late life, defined as age 76. Compared to women who never used hormones, those taking hormones only at midlife had a 26% decreased risk of dementia. This link held true even when the researchers controlled for other factors that contribute to dementia, such as high cholesterol and stroke.

However, taking hormones in late life may counteract whatever benefits are seen by taking hormones at midlife, the authors said. Women taking hormone therapy only in late life had a 48% increase in dementia. Women using hormones at both midlife and late life did not differ in their dementia risk from women who didn’t take hormones.

“The reduced risk of dementia associated with midlife hormone therapy use only lends support to the notion that it is not only early postmenopausal use of hormone therapy that is protective, but that use should also be limited to a few years,” the authors wrote.

Animal studies suggest that estrogen benefits brain health, and observational studies have shown that women who take hormones are less likely to develop dementia later in life. But studies such as the Women’s Health Initiative dashed hopes that hormones protected against cognitive impairment. Research now is focusing on whether there is a “critical window” for use — a specific time of life when hormones would do more good than harm.

High-stress jobs a health risk to women?

NEW YORK – Women with high-stress jobs face about 88 per cent more risk of a heart attack than if they had low workplace strain, according to Harvard researchers.

The scientists defined the stressful positions as those with demanding tasks and little authority or creativity.

Those jobs were also associated with a 40-per-cent greater chance of getting any kind of cardiovascular disease, according to a study presented yesterday in Chicago at the American Heart Association’s Scientific Sessions.

Job strain, social isolation and some personality traits have been recognised as raising risks in both men and women, according to the Dallas-based heart association.

Past studies that focused on men, the traditional breadwinners, found that higher job stress raised heart risks.

This is the longest major one to look at stress in women, who now make up nearly half of the workforce in the United States.

“The big thing is, what’s happening to you now in terms of mental tension has long-term effects on your health,” said the study’s senior author, Assistant Professor Michelle Albert of the Harvard Medical School, who is also a cardiologist at the Brigham and Women’s Hospital, both located in Boston.

The study analysed job strain in 17,415 participants from the Women’s Health Study, a US project that began in 1991 and ended last year, with funding from the National Institutes of Health, based in Bethesda, Maryland. Bloomberg