Obesity in women: Causes, health outcomes and ways to manage it

Stepping on the scales at the doctor's office isn't a fun experience at the best of times. With many women strongly linking their self-esteem to their weight, it can feel like judgment day as you anxiously wait for the GP to calculate your BMI.

What's even more confronting is when the term 'obesity' comes up — whether it's a formal diagnosis or simply being told you're at risk.

But what does it actually mean to be obese, and what are the implications for women's health? Plus, what are the best weight loss interventions for obesity, so you can take your health into your own hands?

Read on for everything you need to know, to demystify obesity in women.

What is obesity?

Obesity refers to an excessive accumulation of body fat that presents a risk to your health. In the UK, a BMI (body mass index) of over 30 is typically considered to be obese [1] — although, waist circumference should also be taken into account, especially in the case of particularly athletic or muscular people.

While the terms obesity and morbidly obese are often used interchangeably, there's an important difference. Morbid obesity is considered an advanced form of obesity and usually involves a BMI over 40 [2].

Meanwhile, a BMI between 18.5 and 24.9 is considered a healthy range, and between 25 and 29.9 is considered overweight [3].

How common is obesity?

According to data from The Health Survey for England 2021, 25.9% of adults in England are obese and a further 37.9% are overweight [4]. Plus, nearly ¾ of people aged 45-74 are overweight or obese.

Is obesity more common in men or women?

Interestingly, men from all ages and social backgrounds are more likely to be overweight or obese than women but 4 times less likely to undergo weight loss surgery [5] (which perhaps reflects broader body image issues).

In the UK, men are more likely to be overweight or obese at 68.6% versus 59% of women [4].

What is considered obesity for a woman?

As BMI isn't adjusted for gender, the ranges for obesity are the same for males and females. However, as women and men tend to have slightly different body fat distribution, a waist circumference of over 80cm (compared to 95cm in men) is considered a sign of excess belly fat [5].

What commonly causes obesity in women?

Most of the common causes of obesity are the same between men and women. These include:

Genetics

Research shows that genetics can play anywhere between a 25-80% role in one's weight, depending on the person [6]. That's why if you have a genetic predisposition for carrying excess weight, staying in shape can often feel like a losing battle.

Poor diet

One of the biggest causes of obesity is consuming more calories than you burn. Lifestyle, lack of food education, poor access to nutritious food and underlying mental health issues are all important contributors to this.

Lack of exercise

Living a sedentary lifestyle (sitting for most of the day) combined with a lack of rigorous physical activity has been found to double the risk of obesity [7].

Alcohol consumption

Drinking alcohol has a strong link with carrying excess weight — hence the term, beer belly. Research has found that drinking more than 7 times per week was associated with an increased risk of weight gain and development of overweight and obesity [8].

Stress

While the psychological factors of weight gain are often overlooked, they play a crucial role. Stress and anxiety can lead to overeating and making poor food decisions. Chronic stress is also linked to a low quality of sleep, which is also linked to being overweight or obese.

Other important factors in women with obesity are:

• Hormones: Women have an orchestra of different hormonal processes occurring in the body at any given time, and this can impact body weight. For example, imbalances with the female sex hormone oestrogen can cause insulin resistance, and make it difficult to shift stubborn body fat. Other hormones like insulin, androgens and growth hormones impact metabolism, appetite and body fat distribution, too [9].
• Age: Ageing is a key contributor to obesity in both men and women. However, women have even more challenges to contend with, as menopause-related hormone changes can lead to changes in body composition. Between the ages of 45 and 55, women typically gain a kilo a year [10].
• Pregnancy: It's no secret that pregnancy can significantly change the body. The average weight gain for a normal-weight woman during pregnancy is 7-11.5 kilos [11], and some find it tough to shift the weight after giving birth.

Does being overweight or obese affect some women more than others?

Certain women are more susceptible to obesity than others. Apart from age and genetics, some of these risk factors include:

Metabolic or hormone issues

Due to the link between hormones and body weight, hormonal issues such as hypothyroidism and Cushing's Disease can increase your risk of obesity [12].

Socioeconomic status

Income is another important independent risk factor for obesity. Research consistently shows that people who live in lower socioeconomic areas are significantly more likely to be overweight or obese [13]. This is partly because fast food tends to be more affordable and accessible than healthy, home-cooked meals.

Mental illness

Numerous studies have shown a strong correlation between obesity and psychological conditions like depression, anxiety and bipolar disorder [14]. While it's not always clear what comes first (a chicken or the egg scenario), it's clear that these can go hand in hand.

What are the health effects for women who are at an unhealthy weight?

It's important to note that obesity is not just a cosmetic issue — but a significant health issue as well. Some of the future health risks of obesity in women include:

Cardiovascular disease

Excess weight can lead to a build-up of fat around the arteries, which can restrict blood flow to the heart. As a result, there's a strong link between obesity and chronic medical conditions like high blood pressure, stroke and heart attacks [15].

Breast cancer

Extra fat cells can lead to a build-up of oestrogen in the body, which can increase breast cancer risk — particularly in postmenopausal women. It can also increase the risk of the cancer coming back, after going into remission [16].

Other cancers

There are a few other obesity-related cancers, such as endometrial cancer, liver cancer and colorectal cancer [17].

Pregnancy complications

Obesity puts a lot of pressure on the body, which can create additional risks during pregnancy. For example, women who are obese before pregnancy are 8 times more likely to develop gestational diabetes [18].

Obstructive sleep apnoea

It's estimated that 58% of mild-to-severe cases of sleep apnoea cases are due to obesity [19]. Excess fat tissue in the upper respiratory tract can narrow the airways, which can lead to this serious sleep disorder.

In addition to disruptive snoring, this can lead to poor sleep quality and other health conditions like stroke and type 2 diabetes.

Metabolic syndrome

Otherwise known as metabolic disease, this is a cluster of risk factors that disrupt crucial metabolic processes in the body.

Combined with high blood pressure, insulin resistance and high cholesterol, obesity significantly increases the risk of developing metabolic syndrome over time. This can lead to serious health conditions, including heart disease, diabetes and reproductive health issues.

Does it matter where on my body I carry the weight?

Unfortunately, we don't get to choose which areas of the body we gain (or lose) weight from. Younger women tend to store fat around the hips and thighs, whereas, in postmenopausal women, this tends to shift to around the belly.

Not only does fat storage affect body composition, but it also has important health implications. Research shows that visceral fat is the most dangerous to your health [19].

Often referred to as hidden fat, this is stored deep inside the belly and wraps around the organs including the liver and intestines. While you can't always see visceral fat, it's a sign of metabolic disease and is linked to health issues including high blood pressure, insulin resistance and heart disease.

How to approach weight loss sustainably

Obesity is a serious health issue, but it's also a highly treatable one. By becoming an active participant in your own wellness journey, you can empower yourself to reach your healthiest weight. But, which weight loss interventions are the best? Should you adopt a clean eating diet, try weight loss patches, or consider bariatric surgery?

At the end of the day, the best way to address obesity (or other weight-related issues) is with a tailored, holistic approach. Women's health is complex, and therefore a one-size-fits-all approach simply doesn't work.

With Juniper's Weight Reset Programme, we address the underlying factors of weight gain (including metabolism and hormones) from the inside out. We combine highly effective medication with lifestyle and health coaching to target weight on a cellular level. With this sustainable, long-term approach to weight loss, you'll reach your healthiest weight — and will actually be able to keep it off.