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"If you want to have children, every kilo counts!"
"If you want to have children, every kilo counts!"

Apart from classic secondary diseases such as cardiovascular complaints, the extra kilos for women are mainly at the expense of their hormonal balance - the cycle gets out of balance, the desire to have children remains unfulfilled. Gynecologist Julian Marschalek on the "risk factor gender":

Dr. Julian Marschalek is a gynecologist in Vienna. With a focus on reproductive medicine and endocrinology, he is deputy. Head of the in-vitro fertilization outpatient clinic at the AKH.
Dr. Julian Marschalek is a gynecologist in Vienna. With a focus on reproductive medicine and endocrinology, he is deputy. Head of the in-vitro fertilization outpatient clinic at the AKH.

The big WOMAN themed special for your feel-good weight

Typically female, classically male: From genetics to external characteristics and psychological aspects to the socio-cultural dimension - there are many gender-specific characteristics. And only now, after years of neglect, are they making their way out of the blind corner of insignificance into the focus of modern medicine. Because the differences between women and men, ergo the long-term ignored factor “gender”, is gaining importance as an influencing factor on diseases as well as on medical treatment, research and prevention. The woman is no longer a "little man"; it is now at the center of general medical research. A long overdue necessity.

Because in order to better understand the complexity of the development of certain diseases in women, to recognize health risks at an early stage and ultimately to be able to optimize therapy options, a differentiated view is required. A look that forms the basis of Julian Marschalek's everyday professional life. For the renowned Viennese gynecologist, it is precisely this complexity, that of the female organism, that makes his job so fascinating for him. For Marschalek - who originally wanted to become a transplant surgeon in the course of his training - it took detours to finally gain a foothold in gynecology. “Destiny”, he is convinced of that today.

Unfair: A tendency to be overweight

But what does this gender medicine excursus have to do with obesity? Lots of it - both in terms of how it is created and how it affects it. The fact that a differentiated perspective is also required, or rather, especially in the case of obesity, can be explained quite simply: “Women have an increased tendency to be overweight because of their gender alone,” emphasizes the doctor. In addition to social and economic factors, certain hereditary genes, which influence both appetite and energy balance, and hormonal fluctuations, are responsible for this. “Statistics show, for example, that the proportion of obesity is increasing in menopausal women. The reason: While the female sex hormones decrease - an unhealthy redistribution of fat to the abdominal region with increased metabolic risks is the result - the appetite-stimulating hormones increase."

But the problem is no longer uncommon for young women either. And there are more and more. According to the WHO, every third child is overweight or even obese. A literal burden that those affected often carry with them into old age: "Evaluated figures have shown that the foundation for obesity is often laid in childhood - around 80 percent of overweight children struggle with it in later years," warns the expert. The modern lifestyle is mainly responsible for this - a disease-causing combination of a one-sided, high-calorie diet and too little exercise. "It is all the more important to do preventive work in good time, to set a good example for children and to give them access to a healthy life in order to reduce the risk of serious secondary diseases to a minimum."

An approach that desperately deserves increased attention given the numbers. After all, 42 percent of women in this country are overweight and eleven percent obese. Numbers that Marschalek can confirm from his everyday practice. He estimates the proportion of his overweight patients at around 20 percent - consequently every fifth patient is significantly too heavy. "That may primarily be due to my main focus as a reproductive medicine specialist and gynecological endocrinologist," he puts into perspective, but without wanting to play it down.

It's a fine line

Because many of the complaints raised in his everyday practice are precisely due to the "too much". "Regardless of why a woman consults me, the body mass index is always recorded as part of my anamnesis - so weight is invariably an issue." Woman can be connected, it is especially important in overweight patients to take out emotionality. What is needed is educational work on a factual level in order to make health relationships understandable and understandable,”appeals Marschalek. Understanding that is urgently needed. According to a current market research survey, women still see the aesthetic aspect as the main motivation for weight loss - health, on the other hand, was placed at the bottom of the list.

"5, 5 days: Every kilogram lost shortens the time until pregnancy occurs by an average of 5, 5 days."

“Most women see first and foremost that they have a weight problem; many are also aware of possible health consequences and can draw a connection between being overweight and diseases such as high blood pressure or diabetes. Very few people know that fat is the largest endocrine organ in the human body, whose fat cells have a high level of hormonal activity and thus have a direct influence on the hormonal balance. The real health implications of their problem therefore remain unrecognized by many women affected."

What is needed is interdisciplinary cooperation. Good advice is not enough
What is needed is interdisciplinary cooperation. Good advice is not enough

The consequences for women

In addition to the often increased risk of cancer of the breast or the lining of the uterus, the reproductive medicine specialist mentions the unfulfilled desire to have children as an example: “The fact that failure to conceive is in many cases correlated with obesity has been proven since the 1950s. Even back then, initial studies showed that a high percentage of women with hormonal disorders such as menstrual cramps and the subsequent unfulfilled desire to have children are overweight. But there is still a lack of awareness today.”One thing is certain: the prevalence of menstrual disorders, infertility and sexual dysfunction in women with obesity, i.e. a BMI of over 30, is significantly higher. "With regard to fertility, it was even possible to demonstrate that from a BMI of 29, the spontaneous pregnancy rate decreases by four to five percent with each additional BMI point."

Generalized and technically incorrectly expressed, this is due to an imbalance between male and female sex hormones. "The serum levels of both male and female hormones, which have been shown to be elevated in obesity, have an effect on the central sex hormone control in the brain via a feedback system - the female organism becomes imbalanced," explains the endocrinologist. "This imbalance of sex hormones with the predominance of male hormones can, similar to other hormone disorders - for example polycystic ovary syndrome - promote obesity and become an additional antagonist of the desire to have children."

»What is needed is interdisciplinary cooperation. Good advice is not enough. «

Losing weight for family happiness

For many couples, artificial insemination is ultimately the theoretical way out of their misery into family happiness. But, as is so often the case, practice is different: “In the case of existing obesity, in vitro fertilization is usually far from a guarantee of fulfillment the desire to have children. Because the effects of being very overweight represent considerable complications - the success rate is well below that of women of normal weight,”says the deputy head of the IVF outpatient department at Vienna General Hospital.

Weight reduction can increase the reproductive outcome and thus the chances of family happiness. "A study with over 2,300 overweight subjects came to the impressive result that every kilogram of body weight lost shortens the time to pregnancy by an average of 5.5 days." A previous weight reduction is also essential for the further course of the pregnancy: " Because even with successful fertilization, obesity pregnancy is far from guaranteed - the risk of miscarriage in the early stage is significantly increased and the pregnancy must be classified as a high-risk pregnancy in any case. The renowned HAPO study showed that the maternal BMI is strongly associated with excessive child weight gain. An effect that, according to studies, has a metabolic effect into adulthood and can thus set the health course of the child before it is born."

Interdisciplinary cooperation is required, which is often neglected, in order to be able to sustainably decrease. "Many of those affected feel left alone with their problem and often encounter irony," says Marschalek. "Good advice alone is simply not enough for such a complex, multifactorial problem - it is important to find individual solutions together."

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