Ob-gyns need to appreciate the unique challenges facing their overweight and obese urban patients when it comes to counseling them about diet and exercise, according to The American College of Obstetricians and Gynecologists. In new recommendations issued today, The College says physicians and public health officials should also take into consideration individual behaviors as well as the broader community obstacles to healthy lifestyles in order to help women lose weight.

Approximately one-fourth of all women in the US are overweight and more than one-third are obese, according to the Centers for Disease Control and Prevention. All women are at high risk for becoming obese, but minority women, low-income women, and women in urban areas are at particularly high risk, says The College. Obesity is a risk factor for numerous health conditions including diabetes, hypertension, high cholesterol, stroke, heart disease, certain cancers, and arthritis. A person with a body mass index (BMI) of 25.0 or higher is considered overweight and is considered obese if it's 30.0 or greater.

"Given that approximately 80% of all adult women live in urban areas, it is so important for physicians to understand the constraints that many of our urban-dwelling patients face whether they are normal weight or obese," said Wanda K. Nicholson, MD, a member of The College's Committee on Health Care for Underserved Women and who developed the recommendations. "Finding time to counsel women about weight loss, nutrition, and exercise during a short office visit continues to be a significant challenge for doctors."

Low-income urban areas generally offer residents few options for obtaining healthier foods. One problem is that often there are no large supermarkets or grocery stores nearby for people to buy fresh fruits and vegetables. Instead, the primary sources of groceries in many urban neighborhoods are small, "corner" stores with limited selections of produce. "Just getting transportation to a supermarket outside of their neighborhood may pose a significant, if not insurmountable obstacle," said Dr. Nicholson.

Moreover, low-income neighborhoods often have high concentrations of fast food restaurants and convenience stores that offer high-calorie, high-fat foods that only help to exacerbate obesity. Even when healthier food products are available, they are often more expensive than the low-cost, high-calorie foods that are more conveniently obtainable.

"Equally challenging is that opportunities for safe exercise are more restricted in urban areas so women are less likely to go outside for daily physical exercise," said Maureen Phipps, MD, chair of Committee on Health Care for Underserved Women. Even when a park is close by, personal safety concerns may prevent women from engaging in outdoor activities. Working with a woman to identify safe venues to exercise, such as the YMCA or community swimming pool, is one way to help increase her potential for exercise and weight control, says Dr. Phipps.

Despite the difficulties facing women in urban areas, ob-gyns can help their patients by discussing healthy lifestyle behaviors at each office visit, encouraging patients to shop at local farmers markets, and providing patient information about recommended nutritional guidelines, daily calorie intake, and physical activity. On a broader community level, physicians can advocate for free wellness programs at their hospital, support construction of safe, accessible outdoor recreational areas, and promote community initiatives to increase supermarkets in areas lacking them.

Committee Opinion #470, "Challenges for Overweight and Obese Urban Women," is published in the October 2010 issue of Obstetrics & Gynecology.

American College of Obstetricians and Gynecologists