Review: Sex-Specific Aspects in the Bariatric Treatment of Severely Obese Women
Abstract
:1. Introduction
2. Methods
2.1. Electronic Literature Search in Scientific Databases
2.2. Selection and Inclusion Criteria
2.3. Summarizing into Main Categories
3. Results
- Female sexuality and sexual function
- Contraception
- Fertility
- Pregnancy and breastfeeding
- Sexual hormones and polycystic ovary syndrome (PCOS)
- Menopause and osteoporosis
- Pelvic floor disorders and urinary incontinence
- Female-specific cancer
- Metabolism, outcome, and quality of life
- Other
- Social and mental health aspects
- Eating behavior and disorders
3.1. Female Sexuality and Sexual Function
- There is strong evidence for improved sexual function as well as sexual quality of life and satisfaction with sexual life in obese women due to bariatric surgery.
- Although the prevalence of female sexual dysfunction decreases after bariatric surgery, it is still higher than in non-obese women.
- While there is an improvement of sexual function due to reduced weight, other aspects such as excessive hanging skin and social or mental aspects may be important for the sexual life of women after bariatric surgery.
- In the aftercare of bariatric surgery, changes in sexual behavior must be considered. There should be sufficient education of patients in terms of behaviors that pose risks for unintentional pregnancies and sexually transmitted infections.
3.2. Contraception
- There is a lack of evidence regarding the effectiveness of oral contraceptives among women undergoing bariatric surgery.
- In order to avoid any risk that comes along with (unplanned) pregnancy, especially in the postoperative period, women who have bariatric procedures are discouraged from using oral contraceptives.
- In clinical practice, contraceptive and pregnancy counseling by bariatric physicians is often not performed at all or falls short.
- Contraceptive counseling can improve the use of safe contraceptive methods and therefore avoid risky pregnancies.
- Better awareness of or knowledge about contraceptive needs after bariatric surgery by physicians can improve the quality of contraceptive counseling.
3.3. Fertility
- Obesity is linked to infertility by complex mechanisms and associations.
- There is evidence for significant improvement of various factors associated with infertility due to bariatric surgery.
- In the treatment of infertility in women, bariatric surgery is becoming an increasingly important issue.
- In order to improve the evidence, further prospective epidemiological research is required.
3.4. Pregnancy and Breastfeeding
- Obesity-related pregnancy risk can decrease due to weight loss as a result of bariatric surgery.
- After bariatric surgery, there is an increased risk of micronutrient deficiencies in pregnant women. Sufficient supplementation and monitoring of pregnant women, especially after bariatric procedures that include malabsorptive aspects, is recommended.
- Due to the extreme weight loss, there is increased fetal risk in the postoperative period. Clinical guidelines recommend contraception/avoiding pregnancy for at least 12–24 months after surgery, depending on the source.
- There might be a lack of evidence for the validity of oral glucose tolerance testing to diagnose gestational diabetes in women with a history of bariatric surgery.
- Breastfeeding can be a protective factor in the development of obesity and is important for the newborn.
- There is no indication of problems with breast milk after bariatric surgery. Therefore, the WHO’s recommendations for breastfeeding also apply to women with a history of bariatric surgery.
3.5. Sexual Hormones and Polycystic Ovary Syndrome (PCOS)
- PCOS and other complex dysregulations of the female sex hormone balance are associated with obesity.
- Weight loss due to bariatric surgery improves PCOS significantly and can regulate hormonal disorders such as obesity-related gonadal disorders.
- In the treatment of obesity-related gonadal disorders/PCOS in severely obese women, bariatric surgery should be taken into consideration as a therapeutic option.
- Regarding the nonspecific inflammatory marker CRP and the metabolic protecting hormone adiponectin, first scientific results indicate positive effects due to bariatric surgery.
3.6. Menopause and Osteoporosis
- Although there is increased intake of macronutrients, severely obese women often suffer from micronutrient deficiencies, especially vitamin D. Even before bariatric surgery, severely obese women represent a vulnerable group in terms of the development of osteoporosis.
- Due to continued diminished intake and affected absorption, bariatric surgery can increase that risk.
- Prophylactic substitution of calcium is recommended; vitamin D and parathyroid hormones should be observed closely in the postoperative period.
- There is a lack of evidence regarding the influence of bariatric surgery on menopausal symptoms. Initial research indicates a positive effect.
3.7. Pelvic Floor Disorders and Urinary Incontinence
- Pelvic floor disorders, and particularly urinary incontinence, are associated with obesity.
- Pelvic floor disorders and urinary incontinence can be improved by weight loss after bariatric surgery.
- There is a lack of research regarding the effects of bariatric surgery on prolapse symptoms and anal incontinence.
- In order to improve the evidence, further prospective epidemiological research with longer follow-up periods and more cases is required.
3.8. Female-Specific Cancer
- Obesity is associated with increased risk of female-specific cancer, such as breast and endometrial cancer.
- Weight loss as a result of bariatric surgery decreases the incidence of endometrial and breast cancer in severely obese women.
- First research indicates that bariatric surgery can lead to regression and healing of endometrial hyperplasia, a precancerous condition that can develop into endometrial cancer.
3.9. Metabolism, Outcome, and Quality of Life
- Although the prevalence of obesity is equal in men and women or even higher in men, men represent a minority among patients who undergo bariatric surgery.
- If treated, male patients have a higher BMI and comorbid risk profile on average. As a result, the benefit of the bariatric procedure is as high as it is in women. Nevertheless, satisfaction with the operation is greater in men.
- Further research about sex-specific aspects in the outcome of bariatric surgery, especially regarding metabolic aspects, is needed.
3.10. Other
- Similar to the decision for bariatric surgery, sex-specific aspects might affect the decision to undergo plastic surgery such as abdominoplasty after weight loss due to bariatric surgery.
- Abdominoplasty to reduce excessive hanging skin after bariatric surgery can improve quality of life similarly in men and women.
4. Discussion
4.1. Summary
4.2. Limitations
4.3. Further Approaches
4.4. Valorization
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Abbreviations
AMH | anti-Mullerian hormone |
BMI | body mass index (kg/m2) |
CRP | C-reactive protein |
DHEAS | DHEAS |
FSFI | Female Sexual Function Index |
HbA1C | hemoglobin A1C |
ICIQ-IU | Incontinence Questionnaire-Urinary Incontinence |
non-HDL-C | non-high-density lipoprotein cholesterol |
PFDI | Pelvic Floor Disability Index |
SD | standard deviation |
WHO | World Health Organization |
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Scopus |
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Dates of Search | Database | Publication Years | Further Search Settings | Search Terms | Hits |
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30/09/2019–05/10/2019 | MEDLINE | Last 5 years | In title | bariatric AND women | 113 |
bariatric AND female | 21 | ||||
bariatric AND sex | 11 | ||||
bariatric AND gender | 9 | ||||
07/10/2019 | Academic Search Premier | Since 10/2014 | In title/subjects | bariatric AND women OR female OR woman OR females | 66 |
bariatric AND sex OR gender | 10 | ||||
07/10/2019 | PsycInfo | Since 10/2014 | In title/subjects | bariatric AND women OR female OR woman OR females | 18 |
bariatric AND sex OR gender | 2 | ||||
08/10/2019 | Cochrane | – | In title/subjects | bariatric | 13 |
08/10/2019 | Scopus | Since 2015 | In title | bariatric AND women OR female OR sex OR gender | 136 |
Sum | 399 |
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Share and Cite
Jäger, P.; Wolicki, A.; Spohnholz, J.; Senkal, M. Review: Sex-Specific Aspects in the Bariatric Treatment of Severely Obese Women. Int. J. Environ. Res. Public Health 2020, 17, 2734. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17082734
Jäger P, Wolicki A, Spohnholz J, Senkal M. Review: Sex-Specific Aspects in the Bariatric Treatment of Severely Obese Women. International Journal of Environmental Research and Public Health. 2020; 17(8):2734. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17082734
Chicago/Turabian StyleJäger, Pia, Annina Wolicki, Johannes Spohnholz, and Metin Senkal. 2020. "Review: Sex-Specific Aspects in the Bariatric Treatment of Severely Obese Women" International Journal of Environmental Research and Public Health 17, no. 8: 2734. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17082734