Not a day goes by when we don't see a social media debate around body image, fat-shaming, and health. For example, a recent controversial magazine cover in Cosmopolitan magazine of a plus-size model with the caption 'this is healthy' had the internet divided on whether normalising plus-size bodies could encourage people to let go of their health.
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Admittedly, it is never ok to shame anyone based on their size, and nothing gives the world the right to deem anyone as healthy or unhealthy based on their size. But obesity, particularly morbid obesity, does come with its own set of health problems, as does being extremely skinny. This article will explore why both ends of the weight spectrum can be problematic, and a more active lifestyle (rather than a number on the scale) is the ticket to good reproductive health.
The female hormone estrogen is produced primarily in your ovaries and by the body's fat reserves. So as the number on the scale rises, so does the body's ability to produce estrogen from fat cells since the fat reserves increase. So here's the thing—when the ovaries produce estrogen, it is regulated by the nervous system. The fat cells producing hormones? Not so much.
So the excess hormone in our body, without the much-needed waxing and waning as seen in the normal menstrual cycle, results in ovulation being affected. It is akin to taking birth control pills which oversupply hormones to your body and shut down ovulation. This unhealthy production of hormones is one of the primary reasons for reproductive difficulties in the higher weight population.
Another mechanism by which being overweight can affect reproduction is the overproduction of the male hormone testosterone. This is seen in the extremely common PCOS or polycystic ovarian syndrome. Obesity leads to insulin resistance, affecting the body's ability to take up blood glucose. This, in turn, gives rise to higher levels of male hormones in the female body.
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Fear not, every woman has small amounts of male hormones in their bodies and vice versa, but PCOS brings along the excess body hair and skin breakout because of these male hormones. In addition, PCOS affects menstrual cycles and ovulation and women with PCOS seeking fertility treatments are often advised by their doctor first to reduce weight to conceive.
Apart from producing the hormone estrogen, the fat cells also produce the hormone called leptin. This hormone has the primary role of telling the body that it has enough energy reserves and can take up the duties of energy-expensive functions such as hitting puberty or sustaining a pregnancy. But too much of anything is terrible, and so is the hormone leptin. Excessive leptin levels in our blood work against the ovaries and result in hampering egg release.
By now, you must have realised that fat is not just passively sitting in all our love handles but is metabolically active tissue. If a person conceives naturally or by assisted means, being overweight often results in more pregnancy losses than among the population with average weight. This is because the fat stores produce many other hormones that affect the pregnancy and the inner lining of the uterus, which is the reason for these pregnancy losses.
On the other end of the bodyweight spectrum lies the extremely low body mass person. With the distorted beauty standards plaguing our media these days, eating disorders, body dysmorphia and obsession with being extremely skinny are very prevalent. In a bid to achieve the "perfect body" (a perfect body does not exist. It's just an unattainable beauty standard that exists) impressionable tweens often end up developing eating disorders like anorexia or bulimia.
This, coupled with the high demands of the growing pubertal body, often leaves the body neglected of proper nourishment and the girl's development suffers. In addition, eating disorders often lead to delayed attainment of periods and stopped periods after puberty. Therefore, the valuable growing years of a girl are to be met with nourishment and robust activity.
Weight gain and overcoming an eating disorder is an uphill battle that needs a multidisciplinary approach. Someone struggling with it may require nutrition counselling and perhaps even psychiatric evaluation. It is not possible to shake off body dysmorphia by just telling the person to get over it and eat healthily. Keeping a lookout for depression and treatment for the same may go a long way in helping such patients.
Dr Farah Adam Mukadam is a family physician and author of the book New Borns and New Moms: An Urban Indian Mother's Guide to Life after Childbirth. She goes by the moniker Momstein on YouTube and Instagram