Obesity, A Growing Problem
Contribution from faculty and Staff at the Medical University of South Carolina (MUSC) Weight Management Center
Originally appeared in the December, 2011 issue of Quality Care®
Carrying excess weight especially around the abdominal area applies pressure to the pelvic floor and the bladder. This can cause issues with bladder control. “As people age they naturally lose muscle mass and it is easy to replace this with fat. This is because people become less active and engage in less rigorous exercise,” according to Joshua Brown, PhD, director of Clinical Services at the Medical University of South Carolina (MUSC) Weight Management Center, “This doesn’t have to be the case.” Dr. Brown states, “A big part of the problem is when people expect to gain weight as they get older. This expectation sets the stage for rationalized weight gain and acceptance of the ‘middle-age spread’ as an unfortunate facet of life.” He suggests taking action and controlling your activity level to help prevent weight gain. Success of overactive bladder and incontinence treatments, such as drugs or surgeries, can be decreased if a person does not loose excess weight.
Dr. Brown does note that menopause presents unique challenges to weight management efforts. Women who are going through the menopausal transition burn 100-200 fewer calories per day due to changes in physiology. Women should still be aware that decreased activity is the biggest contributor to age-related weight gain.
“Obesity is a well-known risk factor for urinary incontinence (UI)” says Patrick O’Neil, PhD, director of the MUSC Weight Management Center. “UI can be improved with weight loss, even moderate weight loss. A study by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the Office of Research on Women’s Health (ORWH) titled ‘Weight loss to Treat Urinary Incontinence in Overweight and Obese Women’ displays how weight loss can affect a person’s bladder control.” The women were recruited in Providence, Rhode Island and Birmingham, Alabama.
This research involved 338 overweight and obese women who reported at least 10 UI episodes per week. All subjects were at least 30 years of age and had a body mass index (BMI) between 25 and 50 (a weight between 150-300lbs for a women who is 5’5”). Stress incontinence, urgency incontinence and mixed incontinence were documented at the beginning of the study. All participants were trained in how to complete voiding diaries, given a self-help behavioral treatment booklet with instructions for improving bladder control and encouraged to increase physical activity until they were active for at least 200 minutes per week. The participants were separated into two groups: a controlled group and a weight loss group.
After six months, the women in the weight loss group had an average loss of 8% of body weight (17.2lbs) compared with the 1.6% average loss (3.3lbs) of the women in the control group. Women in the weight loss group had an average decrease in the total number of incontinent episodes per week of 47.4% compared to only 28.1% in the control group. The study helps demonstrate how even moderate weight loss can help improve bladder control. It also demonstrates the value of weight loss in combination with other behavioral strategies by those who are overweight or obese. A person whose BMI exceeds 25 is considered overweight.
Although people tend to gain weight, as they get older, obesity has been occurring in younger and younger generations. Tonya Turner, RN, LD, a registered dietitian and nutrition specialist at the MUSC Weight Management Center, believes that a child’s parent or primary guardian plays a large role in prevention of obesity in their child. “One of the most important things a guardian can do is to model healthy behaviors. This can be done through the promotion of healthier food choices such as fruit, vegetables, whole grains as well as lean meats,” said Turner. She suggests having healthy food options assessable at home and limiting the amounts of empty calorie snacks such as sweets, cookies, chips and sugar sweetened beverages. Parents and guardians also serve as role models for physical activity level and commitment to exercise routines.
Just as physical activity is important for adults in weight loss prevention, it is also important for children. “Exercising as a family can help promote healthy habits. Make a point to take a walk or go for a bike ride. Get outside and away from the TV and computer.” Turner also adds, “Children who observe their family and friends making healthier choices as well as living an active lifestyle are more likely to adopt these habits themselves.”
It takes time, patience and hard work to keep the pounds off. If you stay active and eat healthy foods not only will you stay at a healthy weight but you may also see improvements in your bladder control. If you have lost weight and are still experiencing bladder control loss contact your health care provider. Visit the National Association For Continence’s website to find a continence care expert in your area.
About the MUSC Weight Management Center:
Specialists at the Medical University of South Carolina Weight Management Center understand the complexity of weight loss. A team of psychologists, physicians, dietitians and exercise physiologists work together, using their diverse knowledge to help you reduce excess weight. MUSC is an academic medical center so patients benefit from the most current and safe weight management programs, medicines and advances through research.