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What is the difference between genders in the obesity scenario?

Obesity is a global health issue that affects millions of people around the world, and its implications vary based on gender. Men and women face unique challenges when it comes to managing their weight, thus shaping their journey towards a healthy lifestyle. Therefore, I set out to examine the fundamental differences between men and women when it comes to obesity.

Important points such as body composition and dietary patterns can influence these aspects and impact health in general. Certainly, understanding gender disparities in these domains is essential for creating more effective prevention and treatment strategies for each group.

These days, there is growing awareness of the importance of understanding gender differences in obesity. Therefore, the objective of this text is to present current evidence related to the anthropometric characteristics, nutritional and pharmacological aspects of obesity from a gender perspective.



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Gender disparities in obesity

Research in this field is essential to devise more effective prevention and treatment strategies that take into account the individualities of men and women. Recognizing and addressing gender disparities in obesity is a crucial step toward promoting health equity and improving the quality of life for all people.

It is important to highlight that there is a distribution of adipose tissue related to gender. Even with a similar body mass index (BMI), there are notable differences in body composition between men and women. Men have greater fat-free mass and women have greater adiposity. Furthermore, men generally have a central, pear-shaped distribution of adipose tissue. Women tend to have a peripheral distribution of adipose tissue, especially on the limbs and hips. 

The greater visceral adiposity observed in men is associated with negative metabolic consequences, such as elevated levels of postprandial insulin, free fatty acids and triglycerides. On the other hand, peripheral distribution of adipose tissue is less associated with the development of obesity-related complications compared to central distribution. These differences in body composition play a crucial role in understanding gender disparities in obesity and their implications for metabolic health.


Hormones and obesity: what is the relationship?

Sexual hormones are certainly involved in this fat disposition. In women, adipose tissue is mainly concentrated in the lower part of the body, while in men in the abdominal and upper parts. The reduction in estrogen levels during menopause is associated with the transition of the accumulation of gluteofemoral adipose tissue to the central region in women. 

Studies show that hormone replacement therapy in postmenopausal women reduces fat accumulation compared to those who do not receive treatment. Therefore, it is important to emphasize that well-indicated hormones significantly reduce cardiovascular risk. Furthermore, body composition varies between genders, with women having approximately 10% more fat mass compared to men . Certainly, the distribution of ectopic fat differs between genders, with men more prone to visceral lipid accumulation, while women tend to accumulate more fat in the lower extremities, as in the case of lipedema, a condition that affects quality of life and women's eating behavior.


Obesity and gender in Literature

The recent study Obesity: a gender‑view,published on September 8, 2023, in the RevistaJournal of Endocrinological Investigation,reveals that sex hormones have been shown to influence eating behavior, both in “homeostatic” control of energy intake and “hedonic” control of food intake. Physiologically, estrogens affect food intake through signals in both the central system, hypothalamic circuits, and peripheral signals.

For our scenario, it is important to highlight other studies that linked eating behavior with the menstrual cycle, showing that the luteal phase is associated with a desire for carbohydrates and foods rich in sugar. On the other hand, it is known that food choices vary between the sexes, with women consuming more fruits and vegetables, while men consume more foods rich in fat and salt.

Finally, stress and emotions also play a role in eating, with food intake linked to stressful situations, especially in women. Therefore, these data suggest that sex hormones play a fundamental role in eating behavior, but the influence of emotions must also be considered.


Drug treatment for obesity

According to the study, it is important to mention that it is still unclear to what extent gender differences affect the clinical efficacy of these medications, although there are gender-sensitive considerations in the pharmacokinetics and pharmacodynamics of these medications.

Two main mechanisms explain the anorectic effect of liraglutide: a central anorectic effect and the inhibition of gastric emptying. The central anorectic effect acts on brain regions involved in eating behavior. Interestingly, studies in rodents show that the effect of GLP-1 on central reward pathways is critically modulated by estrogens.

In the case of bupropion, it strongly affects noradrenergic and dopaminergic neurotransmission in the brain, altering eating control. Naltrexone acts in conjunction with bupropion, counteracting an opioid-dependent feedback mechanism activated during bupropion treatment, limiting the effect of bupropion on POMC neurons in the hypothalamus. There is evidence that the central anorectic effect of the naltrexone/bupropion combination can be modulated by sex steroids.

Although gender-related differences have been identified in some aspects of the pharmacokinetics of these medications,clinical studies to date have not consistently shown significant differences in the efficacy or safety of these weight loss medications between men and women who would justify dosage adjustments based on gender. Therefore, based on the available scientific evidence, it was not necessary to establish different dosage guidelines for men and women. This indicates that, despite theories, differences in response to these medications between genders have not been shown to be substantial enough to require different dosages.


Take home message

The results indicate that men are more likely to develop obesity compared to women. However, there are considerable differences that depend on the geographic region and the country's level of economic development. Furthermore, men and women present differences in body composition, adipose tissue distribution and metabolism, factors that depend on different hormonal contexts.

It is also evident that sexual hormones play a significant role in influencing eating habits between men and women. Furthermore, it was observed that responses to anti-obesity medications may vary between genders, raising the question: do drug therapies need to be adapted? Today, the answer is no, but we can individualize treatment. 

In summary, understanding gender differences in obesity is critical to developing more effective prevention, treatment, and intervention strategies. This not only recognizes the complexity of gender variables, but also highlights the importance of addressing the individualities of men and women to improve outcomes.


References

MUSCOGIURI, G.; VERDE, L.; VETRANI, C.; BARREA, L.; SAVASTANO, S.; COLAO, A.. Obesity: a gender-view. Journal Of Endocrinological Investigation, [S.L.], p. 1, 23 Sep. 2023. Springer Science and Business Media LLC.

Suggested reading:Obesity has resolution

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