A silent epidemic is sweeping Odisha. The future looks tense as more than three in every five women in the reproductive age group of 15-49 years have been veering around the infertility zone in the State. The National Family Health Survey - 5 has dropped this big health alert for Odisha.
As per the NFHS-5, a whopping 63 percent of women in Odisha in the age group of 15-49 years have a high risk of waist-to-hip ratio (WHR). The WHR has been either equal to or more than 0.85 as against the normal range of 0.67 to 0.80. The scenario in urban Odisha seems very critical as a massive 72 percent of women in the 15-49 years age group have a WHR greater than or equal to 0.85.
In tandem with the emerging epidemic, the significant pop-up in the NFHS-5 report is almost half of the reproductive age-group women in urban Odisha have reported obesity. The body mass index (BMI) has been measured over and above 25 Kg/m2. The BMI measures weight with respect to height.
Obesity - A New Urban Syndrome
In agreement with the recently published NITI Aayog Multidimensional Poverty Index (MPI), where urban areas in all districts in Odisha have a very low MPI score hinting at least deprivation on all fronts - from nutrition to human development, the NFHS-5 2020-21 brings to the fore that when only 13 per 100 women in urban Odisha have been diagnosed as excessive thin (means BMI below normal); a high of 40 percent have developed obesity.
The obese to famished men in urban Odisha has been in the proportion of 32:11.
In contrast, when only 19 percent of rural women in Odisha have higher BMI, more than 22 percent fall in the category of an excessive thin category.
Rural men in Odisha seems to have a very fit body as the excessive thin male is measured at a mere 16.5 percent vis-a-vis 19.7 percent obese.
While obesity is a trigger factor of the high waist to hip ratio (WHR), the startling fact is the proportion of high WHR in urban and rural women vis-a-vis the obese women share in population simply presses the epidemic button.
The Silent Epidemic
As per the NFHS-5 report, the proportion of rural women having high-risk WHR in Odisha is 61 percent when the obese women share is mere 19.2 percent. This shows a majority of rural women in the State despite having normal BMI carry a high WHR risk.
Similarly, in urban Odisha, when 40 percent of women have been diagnosed with obesity, a huge 70 percent has the high-risk WHR.
Why Silent Epidemic?
As per WHO, the subtle difference between BMI and WHR is when the former simply measures obesity, the latter takes the measure of abdominal obesity (means fat deposits in the central body region). This abdominal obesity is missed out in the BMI measurement, WHO says and added that WHR is more important than BMI as individuals having high WHR stands doubly vulnerable to not only heart disease, type-2 diabetes but also render women infertile.
How It Make Women Infertile?
As per a study by Devendra Singh, Department of Psychology, the University of Texas at Austin, USA and which was published in Neuroendocrinology Letters, WHR reliably signals practically all the conditions that affect women’s reproductive status.
"Prior to puberty and again after menopause, females have WHR which is quite similar to that of males; only during reproductive age do women maintain a WHR lower than that of men. The onset of puberty and resultant activation of the menstrual cycle is related to the size of WHR. Females with a high WHR have more irregular cycles and have significantly fewer ovulatory cycles than women with a low WHR. Changes in the size of WHR also track ovulatory phases. WHR becomes significantly lower during ovulation compared to the non-ovulatory phases of the menstrual cycle. Thus, WHR is a reliable indicator of a woman’s fecundability," the study concluded.
The study further added that if endocervical mucus has high pH it impairs mucus-sperm interaction and reduces fertility.
"Endocervical mucus pH has been shown to be inversely related to serum androgen levels and WHR in women, who have a BMI in the normal range. The probability of successful pregnancy induction is also affected by WHR," the study inferred.
The Simple Logic
The simple science logic is all that is described as feminine functions are guided by a hormone called estrogen, whereas all that is masculine is moderated by androgen. If the androgen level rises in females, then the feminine functions will get severely affected. As per WHO, women with high WHR have higher androgen levels, which in turn impairs feminine functions. After menopause, androgen level rises in women.