Recently Oprah Winfrey announced that she will be stepping down from the board of directors of Weight Watchers after 9 years. On top she plans to donate her Weight Watcher shares to the National Museum of American History and Culture to eliminate any perceived conflict. The self-made billionaire has struggled with her weight for decades. 2019 she was diagnosed with prediabetes. She joined the Weight Watchers and lost 42 pounds with the program. Her blood sugar and blood pressure came back to normal ranges. She decided to become an investor for weight watchers.


So, before we dive into the topic why she quit, let`s talk about the impact of obesity on fertility, birth risks and child health.


The relationship between obesity and reproductive functions is still being explored. Overweight women have a higher incidence of menstrual dysfunction and anovulation. Overweight and obese women are at a high risk for reproductive health. The risk of subfecundity and infertility, conception rates, miscarriage rates, and pregnancy complications are increased in these women. They have poor reproductive outcomes in natural as well as assisted conception. These poor reproductive outcomes include assisted reproduction such as ovulation induction, in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI), and ovum donation cycles. Weight loss has beneficial effects on the reproductive outcomes in these patients.“ (1)


Obesity in pregnancy is associated with unfavourable clinical outcomes for both mother and child. Many of the risks have been found to depend linearly on the body-mass index (BMI). A 10% increase of pregravid BMI increases the relative risk of gestational diabetes and that of preeclampsia by approximately 10% each. A 5 kg/m2 increase of BMI elevates the relative risk of intrauterine death to 1.24 . An estimated 11% (!) of all neonatal deaths can be attributed to the consequences of maternal overweight and obesity.


The risks associated with obesity in pregnancy cannot necessarily be influenced by intervention. Preventive measures aimed at normalizing body weight before a woman becomes pregnant are, therefore, even more important. (2)

Alongside its immediate implications for pregnancy complications, increasing evidence implicates maternal obesity as a major determinant of health in the offspring during childhood and later adult life. Observational studies provide evidence for effects of maternal obesity on the offspring’s risks of obesity, coronary heart disease, stroke, type 2 diabetes, and asthma. Maternal obesity may also lead to poorer cognitive performance in the offspring and an increased risk of neurodevelopmental disorders including cerebral palsy. Preliminary evidence suggests potential implications for immune and infectious disease related outcomes. (3)


So there many reasons to reduce the maternal weight before pregnancy, but as we see, even billionaires, who can use all the resources the dieting market offers, struggle with weight loss- till now.


Oprah noted that frustration with her weight has “occupied five decades of space“ in her brain. Obesity is a disease, she added, “it`s not about willpower”.


As we look on what Oprah accomplished in her life, it`s obvious that she is not lacking in willpower.

The media star’s decision to leave WW comes after she disclosed last year that she relies on drugs to maintain her weight (which is now on an absolute low). Winfrey told People Magazine in December that she “released my own shame about it” and went to a doctor to get a prescription, although she didn’t disclose the name of the medication she relies on- but it is highly suggested that it is a GLP-1-agonist like Ozempic (the Ozempic brand of semaglutide is not approved for weight loss but may help you lose weight when using it to treat type 2 diabetes) or Wegovy (Wegovy brand of semaglutide is specifically approved for weight loss, along with diet and exercise, in patients with or without type 2 diabetes.


So how do these drugs work?

They are a class of drugs known as glucagon-like peptide-1 (GLP-1) agonists (incretin mimetics).

They bind to GLP-1 receptors and stimulate insulin release from the pancreas when you need it.

They reduce the amount of sugar released by the liver and slow down food leaving the stomach to help prevent blood sugar spikes ( a reason to pause them before surgery to avoid aspiration of food left in the stomach).


These drugs seem to be a gamechanger in the health industry as they really work and have the potential to improve fertility and decrease maternal and fetal complications. They are not to be seen as “the one solution” that fits all patients struggling with obesity, but seem to really have potential in preselected, educated patients. The importance is to optimise weight BEFORE getting pregnant. Especially in higher risk cases these drugs can play a very important role in weight management before an embryo transfer. In some cases, they may not stop the ability to do VEC and PGTA but could be used prior to FET to reduce BMI and thus Obsteric risk.


But the recommendations are that they are stopped at least 8 weeks before a pregnancy. Negative aspects to be mentioned may be the high cost and the lack of long-term data.


– Dr Dominik Dziura



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Impact of obesity on infertility in women
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