**11. Intervention approaches to reduce the burden of MetSy**

#### **11.1 Health promotion (Ottawa charter)**

Health promotion is 'the process of enabling people to increase control over and to improve their health' Introduced into public health in Ottawa in 1986 [111]. Health promotion strategies can be achieved by developing and changing lifestyles, to impact on the social, economic and environmental conditions that determine health.

The Ottawa Charter for Health Promotion set out five strategies that are essential for the success for any health promotion strategy: Build healthy policy; Create supportive environments; Strengthen community actions; Develop personal skills; and Reorient health services. Health promotion actions should target the population at risk, early in life to stop the metabolic storm, by increasing their knowledge and warning them about the dangers of MetSy, enforcing bans on alcohol and tobacco advertising, promotion and sponsorship, raising taxes on alcohol and tobacco and reducing the price of healthy diet food. It is of vital importance to note that the ideal time for intervention is pre-conception. Health-care workers who attend to women of reproductive age and diagnose obesity, have a duty to counsel and refer these patients to high-risk obstetric specialists for consultation to discuss the many risks associated with obesity in pregnancy [112].

These obese patients should be encouraged strongly to undertake nonsurgical interventions to achieve weight reduction to achieve ideal body weight (BMI, 18.5–24.9 kg/m2) before conception. These include, among others, behavioral modification, dietary changes, exercise, and pharmacotherapy [113]. Dietician consultation is recommended for diet advice that is high in fiber, fresh fruit, vegetables, lean protein, and complex carbohydrates, while avoiding foods that contain large amounts of sugar, saturated fats, and cholesterol. Regular fitness exercises based on available facilities such as brisk walking, stair climbing, jogging, or swimming that use the larger skeletal muscles should be incorporated into weight reduction programs. Once the diagnosis of MetSy in Pregnancy or elements of it is made, it's possible to provide intervention to prevent progression of the condition and complications in pregnancy and the associated adverse perinatal outcomes [114].

Insulin resistance and central obesity are regarded as the main underlying causes of metabolic syndrome. Therefore, reduction in body weight will lead to fatty acid mobilization and should be the key focus in management of the MetSy [115]. Stinson et al. [116] showed that overconsumption of poor diet is an important component of the MetSy, and thus needs to be targeted for its reduction and treatment. A literature review on randomized control trials has shown improvement in MetSy following intervention focusing on diet and lifestyle modification, either in certain components or taken as a whole syndrome within a period of 2 weeks–1 year [117]. Informing and educating the public should include nutrition, promotion of regular physical activity, reduction of substance abuse as well as prevention or management of central adiposity, diabetes, atheromatosis and hypertension, and setting a national agenda to motivate all population groups to change stereotype perceptions and behaviors aimed at health and quality-of-life promotion.

Literature provides evidence of efficacy in adhering to the Mediterranean diet (MeD) in reducing body weight [118]. The Mediterranean Dietary pattern is comprised of fruit, cooked vegetables and legumes, grains (whole, not refined) and, in

**203**

*Metabolic Syndrome in Reproductive Health: Urgent Call for Screening*

Obese women with overtly high BMI of more than 40 kg/m<sup>2</sup>

moderation, wine, nuts, fish and dairy products, particularly yogurt and cheese. It is a food pattern that has the potential of improving health and quality of life in people who adhere to it appropriately, characterizing a way of life and culture [119]. These interventions to alter diet and lifestyle have the potential to succeed only if they are executed early, and thus, offer enough evidence to develop appropriate public policies.

with the presence of comorbid NCD conditions (such as diabetes mellitus, coronary artery disease, or severe sleep apnea), should be referred to a specialist surgeon for possible bariatric surgery [120]. Great success has been reported with women who have undergone Bariatric surgery followed by healthy lifestyle modifications [121], by generally demonstrating overall recovery in quality-of-life measures and resolu-

Patients who have undergone bariatric surgery should be counseled to avoid pregnancy for a period of 12–18 months after the procedure. Falling pregnant during this interval has been associated with higher risk of surgical complications and

MetSy is not only as a predictor of cardiovascular disease but also as a potential

Noncommunicable disease is rising globally at an alarming rate, future studies focus should be on the strategies needed to improve public health programs and policies aimed at reducing the prevalence of metabolic syndrome through screening at all contacts for all types of patients to save the future generations. Instituting early and targeted lifestyle interventions such as balanced diet and frequent physi-

The authors declare that there is no conflict of interest that could be perceived as

contributing factor to poor reproductive health and interfere with fertility in both male and female affected across her lifespan. Perhaps the most concerning information presented in this chapter is the Barker hypothesis, that the metabolic syndrome's adverse effects are likely transgenerational where children born to obese mothers are at increased risk for obesity, diabetes and cardiovascular disease later in life. There is also increasing and worrying evidence that lifestyle factors such as alcohol binge consumption increases the incidence of metabolic syndrome. Obesity exerts it detrimental effect in the human body by generating a physiological resis-

tant state in the such as a leptin resistant state, insulin resistant.

cal activity for metabolic syndrome is a medical exigency.

prejudicing the impartiality of the review.

or BMI of 35 kg/m<sup>2</sup>

*DOI: http://dx.doi.org/10.5772/intechopen.95971*

**11.2 Bariatric surgery and pregnancy**

tion of their medical comorbidities [122, 123].

**12. Summary**

**Conflict of interest**

exposure of the foetus to rapid weight change [124].

*Metabolic Syndrome in Reproductive Health: Urgent Call for Screening DOI: http://dx.doi.org/10.5772/intechopen.95971*

moderation, wine, nuts, fish and dairy products, particularly yogurt and cheese. It is a food pattern that has the potential of improving health and quality of life in people who adhere to it appropriately, characterizing a way of life and culture [119]. These interventions to alter diet and lifestyle have the potential to succeed only if they are executed early, and thus, offer enough evidence to develop appropriate public policies.

#### **11.2 Bariatric surgery and pregnancy**

Obese women with overtly high BMI of more than 40 kg/m<sup>2</sup> or BMI of 35 kg/m<sup>2</sup> with the presence of comorbid NCD conditions (such as diabetes mellitus, coronary artery disease, or severe sleep apnea), should be referred to a specialist surgeon for possible bariatric surgery [120]. Great success has been reported with women who have undergone Bariatric surgery followed by healthy lifestyle modifications [121], by generally demonstrating overall recovery in quality-of-life measures and resolution of their medical comorbidities [122, 123].

Patients who have undergone bariatric surgery should be counseled to avoid pregnancy for a period of 12–18 months after the procedure. Falling pregnant during this interval has been associated with higher risk of surgical complications and exposure of the foetus to rapid weight change [124].

### **12. Summary**

*Lifestyle and Epidemiology - The Double Burden of Poverty and Cardiovascular Diseases...*

**11. Intervention approaches to reduce the burden of MetSy**

ated with increased scrotal temperatures [110].

**11.1 Health promotion (Ottawa charter)**

associated with obesity in pregnancy [112].

health.

pregnancies in 19.6% [109]. Prolonged inactivity in obese men has also been associ-

Health promotion is 'the process of enabling people to increase control over and to improve their health' Introduced into public health in Ottawa in 1986 [111]. Health promotion strategies can be achieved by developing and changing lifestyles, to impact on the social, economic and environmental conditions that determine

The Ottawa Charter for Health Promotion set out five strategies that are essential for the success for any health promotion strategy: Build healthy policy; Create supportive environments; Strengthen community actions; Develop personal skills; and Reorient health services. Health promotion actions should target the population at risk, early in life to stop the metabolic storm, by increasing their knowledge and warning them about the dangers of MetSy, enforcing bans on alcohol and tobacco advertising, promotion and sponsorship, raising taxes on alcohol and tobacco and reducing the price of healthy diet food. It is of vital importance to note that the ideal time for intervention is pre-conception. Health-care workers who attend to women of reproductive age and diagnose obesity, have a duty to counsel and refer these patients to high-risk obstetric specialists for consultation to discuss the many risks

These obese patients should be encouraged strongly to undertake nonsurgical interventions to achieve weight reduction to achieve ideal body weight (BMI, 18.5–24.9 kg/m2) before conception. These include, among others, behavioral modification, dietary changes, exercise, and pharmacotherapy [113]. Dietician consultation is recommended for diet advice that is high in fiber, fresh fruit, vegetables, lean protein, and complex carbohydrates, while avoiding foods that contain large amounts of sugar, saturated fats, and cholesterol. Regular fitness exercises based on available facilities such as brisk walking, stair climbing, jogging, or swimming that use the larger skeletal muscles should be incorporated into weight reduction programs. Once the diagnosis of MetSy in Pregnancy or elements of it is made, it's possible to provide intervention to prevent progression of the condition and complications in pregnancy and the associated adverse perinatal outcomes [114]. Insulin resistance and central obesity are regarded as the main underlying causes

of metabolic syndrome. Therefore, reduction in body weight will lead to fatty acid mobilization and should be the key focus in management of the MetSy [115]. Stinson et al. [116] showed that overconsumption of poor diet is an important component of the MetSy, and thus needs to be targeted for its reduction and treatment. A literature review on randomized control trials has shown improvement in MetSy following intervention focusing on diet and lifestyle modification, either in certain components or taken as a whole syndrome within a period of 2 weeks–1 year [117]. Informing and educating the public should include nutrition, promotion of regular physical activity, reduction of substance abuse as well as prevention or management of central adiposity, diabetes, atheromatosis and hypertension, and setting a national agenda to motivate all population groups to change stereotype perceptions

Literature provides evidence of efficacy in adhering to the Mediterranean diet (MeD) in reducing body weight [118]. The Mediterranean Dietary pattern is comprised of fruit, cooked vegetables and legumes, grains (whole, not refined) and, in

and behaviors aimed at health and quality-of-life promotion.

**202**

MetSy is not only as a predictor of cardiovascular disease but also as a potential contributing factor to poor reproductive health and interfere with fertility in both male and female affected across her lifespan. Perhaps the most concerning information presented in this chapter is the Barker hypothesis, that the metabolic syndrome's adverse effects are likely transgenerational where children born to obese mothers are at increased risk for obesity, diabetes and cardiovascular disease later in life. There is also increasing and worrying evidence that lifestyle factors such as alcohol binge consumption increases the incidence of metabolic syndrome. Obesity exerts it detrimental effect in the human body by generating a physiological resistant state in the such as a leptin resistant state, insulin resistant.

Noncommunicable disease is rising globally at an alarming rate, future studies focus should be on the strategies needed to improve public health programs and policies aimed at reducing the prevalence of metabolic syndrome through screening at all contacts for all types of patients to save the future generations. Instituting early and targeted lifestyle interventions such as balanced diet and frequent physical activity for metabolic syndrome is a medical exigency.
