Sex & Gender Effects of Sex and Gender on Obesity and Cardiovascular Disease

Effects of Sex and Gender on Obesity and Cardiovascular Disease

By Nina Faynshtayn, Ynhi Thomas, MD, MPH, MSc; and Connie Newman, MD, on behalf of the SAEM Sex and Gender in Emergency Medicine Interest Group

Consideration of sex and gender is crucial for improving medical care. Historically, in terms of research and clinical practice, differences between men and women have seldom been considered and analyzed thoroughly. One example is cardiovascular health. Women and men present with varying symptoms of acute coronary syndrome, and women are less likely to be diagnosed and treated. Research has focused primarily on men’s bodies, yet there are significant sex differences that need to be studied, such as the effects of cardiovascular drugs and patterns of coronary artery plaque distribution.

Obesity is a risk factor for cardiovascular disease and sex differences in obesity should be considered. Fat deposition differs between males and females. In males, fat is mainly located in the visceral area (which is associated with increased risk of cardiovascular disease), and in premenopausal females, fat deposits are largely subcutaneous. Fat may be dysfunctional in obesity and release substances called cytokines that have negative effects on the heart. Genetic, epigenetic, and hormonal factors are responsible for sex differences in adipose tissue distribution. Estrogen plays a critical role in energy balance, acting on the brain to reduce food intake and increase physical activity and energy expenditure. Also, it is important to note that estrogen deficiency, which occurs during menopause, is associated with diabetes and obesity.

“Beyond physiological differences, lifestyle differences based on sex and gender may influence obesity.”

“Historically, in terms of research and clinical practice, differences between men and women have seldom been considered and analyzed thoroughly.”

Beyond physiological differences, lifestyle differences based on sex and gender may influence obesity. Specifically, men and women differ in terms of their macronutrient consumption, as well as food cravings, with women consuming more total sugar, total fat, and saturated fat, while also craving more sweet foods. Greater understandings of sex and gender differences in adipose tissue and obesity could lead to novel approaches to weight reduction and weight management. In studies comparing effects of lifestyle changes on body weight in men and women, results were inconsistent, with several showing small sex differences in weight loss, but not prespecifying the comparison of sex and gender differences. Other limitations of studies on sex and gender differences in weight loss include an unequal number of men and women, limited data for percent change in body weight, lack of studies that defined sex differences in weight loss as a primary end point, and data collection and research methods. Some studies suggest sex differences in preferences for types of lifestyle interventions, though more research is needed on sex and gender tailored interventions.

In anthropological terms, obesity can be considered a “social contagion,” which is a concept proposed by Christakis and Fowler. With this idea, social networks play a crucial role in the “spread” of obesity, such as with peers and in friendships. Thus, these networks may be implicated by gender as well. However, a review of various studies demonstrated inconclusive findings regarding the consideration of obesity as a gendered social contagion.

Overall, more research is needed, especially with randomized controlled trials, extensions of studies, comparisons of interventions, and the effects of geography, social networks, access to healthy foods, and educational levels. Elucidating the state-of-the-art concept of obesity as a gendered social contagion may identify areas for novel emergency medicine research with immense public health significance. ABOUT THE AUTHORS

Nina Faynshtayn is an undergraduate research assistant at Brown University.

Dr. Thomas is assistant director of justice, equity, diversity, and inclusion in the Henry J.N. Taub Department of Emergency Medicine at Baylor College of Medicine and assistant medical director of operations research and assistant medical director of behavioral health initiatives at Ben Taub Emergency Center, Harris Health System.

Dr. Newman is an adjunct professor of medicine, New York University Grossman School of Medicine, New York, NY and past president of the American Medical Women’s Association

About SGEM

The Sex and Gender in Emergency Medicine (SGEM) Interest Group works to raise consciousness within the field of emergency medicine on the importance patient sex and gender have on the delivery of emergency care and to assist in the integration of sex and gender concepts into emergency medicine education and research. Joining SGEM is free! Just log into your member profile. Click “My Account” in the upper right navigation bar. Click the “Update (+/-) Academies and Interest Groups” button on the left side. Select the box next to the academy you wish to join. Click “save.”