Obesity is a disease that affects one-fourth to one-third of the adult American population and is the second leading cause of preventable mortality and morbidity in the United States. Each year, obesity causes at least 300,000 excess deaths in the US, and healthcare costs of Americans with obesity amounted to approximately $75.1 billion in 2003. The cost to Washington State hovers near $1.3 billion dollars each year.

    The number of obese and overweight Americans has continued to increase since 1960, a trend that does not appear to be slowing down. Today, 64.5 percent of adult Americans (about 127 million) are categorized as being overweight or obese. Furthermore, low-income women in minority populations appear most likely to be overweight, particularly in Hispanic or Native American populations.

    The health risks associated with obesity are well known and include increased risk for development of high blood pressure, diabetes (Type 2), heart disease, stroke, gallbladder disease and cancer of the breast, prostate and colon.

    While the treatment of obesity may be the domain of other medical providers, this issue is of particular concern in the family planning setting. For example, it has been reported that women who weigh at least 150 pounds are 1.6 times more likely to experience oral contraceptive failure. In this same study, those women who weighed the most and took low-dose birth control pills were 4.5 times more likely to become pregnant. In other words, those women clearly trying to avoid pregnancy were more likely to experience an unintended pregnancy. Other conditions and complications related to obesity specific to reproductive health include:

• The rate of diminished ovulation, response to fertility treatment, pregnancy rates and pregnancy outcomes in obese women. In fact, it is suggested that 6% of infertility can be tracked to obesity
• Gynecological complications such as miscarriage and difficulties in performing assisted reproduction due to excess body fat
• The increased frequency of menstrual abnormalities and disturbances in women with severe obesity
• The elevated risk of pregnancy hypertension, gestational diabetes, urinary infection, cesarean section delivery and toxemia associated with high pre-pregnancy weight
• The high risk of developing breast cancer after menopause in women with obesity
• Shorter life span for pre-menopausal women who are overweight and have breast cancer
• Three to four times the risk of endometrial cancer in obese women

    However, there is hope. If maintained, even weight losses as small as 10 percent of body weight can improve one's health. In addition, infertile women with obesity who lose weight have shown improvement in becoming pregnant when actively attempting and reach full term. In addition, weight loss of about 10 percent of initial weight is effective in improving menstrual regularity, ovulation, hormonal profiles and intended pregnancy rates.

    The project is a three-tiered model designed to serve these clients who are low or no risk, at-risk, and highest risk for obesity and overweight. Services are offered to individuals while they are obtaining services from Family Planning of Clallam County. Intervention is offered as education, referral, advocacy, and support.

• Reduction of obesity in FPCC clients and improved contraceptive effectiveness
• Increased awareness of reproductive health risks associated with obesity
• Improved health and well-being of individuals at-risk for obesity or those currently considered medically obese
• Provision of high quality clinical family planning to improve the overall health of individuals