New national guidelines aim to prevent obesity in midlife women

"More than two-thirds of middle-aged women are overweight or obese. Given women's increased risk for weight gain in midlife, there is a critical need for intervention aimed at preventing obesity and the host of serious health outcomes associated with it," said Kimberly D. Gregory, MD, MPH, corresponding author of the clinical guidelines and vice chair, Women's Healthcare Quality and Performance Improvement in the Department of Obstetrics and Gynecology at Cedars-Sinai.

Gregory is part of the Women's Preventive Services Initiative (WPSI), which developed the recommendations based on the review of clinical trials involving nearly 52,000 middle-aged women. The initiative was launched in 2016 by the American College of Obstetricians and Gynecologists and operates in collaboration with the U.S. Department of Health and Human Services, Health Resources and Services Administration.

"In the past, most studies and recommendations have focused on investigating the benefits and harms of weight-loss tools used by women who were already overweight. But as a prevention strategy, these new guidelines strongly encourage healthcare providers to begin addressing the issue of weight gain and obesity risk with patients who are at normal weight," said Gregory.

Obesity has been declared epidemic in the United States, with 42% of adults having a body mass index (BMI) of over 30, according to the Centers for Disease Control and Prevention (CDC). A BMI of 18.5-25 is regarded as healthy, and one between 25 and 30 qualifies as overweight.

According to the study, women gain weight at an average of 1.5 pounds per year during midlife, which increases their risk for transitioning to an overweight or obese BMI. The new guidelines emphasize the need to help with weight management by counseling women while they are at a healthy weight and not waiting until they are overweight or have developed obesity.

"Women are at higher risk for severe obesity due to menopause and age-related physiological changes," said Amanda Velazquez, MD, director of Obesity Medicine in the Department of Surgery at Cedars-Sinai. "Significant weight gain is associated with a serious risk of developing cardiovascular disease, hypertension, Type 2 diabetes, fatty liver disease and numerous cancers. That is why advising middle-aged women with normal to overweight BMI on the need to limit weight gain is critical," said Velazquez, who did not participate in the study.

The WPSI review suggests that some behavioral counseling approaches to prevent future weight gain in midlife women could result in modest weight loss. Obesity and weight-loss expert Velazquez says it is important to remember that weight management is a lifelong journey and investment in good health and that there is plenty of help available.

"Do not give up. It is never too late to start making changes. There are quite a few weight management tools available, including individualized lifestyle plans, support groups that provide accountability and community, nutritional counseling, and new weight-loss medications. For people with severe obesity, a BMI over 40, bariatric surgery may be an option to consider," said Velazquez.