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WPSI Issues New Clinical Guidelines for Obesity Prevention in Women 40 to 60

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Women between 40 and 60 years old are the focus of new national guidelines aimed at preventing unhealthy weight gain that can lead to serious illness.  The Women’s Preventive Services Initiative (WPSI)’s new clinical guideline recommends that clinicians discuss obesity prevention strategies with female patients aged 40 to 60 years or refer them for such counseling even if they are not overweight.

WPSI, a national coalition of women’s health professional organizations and patient advocacy representatives, was launched in 2016 by the American College of Obstetricians and Gynecologists and operates in collaboration with the US Department of Health and Human Services, Health Resources and Services Administration with the intent of improving management of health issues impacting women.  With the obesity epidemic continuing to grow, the organization set its sights on providing guidance to prevent obesity among women in midlife.  The recommendationand evidence review, just published in the journal Annals of Internal Medicine, are based on a systematic review of published evidence.

National epidemic affects ~half of midlife women

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 is categorized as overweight.  Obesity is an especially common condition in women during midlife, affecting ~43% of American women aged 40 to 59 (Hales CM et al. NCHS Data Brief. 2020), who may experience physiologic changes related to aging, menopause, reduced physical activity, and changes in body composition.

Obesity increases the risk for many chronic conditions including hypertension, dyslipidemia, type 2 diabetes, coronary artery disease, stroke, and all-cause mortality.  Further, it is causally related to cancer at 13 different anatomical sites including the endometrium, ovary, and breast (Colditz GA, Peterson LL. Clin Chem. 2018.; American College of Cardiology/American Heart Association Task Force on Practice Guidelines, Obesity Expert Panel, 2013. Obesity(Silver Spring) 2014.).  According to the Annals paper, 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.

A gap not addressed before

Importantly, although clinical guidelines have previously been issued by the United States Preventive Services Task Force (USPSTF) for individuals with obesity or cardiovascular disease risk factors, previous clinical recommendations have not specifically addressed obesity prevention in midlife women with normal or overweight BMI.  The WPSI recommendations address this gap by considering evidence on the effectiveness and harms of behavioral interventions to prevent weight gain and obesity in women aged 40 to 60 years without obesity.

The new guidelines emphasize the need for clinicians to help with weight management by counseling women while they are still at a healthy weight rather than waiting until they are overweight or have developed obesity.  They recommend that healthcare providers initiate or refer patients for individualized counseling about healthy eating and physical activity in order to maintain a healthy weight for those with a normal-range body mass index (BMI), or to maintain or limit weight gain for those women whose BMI falls in the “overweight” BMI category.

The guideline’s data basis

WPSI’s recommendations are based on the work of a team of researchers from Oregon Health & Science University which conducted a systematic review of 7 randomized control trials (RCTs) comprised of 51,638 participants.  Five of the trials which were included focused on counseling participants, with clinicians offering advice or specific recommendations on behavior change, such as weight monitoring, dietary changes, or physical activity.  Also included were 2 exercise trials, one that evaluated medically supervised exercise, and another that prescribed both exercise and counseling.

Findings, both benign and cautionary

The investigators found that in 4 of the 5 counseling trials, participants achieved favorable weight changes; however, in the 2 trials focused on exercise, patients did not.  Further, they report that there were no adverse psychological effects associated with counseling interventions.  However, a rise in self-reported falls was evident in one trial which included an intervention to increase physical activity in previously inactive women who were overweight.

Topline recommendation specifics

The WPSI recommends counseling midlife women aged 40 to 60 years with normal or overweight BMI (18.5–29.9 kg/m2) to maintain weight or limit weight gain to prevent obesity and to evaluate the benefits and harms of interventions to prevent weight gain and obesity among this patient population.  Obesity prevention counseling may include individualized discussion of healthy eating and physical activity.  The recommendation was made based on the balance of benefits and harms reported in the included studies in the systematic review, known health benefits of preventing obesity, and the minimal harms anticipated in counseling.

Evidence review recap highlights

  • 7 randomized clinical trials included 51,638 participants.
  • 4 trials demonstrated statistically significant favorable differences in weight change for counseling interventions.
  • 1 trial of counseling and 2 trials of exercise showed no differences.
  • 1 of 2 RCTs reported improved quality-of-life.
  • Interventions did not increase measures of depression or stress.
  • 1 trial showed that self-reported falls (37% vs 29%; P<.001) and injuries (19% vs 14%; P=.03) were higher with exercise counseling.

A stigma-blunting bonus?

The authors note that normalizing counseling about healthy diet and physical activity by providing it to all midlife women may also mitigate concerns about weight stigma resulting from only counseling women with obesity.

“More than two-thirds of middle-aged women are overweight or obese,” stated Kimberly D. Gregory, MD, MPH, in a statement accompanying the release of the guideline.

Gregory, a participant in WPSI, corresponding author of the guidelines, and vice chair, Women’s Healthcare Quality and Performance Improvement in the Department of Obstetrics and Gynecology at Cedars-Sinai, continued, “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.”

“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,” she concluded.  “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.”

The authors add that further research is needed to identify optimal behavioral interventions that are effective, feasible, and sustainable, and which can be implemented in primary care settings among diverse populations.

Read the full executive summary of WPSI’s clinical guidance at no cost at “Preventing Obesity in Midlife Women: A Recommendation From the Women’s Preventive Services Initiative.” 

 Clinicians’ Bonus:  More To Know

Obesity Prevention resources for you and to share with your patients

 Here is a free, patient-directed summary of the new guideline recommendations from Annals of Internal Medicine, “Summary for Patients: Preventing Obesity in Midlife Women,” as well as a brief video, “Preventing Obesity in Midlife Women: A Systematic Review for the Women’s’ Preventive Health Initiative,” which you might consider sharing in your counseling.

 Also, be sure to explore the CDC’s impressive collection of resources on diet and physical activity for both clinicians and patients.

Finally, consider bookmarking the Office of Disease Prevention and Health Promotion’s provider-directed multimedia tools collection which includes posters, handouts, and videos.


The contents of this feature are not provided or reviewed by NPWH.

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