The Women's Preventive Services Initiative (WPSI), a national coalition of women's health professional organizations and patient advocacy representatives, has issued a new clinical guideline recommending that clinicians discuss obesity prevention strategies with female patients aged 40 to 60 years even if they are not overweight. According to the guideline, counseling should include individualized discussion with patients about healthy eating and physical activity to maintain a healthy weight for those with a normal-range body mass index (BMI), or to maintain or limit weight gain for those whose BMI is categorized as overweight. The recommendation is based on a systematic review of published evidence. The recommendation and evidence review are published in Annals of Internal Medicine.

Obesity is a common condition in women during midlife, affecting about 43% of American women aged 40 to 59, 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, and is causally related to cancer at 13 different anatomical sites including the endometrium, ovary, and breast. Previous clinical recommendations have not specifically addressed obesity prevention in midlife women with normal or overweight BMI. The WPSI recommendation addresses 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.

Evidence review

Researchers from Oregon Health & Science University conducted a systematic review of 7 randomized control trials (RCTs) comprised of 51,638 participants. Five of the included trials focused on counseling participants, with clinicians offering advice or specific recommendations on behavior change, such as weight monitoring, dietary changes, or physical activity. There were two exercise trials, one that evaluated medically supervised exercise, and another that prescribed both exercise and counseling. The authors found that in 4 of the 5 counseling trials participants achieved favorable weight changes, but in the 2 trials focused on exercise, they did not. The authors also report that there were no adverse psychological effects associated with counseling interventions, but one trial reported increased self-reported falls with an intervention to increase physical activity in previously inactive women who were overweight.

Recommendation

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. 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 minimal anticipated harms of counseling. 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. They add that further research is needed to identify optimal behavioral interventions that are effective, feasible, and sustainable, and can be implemented in primary care settings among diverse populations.