Watching weight for women

This month's issue addresses weight gain in women, celiac disease, and mRNA COVID-19 vaccines and myocarditis.

Weight gain in mid-life is common for women, but not inevitable, and physicians may be able to help prevent it. The Women's Preventive Services Initiative (WPSI) recently recommended that clinicians counsel women ages 40 to 60 years with a normal or overweight body mass index to maintain weight or limit weight gain to prevent obesity. But while that recommendation may seem simple, physicians should take care in implementing it, experts said. Our story in this issue discusses the challenges to weight maintenance that patients face, the potentially large effects of small changes, and the importance of tailoring advice as well as avoiding stigma.

Although awareness of celiac disease has increased in recent years, there's still room for improvement in diagnosis and treatment. The classic presentation includes chronic diarrhea or bloating, weight loss, and malabsorption, but patients can also present with constipation, fatigue, or iron deficiency anemia, among other features. It's an important condition to pin down, because both false-positive and false-negative diagnoses can have adverse consequences. Our story in this issue reviews updated guidelines on this topic and covers the basics of the diagnostic workup, the differences between celiac disease and nonceliac gluten sensitivity, gluten challenges, and optimal follow-up.

Three years in to the COVID-19 pandemic, data on SARS-CoV-2 infection, transmission, and vaccination have continued to emerge and evolve. The potential for myocarditis risk associated with the mRNA COVID-19 vaccines has been debated since soon after their rollout, and a clearer picture is now developing. At the Heart Failure Society of America's annual meeting in October 2022, an infectious diseases expert from the U.S. Department of Defense and the University of California, San Diego, provided an overview of the latest research, including a strong safety signal for heightened risk in healthy young men and whether the same risk is seen after booster doses.

Even before the pandemic, physicians, whether in training or established in practice, dealt daily with uncertainty. How they do so, though, can affect both their own well-being and the care they provide. Too much comfort with uncertainty could make a physician less likely to ask for help, for example, while too little could lead to burnout and less career satisfaction. Senior Writer Mollie Frost talks to two experts about what research in this field has shown and gets their tips on how physicians can learn to manage uncertainty productively.

Among other highlights, this issue also includes a Guest President's Message from ACP's Treasurer, Janet A. Jokela, MD, MPH, MACP, and a Pearls from I.M. Peers column that reminds clinicians to consider the source, and the initial intended patient population, when implementing diagnostic criteria.

Do you counsel patients about avoiding mid-life weight gain? How do you deal with uncertainty? Let us know.


Jennifer Kearney-Strouse
Executive Editor