New guideline targets preventing obesity in midlife women

A new clinical guideline recommends counseling women ages 40 to 60 years with a body mass index (BMI) of 18.5 to 29.9 kg/m² about maintaining weight or limiting weight gain.

The Women's Preventive Services Initiative (WPSI) recommends that the counseling include individual discussion with patients about healthy eating and physical activity, with the goals of maintaining a healthy weight for those with a normal-range BMI and maintaining weight or limiting weight gain for those who are overweight. The recommendation and a supporting evidence review were published Aug. 2 by Annals of Internal Medicine.

The review included seven randomized control trials comprising 51,638 participants. Five 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. In four of the five counseling trials, participants achieved favorable weight changes (mean difference in weight change, −0.87 to −2.5 kg), but the two trials focused on exercise did not show an effect. Interventions did not increase measures of depression or stress in one trial; self-reported falls (37% vs. 29%; P<0.001) and injuries (19% vs. 14%; P=0.03) were higher with exercise counseling in one trial.

The WPSI made its recommendation based on the balance of benefits and harms reported in the included studies, known health benefits of preventing obesity, and minimal anticipated harms of counseling, the guideline said. The authors noted 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 intensive interventions can be used, when available, and may include referrals,” the authors wrote. “The WPSI recognizes that there are many contributing factors to obesity, additional considerations, and potential for harm. Factors such as chronic stress, trauma, and socioeconomic conditions should be considered when counseling, and counseling should be sensitive to weight stigma, cultural considerations of body image, individual variability in body composition, accessibility to safe spaces for physical activity, financial resources, childcare, leisure time, and availability of healthy foods.”