Program Reduces Waist Circumference, Maybe Hot Flashes

Jenni Laidman

February 19, 2014

Women transitioning into menopause saw their waist circumference decrease, diastolic blood pressure fall, and frequency of self-reported hot flashes decline after participation in a 6-month individualized intervention program to control central obesity.

Diana L. Bitner, MD, medical director of Women's Health Network, Spectrum Health, Grand Rapids, Michigan, and clinical assistant professor, Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, Grand Rapids, and Robert A. Wild, MD, PhD, professor, Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, reviewed the data of women who took part in a program called WAIPointes (WAI stands for Who Am I), an individualized program that looked at a variety of health measures among women aged 35 to 55 years. They published the results of their analysis online February 10 in Menopause.

Of the 103 women who started the program, 83 completed it and 75 consented to data review. Complete data were available for 68 women. The women answered a questionnaire about their knowledge of chronic disease risk and phases of ovarian function at the start of the program, and clinicians recorded height, weight, waist circumference, and body fat at each visit. Participants met with either an obstetrician-gynecologist or a family practice nurse during each clinical visit. Fasting blood glucose, blood lipids, and ovarian function were also tested initially, and the women received a pedometer to record daily steps. During regular clinic visits, the women learned of their health status and developed goals from which a personalized plan was devised.

Among women who completed at least 4 of 5 follow-up visits, median waist circumference fell from 35.2 to 33.7 inches (P < 0.00), and median diastolic blood pressure fell from 75.2 to 71.2 mm Hg (P < 0.00).

The participants also reported that menopause symptom severity fell. Hot flashes were rated as 3, rare and predictable; 2, moderate and predictable; or 1, frequent and unpredictable. On average, participants said hot flashes improved from 2.56 to 2.79 (P < 0.00). The composite score of menopause symptoms, which were rated on a similar 3-point scale, improved from 2.28 to 2.76 (P < 0.00).

The authors found improvements in multiple areas of health behaviors during the study. At the start of the program, 36 women followed a plan to stay physically active, and at the end, 56 did, which was a 56% increase. Thirty-one had a plan for weight control at the start, and 57 did at the program's conclusion, for an 84% increase. Twenty participants started the program with a plan to decrease their risk for diabetes, and at the conclusion, 51 had a plan, for a 155% increase. At the start, 12 women had a plan to manage menopausal symptoms, and at the conclusion, 59 did, for a 392% increase. When the women entered the program, 33 knew their risk factors for heart disease; at the conclusion, 58 did, which was a 76% increase. At the start, 21 followed a plan to decrease heart disease risk; at the conclusion, 55 did, for a 162% increase.

"Empowerment through education is a cornerstone of our intervention," the authors write. They listed their research strengths as the low drop-out rate and insurance reimbursement for clinic visits.

"There seems to be a big role for empowerment," Nanette Santoro, MD, told Medscape Medical News. Dr. Santoro, who was not involved in the current study, is a professor and E. Stewart Taylor Chair of Obstetrics and Gynecology at the University of Colorado at Denver. "Information alone can be powerful. The modest changes in risk factors can spell out to major changes in a population's risk for disease. So the message I would take home from this paper is that behavioral and lifestyle interventions often get short shrift because we doctors feel that our patients don't take us up on the recommendations. However, we need to package them appropriately and engage our patients better, and keep it up, because they cost nothing, and they can make a difference!" Dr. Santoro said.

Control Group Needed

"This intervention can increase health awareness and improve health-related behaviors that result in reduced waist circumference. That's good," Andrew M. Kaunitz, MD, professor and associate chairman, Department of Obstetrics and Gynecology, University of Florida College of Medicine, Jacksonville, told Medscape Medical News. "There are so many interventions that do not make a positive difference," continued Dr. Kaunitz, who was not involved in the study.

"But I think there are some caveats with that good news," he said. Among them are questions about whether insurance would cover such an intervention consistently. Further, Dr. Kaunitz was cautious about reports of lessened hot flash frequency and intensity. "Clinical trials to treat hot flashes have a very high placebo effect, as high as 40%," he said. "This study was uncontrolled. There was no placebo group that went through the motions without the same intervention. In [the] absence of a comparator group, it's very hard to interpret the reduction of hot flashes."

Additional research must determine whether changes seen in this study will be sustained for a longer period and whether the same results would occur with a more diverse population. Participants in the current study were almost all white (97%), married (87%), and employed (89%).

Dr. Santoro also noted the lack of a control group as a study weakness. "So we do not know how much the decrease in risk factors and symptom scores was directly and irrefutably due to the intervention alone, which the authors of course readily acknowledge," she said. "I really hope that the monitoring gets expanded in the further investigations that are warranted on the basis of these findings."

The authors and commentators have disclosed no relevant financial relationships.

Menopause. Published online February 10, 2014. Abstract

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