Docs Call Attention to Women Piling on Pounds in Midlife

Pam Harrison

October 10, 2017

Experts have singled out midlife as a time when women are particularly prone to pile on the pounds and have put forward a series of recommendations to help prevent and tackle weight gain as women enter their menopausal years.

"We singled out this group of patients because they have unique challenges, including menopausal symptoms, [that work against] the adoption of a healthy lifestyle as well as unique consequences of weight gain, in particular, its central distribution," lead author of the new review, Ekta Kapoor, MBBS, endocrinologist, Mayo Clinic, Rochester, Minnesota, told Medscape Medical News in an email.

"Targeting lifestyle habits during midlife and beyond will help prevent further health consequences down the road," she added in a statement from her institution, noting, "It's never too late to start making healthy lifestyle choices."

Entitled "Weight gain in women at midlife: A concise review of the pathophysiology and strategies for management" and aimed at internal-medicine physicians and primary-care doctors, the paper was published online October 1, 2017 in the Mayo Clinic Proceedings.

Offer Weight-Management Advice Even If It Isn't Asked for

The key recommendation put forward is to underscore the importance of routine screening for obesity in both perimenopausal and postmenopausal women.

If a woman has a body mass index (BMI) signaling she is overweight or obese, physicians should offer relevant, weight-management counseling — even if the patient doesn't ask for it.

"Oftentimes, patients are embarrassed to bring up weight-related concerns," Dr Kapoor explained. "But once the physician initiates a compassionate discussion and shows concern, patients are more willing to talk about it."

Although not available in all office settings, Dr Kapoor and colleagues recommend physicians take a multidisciplinary approach to weight control when such resources are available.

That said, the authors emphasize that physicians themselves are well poised to educate and support patients in their efforts to lose weight and to help them set realistic goals to avoid disappointment.

A hypocaloric diet is pivotal to a weight-loss plan, and patients can choose whatever diet they prefer, provided they achieve a daily deficit of between 500 to 750 calories.

In other words, most women should consume no more than 1200 to 1500 calories a day to lose weight, at which point, they can expect to lose on average, 0.5 to 0.75 kg (1.1–1.65 lb) a week, the authors observe.

Mediterranean Diet Good for Improving CVD Risk Profile

And if a woman feels she can follow the Mediterranean diet, which is high in plant-based foods, whole grains, nuts, and legumes, this diet has the added advantage of improving a patient's cardiovascular disease (CVD) risk profile and as such, deserves special consideration for at-risk patients such as obese, menopausal women, the researchers say.

"Patients should [also] be encouraged to use weight-management tools such as calorie-counting apps (eg, MyFitnessPal, Lose It!) and online resources (eg, the National Weight Control Registry)," they suggest.

Of course, physical activity goes hand-in-hand with a weight-loss program, and women who are more active when they enter the menopause — or who increase their activity during or after it — are less likely than inactive women to gain weight.

Guidelines recommended patients exercise between 150 and 175 minutes a week, either in the form of brisk walking or some other aerobic activity.

"Resistance exercises are particularly beneficial because they improve lean body mass, thereby increasing the basal metabolic rate and energy expenditure," the authors point out.

Similarly, women who receive hormone-replacement therapy (HRT) tend to be leaner and have less central obesity.

Thus, if there are no contraindications to a woman receiving HRT, they may well benefit from its use, particularly if experiencing bothersome hot flushes, sleep disturbances, or mood changes, all of which can disrupt efforts to embrace and maintain a healthy lifestyle.

Weight-Loss Medications

The Mayo Clinic group also recommend that women with a BMI in excess of 30 kg/m2 or > 27 kg/m2 in the presence of a weight-related comorbid condition be offered one of several available therapeutics that help promote weight loss.

Medications that have been approved for weight loss include appetite suppressants such as phentermine and phentermine/topiramate extended release (Qsymia, Vivus).

Other agents that have also been approved for weight loss include liraglutide (Saxenda, Novo Nordisk) , lorcaserin (Belviq, Eisai/Arena Pharmaceuticals), and naltrexone/bupropion sustained release (Contrave, Orexigen Therapeutics,).

The authors caution, however, that weight-loss drugs typically induce only about a 5% to 10% weight loss and they should really be mainly recommended for women who are motivated to adopt healthy lifestyle changes but who can't seem to lose weight despite their best efforts.

For women with a BMI in excess of 40 kg/m2 — or 35 kg/m2 if they have weight-related complications — bariatric surgery is indicated, and surgical options should be discussed along with other, less-invasive bariatric techniques.

Weigh Regain Is the Biggest Enemy

Nevertheless, approximately half of patients who manage to lose significant amounts of weight are back to their baseline weight within 3 to 5 years, the Mayo Clinic authors caution.

"[Thus], patients should be prepared and counseled about weight plateau and potential regain after initial weight loss," they recommend.

People who are more likely to maintain weight loss have good social support, receive consistent behavioral counseling, and engage in physical activity of between 200 to 300 minutes a week.

In contrast, patients who engage in lower levels of physical activity, who eat for emotional reasons, and who lack social support are more likely to regain the lost weight.

"Weight-loss attempts are absolutely worthwhile — despite the knowledge that half of patients will gain the weight back in 3 to 5 years," Dr Kapoor insisted.

"Weight maintenance simply calls for more intensive efforts in terms of paying attention to the diet and an even greater focus on exercise than is required for initial weight loss," she reaffirmed.

On average, women in their 50s and 60s gain about 1.5 pounds a year.

Dr Kapoor had no relevant financial relationships. Disclosures for the coauthors are listed in the paper.  

Mayo Clin Proc. Published online October 1, 2017. Article

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