Preventing Obesity in Midlife Women

The Women’s Preventive Services Initiative (WPSI) recommends counseling midlife women aged 40 to 60 years with normal or overweight body mass index (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.

Midlife women between 40 and 60 years of age are at increased risk of weight gain, some gaining an average of 1.5 lbs (0.7 kg) per year. Preventing obesity reduces risk of chronic health conditions such as heart disease, diabetes mellitus, arthritis, and certain cancers. Although clinical guidelines have been issued by the United States Preventive Services Task Force (USPSTF) for individuals with obesity or cardiovascular disease risk factors, no current guidelines include prevention of obesity among women with normal or overweight BMI.

Clinical trials of counseling interventions indicate the effectiveness of counseling on weight maintenance or weight loss in midlife women with normal or overweight BMI. Although all trials included dietary and physical activity counseling as interventions, specific components varied. Weight maintenance or loss was reported at follow-up times ranging from 1 to 7.5 years. Studies suggest more frequent counseling may be more effective, although the optimal type, intensity, periodicity, delivery method of counseling, and its effect on long-term health outcomes were not evaluated. In addition to clinical trials of counseling, the WPSI bases its recommendation on the known health benefits of preventing obesity, as well as national guidelines outlining standards for physical activity and diet in the United States.

The WPSI suggests clinicians offer or refer women to individualized counseling based on assessment of a patient’s BMI and diet and exercise habits. Patients with normal weight and healthy habits can receive positive reinforcement. Women with overweight BMI and with unhealthy diet and exercise habits should receive at least brief counseling.  Periodicity and intensity of reinforcement and counseling can be individualized based on the patient’s BMI, previously established habits, and acceptance. The Centers for Disease Control and Prevention provides resources for diet and physical activity for patients and clinicians.

Clinicians should individualize counseling taking into consideration contributing factors associated with obesity including chronic stress, trauma, and socioeconomic conditions. Counseling should be sensitive to weight stigma, the influence of culture on body image, individual variability in body composition, accessibility to safe spaces for physical activity, financial resources, childcare, leisure time, and availability of healthy foods.

• Research of the effectiveness of interventions in reducing progression to obesity in midlife women with normal to overweight BMI.
• Studies of the effectiveness of different approaches for delivering interventions to prevent obesity including different formats (eg, virtual and remote), content, frequency, and intensity.
• Studies of the effectiveness of interventions conducted in diverse populations to identify benefits and harms in different patients and population groups.
• Studies that evaluate the effect of cultural components and psychiatric effects of weight stigma and body image.
• Studies of health outcomes in relation to variability in individual body composition.