All women 40-60 should have weight counseling, coalition urges

WASHINGTON, Aug. 1 (UPI) -- A new guideline -- unveiled Monday and already stirring up controversy -- urges clinicians to discuss obesity prevention strategies with all female patients ages 40 to 60, even if they are not overweight.

The clinical guideline, which was published in the Annals of Internal Medicine, was developed by a national coalition called the Women's Preventive Services Initiative.


The federally funded initiative was launched by the American College of Obstetricians and Gynecologists in 2016 to review and update recommendations for women's preventive healthcare services.

The guideline recommends counseling to include individualized discussion with female patients about healthy eating and physical activity to help maintain a healthy weight for those with a normal body mass index -- or limit weight gain in women whose BMI classifies them as overweight.

Obesity, a common condition that affects roughly 1 in 4 U.S. women in this age range, increases the risk for many chronic conditions, including hypertension, type 2 diabetes, coronary artery disease and stroke, the guideline's authors said.


If the category is broadened to include overweight as well as obese women, more than 70% of women aged 40 to 60 years in the United States fit into it, according to a patient summary accompanying the guideline's release.

Previous recommendations have stopped short of calling for preventive measures in middle-aged women who are not obese.

Yet, the evidence is clear that obesity can lead to poor health outcomes, Dr. Christopher M. Zahn, chief for clinical practice and health equity and quality at ACOG, said in an email to UPI.

"Counseling all of our midlife patients, particularly those who are entering or going through menopause, about weight management can help give them all the tools they need to live healthier lives," Zahn said.

Dr. Mary Rosser, an obstetrician-gynecologist in New York City, agreed on the need for broad discussion.

"Rather than just discuss obesity with patients who have an issue, this targets a broad audience of all middle-age women to get their attention and influence positive lifestyle decisions," Rosser told UPI in an email.

But at least one physician, after reviewing the guideline and its rationale, disputes many aspects of it.

Dr. Kate White, associate professor of obstetrics and gynecology at Boston University School of Medicine, said such broad-based weight counseling "could come across as insensitive" to middle-aged female patients who have different priorities, and may feed into the debunked perception that weight loss is a matter of willpower.


Plus, she said, admonishing a person not to gain weight as they get older "is a really hard directive to follow."

"I don't want to argue there is a problem [with obesity and related health problems]. What I have are some concerns about is this as a way to address it," White told UPI in a phone interview.

White said her first concern is that counseling about weight loss, without evidence-based recommendations for what works at keeping off pounds in the long term, "is at best pointless and at worst damaging."

Weight cycling "is associated with increased weight gain over time, insulin resistance, which sets you up for diabetes, high cholesterol, high blood pressure and increased mortality," White said.

The weight-counseling recommendations, if adopted by the Department of Health and Human Services' Health Resources and Services Administration, will help ensure that women receive a comprehensive set of preventive services without having to pay a co-payment, co-insurance or deductible, according to the coalition's website.

White said doctors must be thoughtful about what they spend their time on during brief patient visits. "One reason for the guideline is to try to get insurers to cover extra time" for obesity counseling, she said, "but my question is, does it work?"


The guideline's authors said their recommendations are "based on a systematic review of published evidence" that suggests some behavioral counseling approaches to prevent weight gain in midlife women may result in modest weight loss "without causing important harms."

White said, however, that in the seven studies reviewed by the guideline's authors, time spent on various interventions only led to women's weight loss ranging from 1.9 pounds to 5.5 pounds.

Moreover, White said, the guideline authors concede their review of previous research looked at only one study that reported outcomes by race and ethnicity -- and no studies that reported outcomes based on socio-demographics.

This amounts to "a hand wave, waving aside the things that matter the most" on why women gain weight, such as lack of access to healthy foods, scant time to exercise and numerous challenges related to living in disadvantaged communities, she said.

"To come in and say, 'You should add losing weight on top of [difficult circumstances] is, willfully or not, blind to how people live and how difficult it is to lose weight and keep it off," White said.

She added: "You can't minimize the risk that bringing up weight with all patients is going to feed further into weight stigma, which evidence has shown has real consequences for people's health."


For people who are overweight or obese, but not showing health consequences, she said, "I think this [guideline] may be a very narrow focus on one indicator of health without keeping in mind the people sitting in front of you."

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