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Weight gain since menopause and its associations with weight loss maintenance in obese postmenopausal women

DOI:10.2147/CIA.S23574
Authors:
Martin Sénéchal at University of New Brunswick
Martin Sénéchal
Hélène Arguin at Université de Montréal
Hélène Arguin
Danielle R Bouchard at University of Manitoba
Danielle R Bouchard
André C Carpentier at Université de Sherbrooke
André C Carpentier
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To examine the association between weight gain since menopause and weight regain after a weight loss program. Participants were 19 obese women who participated in a 15-week weight loss program and a 12-month follow-up. Main outcomes were: body composition, resting metabolic rate, energy intake, energy expenditure, and weight regain at follow-up. All body composition measures significantly decreased after intervention (all P ≤ 0.01) while all measures of fatness increased significantly after the 12-month follow-up (P ≤ 0.01). Body weight gain since menopause was associated with body weight regain (r = 0.65; P = 0.003) after follow-up even after adjustment for confounders. Weight gain since menopause is associated with body weight regain following the weight loss program. Therefore, weight gain since menopause should be considered as a factor influencing weight loss maintenance in older women.
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... The women selected to be enrolled in this weight loss intervention gained 10.7 -5.6 kg during the postmenopausal period. 29 After the intervention, the women reported significant declines in body weight in comparison to their body weight at baseline ( p < 0.05). 29 However, at the 12month follow-up, women regained 2.5 -3.3 kg and exhibited increased BMI ( p < 0.001), waist circumference ( p < 0.001), and fat mass ( p < 0.001), on average. ...
... 29 After the intervention, the women reported significant declines in body weight in comparison to their body weight at baseline ( p < 0.05). 29 However, at the 12month follow-up, women regained 2.5 -3.3 kg and exhibited increased BMI ( p < 0.001), waist circumference ( p < 0.001), and fat mass ( p < 0.001), on average. 29 This suggests that weight gain that occurs during menopausal transition may inhibit efforts to lose weight in the postmenopausal period and decrease risk of CVD in midlife women. ...
... 29 However, at the 12month follow-up, women regained 2.5 -3.3 kg and exhibited increased BMI ( p < 0.001), waist circumference ( p < 0.001), and fat mass ( p < 0.001), on average. 29 This suggests that weight gain that occurs during menopausal transition may inhibit efforts to lose weight in the postmenopausal period and decrease risk of CVD in midlife women. ...
Adverse Changes in Body Composition During the Menopausal Transition and Relation to Cardiovascular Risk: A Contemporary Review
Article
Full-text available
  • Jun 2022
The menopausal transition period in aging women is strongly associated with weight gain. Evidence shows that weight changes during menopause increases the risk of developing cardiovascular disease (CVD) in postmenopausal women. However, the potential mechanisms that cause weight gain and adverse changes to body composition specifically during the menopausal transition period remain to be elucidated. In this contemporary review, we examined recent evidence for adverse changes in body composition at midlife during the menopausal transition and the link to increased CVD risk and described factors that may contribute to these changes, including normal chronological aging, hormonal factors (decreased estrogen, etc.), behavioral factors (changes in diet, physical activity), or other emerging factors (e.g., sleep). This review focused on identifying factors that make the menopausal transition period a critical window for prevention of CVD. Future study is needed to decipher the extent to which hormonal changes, age-related factors, and behavioral factors interact with and contribute to increased CVD risk in women undergoing menopause. Understanding the causes of weight gain during the menopausal transition may help to inform strategies to mitigate adverse CVD outcomes for women transitioning through menopause.
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... The menopausal transition in particular is associated with weight and fat mass gains over time (18,19), which may leave postmenopausal women at an increased risk of weight regain following weight loss. Indeed, Sénéchal et al. (20) reported that participants who gained more weight since menopause had an increased risk of weight regain following a caloric restriction intervention. Although this study did not observe statistically significant associations of energy intake and daily energy expenditure assessed at the end of follow-up with weight regain (20), a second study reported that changes in PA participation assessed with accelerometry were significantly associated with weight regain following diet plus exercise interventions (15). ...
... Indeed, Sénéchal et al. (20) reported that participants who gained more weight since menopause had an increased risk of weight regain following a caloric restriction intervention. Although this study did not observe statistically significant associations of energy intake and daily energy expenditure assessed at the end of follow-up with weight regain (20), a second study reported that changes in PA participation assessed with accelerometry were significantly associated with weight regain following diet plus exercise interventions (15). ...
... The present analyses explored changes in some novel behaviors (e.g., sedentary time, moderate to vigorous PA and sedentary time bouts, and sleep behaviors) measured following an exercise-only intervention that may predict the risk of weight regain. Furthermore, results from this large-scale intervention complement previous findings on PA as a potential risk factor for weight regain following an intervention in postmenopausal women (15,20). Of the 227 participants who experienced weight loss during the 12-month BETA exercise intervention, mean weight regain was 43%, which is similar to other intervention studies that have assessed weight regain during follow-up in postmenopausal women (15,20,(38)(39)(40). ...
Behavioral Predictors of Weight Regain in Postmenopausal Women: Exploratory Results From the Breast Cancer and Exercise Trial in Alberta
Article
Full-text available
  • Jul 2019
Objective: This secondary analysis assessed associations between changes in energy balance and sleep behaviors and the risk of weight regain following exercise-induced weight loss. Methods: Of 400 participants initially randomized in the Breast Cancer and Exercise Trial in Alberta (BETA), 227 lost weight following the moderate- to vigorous-intensity exercise intervention (-4.2 ± 3.6 kg) and were included in this analysis. Self-reported energy intake (EI), sleep duration, quality and timing, and objective measurements of physical activity (PA) and sedentary time were collected at the end of the intervention and the end of follow-up. Linear regression models assessed associations between changes in these behaviors and risk of weight regain during follow-up. Results: Participants regained 43% of the weight lost during follow-up. Reductions in moderate to vigorous PA (β = -1.00; 95% CI = -1.74 to -0.25 h/d; P = 0.01) and steps per day (β = -0.0003; 95% CI = -0.0005 to -0.0001 steps/d; P = 0.004); increases in sedentary time (β = 0.54; 95% CI = 0.67 to 1.02 h/d; P = 0.03), EI (β = 0.001; 95% CI = 0.0003 to 0.002 kcal; P = 0.01), and fat intake (β = 0.004; 95% CI = 0.001 to 0.006 kcal; P = 0.002); and delayed sleep timing midpoint (β = 0.02; 95% CI = 0.004 to 0.03 min; P = 0.01) were associated with weight regain during follow-up. Conclusions: These exploratory results suggest that reductions in moderate to vigorous PA; increases in EI, fat intake, and sedentary time; and delayed sleep timing midpoint were significantly associated with risk of weight regain.
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... However, with increasing obesity levels in young women, MetS and related risks may be manifested earlier in this age group, suggesting that weight gain at an early age predisposes young women to risks as seen with menopausal obesity, due to their earlier and higher rates of obesity-related accumulation of metabolic risks than in men [56]. ...
... Proteins Although energy restriction alone often leads to weight loss, the composition of the lost tissue also matters, and high loss of lean mass could have deleterious metabolic consequences. This is especially critical for women with innately low initial FFM, a tendency toward a plateau in weight loss, and for later weight regain [56,109]. Moreover, because skeletal muscles play roles in energy metabolism, their potential loss in the weight reduction process emphasises the need to focus on the composition of the lost weight for preservation of lean tissue, rather than relating merely to scale weight. ...
Women's higher health risks in the obesogenic environment: a gender nutrition approach to metabolic dimorphism with predictive, preventive, and personalised medicine
Article
Full-text available
  • Jan 2018
Women's evolution for nurturing and fat accumulation, which historically yielded health and longevity advantages against scarcity, may now be counteracted by increasing risks in the obesogenic environment, recently shown by narrowing gender health gap. Women's differential metabolism/disease risks, i.e. in fat accumulation/distribution, exemplified during puberty/adolescence, suggest gender dimorphism with obesity outcomes. Women's higher body fat percentage than men, even with equal body mass index, may be a better risk predictor. Differential metabolic responses to weight-reduction diets, with women's lower abdominal fat loss, better response to high-protein vs. high-carbohydrate diets, higher risks with sedentariness vs. exercise benefits, and tendency toward delayed manifestation of central obesity, metabolic syndrome, diabetes, cardiovascular disease, and certain cancers until menopause-but accelerated thereafter-suggest a need for differing metabolic and chronological perspectives for prevention/intervention. These perspectives, including women's differential responses to lifestyle changes, strongly support further research with a gender nutrition emphasis within predictive, preventive, and personalized medicine.
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... Additionally, given that most of the current study population (88.1%) was female, age-related menopausal factors could be contributing to the age and %TBWL associations observed in the current study. Decreases in estrogen levels and lifestyle changes associated with menopause are linked to an increased tendency to gain weight, difficulty achieving weight loss, and an increased tendency to regain lost weight among obese and peri-and post-menopausal females [20,21]. Indeed, previous studies have indicated that there is an association between female sex and lower %EWL after SG [7]. ...
Sleeve Gastrectomy: Does the Amount of Stomach Removed Matter?
Article
Full-text available
  • Dec 2022
  • OBES SURG
Purpose: Data regarding the associations between percent weight loss and the volume and weight of stomach resected during sleeve gastrectomy (SG) are mixed. The purpose of this study was to evaluate the effect of the size and volume of stomach removed during laparoscopic SG on percent total body weight lost (%TBWL). Methods: An observational case series study was performed on 67 patients for 1 year after SG at a single university-affiliated, tertiary care hospital. Data were collected on demographics, medical history, and %TBWL at 3, 6, and 12 months post-operatively. Pearson's correlation matrices and multiple linear regression analyses were performed. Results: Most patients (88.1%) were female with a mean age of 44 years. The mean volume of stomach resected was 1047.0 cubic centimeters, and the median weight resected was 123.0 g. Follow-up data were available for 44 patients at 1-year post-operation. There was no association between the volume and weight of stomach resected and %TBWL at 1-year post-operation; however, greater %TBWL was associated with younger patient age (r = - 0.525, p < 0.001). Conclusion: One year after SG, no associations between %TBWL and the volume and weight of stomach resected were observed.
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... Age (-) 27,55,83) (+) 26,46) , Female (+) ...
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... Study characteristics are found in Table 3. Thirty of the 49 studies were conducted in the USA . Studies were further conducted in Germany (4) (80) and the Netherlands (81). Twenty-nine studies were follow-up studies on randomized controlled trials, 13 were follow-up studies on non-controlled trials and 7 were observational cohort studies. ...
Determinants of weight loss maintenance: a systematic review: Determinants of weight loss maintenance
Article
Full-text available
  • Oct 2018
Background Discerning the determinants of weight loss maintenance is important in the planning of future interventions and policies regarding overweight and obesity. We have therefore systematically synthesized recent literature on determinants of weight loss maintenance for individuals with overweight and obesity. Methods With the use of the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses statement, prospective studies were identified from searches in PubMed and PsycINFO from 2006 to 2016. We included articles investigating adults with overweight and obesity undergoing weight loss without surgery or medication. Included articles were scored on their methodological quality, and a best‐evidence synthesis was applied to summarize the results. Results Our search resulted in 8,222 articles of which 67 articles were selected. In total, 124 determinants were identified of which 5 were demographic, 59 were behavioural, 51 were psychological/cognitive and 9 were social and physical environmental determinants. We found consistent evidence that demographic determinants were not predictive of weight loss maintenance. Behavioural and cognitive determinants that promote a reduction in energy intake, an increase in energy expenditure and monitoring of this balance are predictive determinants. Conclusion This review identifies key determinants in weight loss maintenance. However, more research regarding cognitive and environmental determinants of weight loss maintenance is needed to advance our knowledge on determinants of weight loss maintenance.
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... 9 La obesidad es un factor de riesgo conocido en enfermedades cardiovasculares, síndrome metabólico, diabetes mellitus, hipotiroidismo, enfermedades inflamatorias y cáncer ginecológico. [10][11][12][13][14] El exceso de peso en estas mujeres está relacionado con un mayor riesgo de desarrollar enfermedades cardiovasculares y metabólicas, así como con una disminución de la calidad de vida y actividad sexual, 9 aumentando el riesgo de muerte por toda causa. 15 La actividad física es una de las estrategias más utilizada entre los distintos tratamientos no farmacológicos disponibles para aliviar los síntomas de la menopausia. 1 Se recomienda en mujeres posmenopáusicas para el mantenimiento de la salud, 17 demostrando ser eficaz en la reducción de síntomas psicológicos, psicosomáticos y vasomotores que ocurren durante la menopausia. ...
Physical activity and obesity in women and their relationship with menopause
Article
  • Sep 2017
Objective: to relate the physical activity level with obesity in premenopausal and postmenopausal healthy women in the health area of Caceres. Methods: A crosssectional descriptive study. The study was carried out during the months of December 2014 and March 2015. 199 women in the health were recruited. 37,7% are premenopausal and 62,3% postmenopausal. It used the International Physical Activity Questionnaire (IPAQ) to measure the physical activity level in its short version. With another questionnaire, data population characteristics such as age, height and weight and gonadal status were collected. Results: Mild physical activity is presented as a risk factor for developing overweight and obesity in all women studied [OR 0,39 (0,20 to 0,76) and OR 0,42 (0,18 to 0,98 ) respectively] and the postmenopausal group [OR 0,30 (0,12 to 0,34) and OR 0,60 (0,23 to 1,56), respectively], while moderate and active physical activity is presented as a protective factor. Conclusions: moderate and vigorous physical activity is a protective factor for the development of overweight in postmenopausal women.
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Nutritional Guidelines, Energy Balance, and Weight Control: Issues for the Aging Active Female
Chapter
  • Feb 2023
During aging total energy expenditure (TEE) decreases by 6% per decade in women, parallel to the reduction in physical activity. Resting metabolic rate (RMR) decreases 1–2% per decade and increases from 50 years (3% per decade). There is a change in fat mass (FM) not associated with the reduction in RMR or loss of fat-free mass (FFM). This increase in FM is higher in women than in men and does not always imply a change in body weight or body mass index (BMI). As caloric intake requirements decrease with aging, the right quality of food and adequate portions become more important. Energy imbalances complicate health and quality of life in both malnutrition and overweight. The ninth edition of the Dietary Guidelines for the USA published in 2020 and incorporating MyPlate are available resources to advise people and help improve nutrition, serving as a guide for adults and older active women also. Adequate calorie intake should be matched to the physical activity level in each, providing the required amount of macronutrients, vitamins, and minerals, and possible food supplements for active women to achieve proper weight control, energy balance, and heath.
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From famine to therapeutic weight loss: Hunger, psychological responses, and energy balance-related behaviors
Article
  • Feb 2021
  • OBES REV
Understanding physiological and behavioral responses to energy imbalances is important for the management of overweight/obesity and undernutrition. Changes in body composition and physiological functions associated with energy imbalances provide the structural and functional context in which to consider psychological and behavioral responses. Compensatory changes in physiology and behavior are more pronounced in response to negative than positive energy balances. The physiological and psychological impact of weight loss (WL) occur on a continuum determined by (i) the degree of energy deficit (ED), (ii) its duration, (iii) body composition at the onset of the energy deficit, and (iv) the psychosocial environment in which it occurs. Therapeutic WL and famine/semistarvation both involve prolonged EDs, which are sometimes similar in magnitude. The key differences are that (i) the body mass index (BMI) of most famine victims is lower at the onset of the ED, (ii) therapeutic WL is intentional and (iii) famines are typically longer in duration (partly due to the voluntary nature of therapeutic WL and disengagement with WL interventions). The changes in psychological outcomes, motivation to eat, and energy intake in therapeutic WL are often modest (bearing in mind the nature of the measures used) and can be difficult to detect but are quantitatively significant over time. As WL progresses, these changes become more marked. It appears that extensive WL beyond 10%-20% in lean individuals has profound effects on body composition and physiological function. At this level of WL, there is a marked erosion of psychological functioning, which appears to run in parallel to WL. Psychological resources dwindle and become increasingly focused on alleviating escalating hunger and food seeking behavior. Functional changes in fat-free mass, characterized by catabolism of skeletal muscle and organs may be involved in the drive to eat associated with semistarvation. Higher levels of body fat mass may act as a buffer to protect fat-free mass, functional integrity and limit compensatory changes in energy balance behaviors. The increase in appetite that accompanies therapeutic WL appears to be very different to the intense and all-consuming drive to eat that occurs during prolonged semistarvation. The mechanisms may also differ but are not well understood, and longitudinal comparisons of the relationship between body structure, function, and behavior in response to differing EDs in those with higher and lower BMIs are currently lacking.
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Associations between the rate, amount, and composition of weight loss as predictors of spontaneous weight regain in adults achieving clinically significant weight loss: A systematic review and meta-regression
Article
Full-text available
  • Mar 2019
Weight regain following weight loss is common although little is known regarding the associations between amount, rate, and composition of weight loss and weight regain. Forty‐three studies (52 groups; n = 2379) with longitudinal body composition measurements were identified in which weight loss (≥5%) and subsequent weight regain (≥2%) occurred. Data were synthesized for changes in weight and body composition. Meta‐regression models were used to investigate associations between amount, rate, and composition of weight loss and weight regain. Individuals lost 10.9% of their body weight over 13 weeks composed of 19.6% fat‐free mass, followed by a regain of 5.4% body weight over 44 weeks composed of 21.6% fat‐free mass. Associations between the amount (P < 0.001) and rate (P = 0.049) of weight loss and their interaction (P = 0.042) with weight regain were observed. Fat‐free mass (P = 0.017) and fat mass (P < 0.001) loss both predicted weight regain although the effect of fat‐free mass was attenuated following adjustment. The amount (P < 0.001), but not the rate of weight loss (P = 0.150), was associated with fat‐free mass loss. The amount and rate of weight loss were significant and interacting factors associated with weight regain. Loss of fat‐free mass and fat mass explained greater variance in weight regain than weight loss alone.
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Accuracy of Self-reported Height and Weight in a Community-Based Sample of Older African Americans and Whites
Article
Full-text available
  • Oct 2010
  • J GERONTOL A-BIOL
To ascertain accuracy of self-reported height, weight (and hence body mass index) in African American and white women and men older than 70 years of age. The sample consisted of cognitively intact participants at the third in-person wave (1992-1993) of the Duke Established Populations for Epidemiologic Studies of the Elderly (age 71 and older, N = 1761; residents of five adjacent counties, one urban, four rural). During in-person, in-home interviews using trained interviewers, height and weight were self-reported (and measured later in the same visit using a standardized protocol), and information were obtained on race, sex, and age. Accuracy of self-reported height and weight was high (intraclass correlation coefficient 0.85 and 0.97, respectively) but differed as a function of race and age. On average, all groups overestimated their height; whereas (non-Hispanic) white men and women underestimated their weight, African Americans overestimated their weight. Overestimation of height and weight was more marked in persons 85 years and older. Specificity for overweight (body mass index [kg/m(2)] ≥ 25) and obesity (body mass index ≥ 30) ranged from 0.90 to 0.99 for African Americans and whites, but sensitivity was better for African Americans (overweight: 0.81, obesity: 0.89), than for whites (0.66 and 0.57, respectively). Height and weight self-reported by African Americans and whites over the age of 70 can be used in epidemiological studies, with greater caution needed for self-reports of whites, and of persons 85 years of age or older.
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Relationship between energy expenditure and visceral fat accumulation in obese women submitted to adjustable silicone gastric banding (ASGB)
Article
Full-text available
  • May 1995
To analyze the relationship between visceral fat accumulation and resting energy expenditure in obese women and to evaluate the effects of a severe weight loss both on energy expenditure and on fat distribution. Twelve premenopausal women, aged 19-50 years, undergoing adjustable silicone gastric banding (ASGB) for morbid obesity participated at the study. The patients were evaluated twice. The baseline evaluation was performed immediately before surgery. After surgery, a diet specifically developed for patients submitted to gastric restriction (2.5 MJ/day) was given to the patients. The second evaluation was performed 6 months after surgery. Resting metabolic rate (RMR) was determined by indirect calorimetry. Total fat area (TFA), visceral fat area (VFA) and subcutaneous fat area (SFA) were measured by abdominal computed tomography. Fat mass (FM) and fat free mass (FFM) were derived by bioelectrical impedance analysis. At baseline, RMR was positively related to VFA (r = 0.60, P < 0.05). ASGB induced a highly significant weight loss of 24.4 +/- 9.0 kg. This weight reduction was mainly due to a loss of FM (68.5 +/- 10.8 vs 48.5 +/- 9.2 kg, P < 0.001), whereas FFM was only slightly reduced (52.6 +/- 4.0 vs 47.9 +/- 4.6 kg, P < 0.05). The BMI reduction was positively related to the baseline BMI and FM values (r = 0.61, P < 0.05 and r = 0.55, P < 0.05, respectively). There was no significant correlation between the BMI reduction and the baseline variables of fat distribution, nor between the BMI reduction and the basal RMR. Weight loss was accompanied by modifications of fat distribution. In particular, the reduction of VFA after surgery was strictly related to the VFA values at baseline (r = 0.91, P < 0.001). Weight loss induced a significant reduction of RMR (7.96 +/- 1.77 vs 6.57 +/- 6.90 MJ/day; P < 0.01). The reduction of the RMR observed with weight loss was significantly related to the FFM loss (r = 0.63, P < 0.05), whereas no correlations were found between the changes of RMR and the FM loss. Regarding to fat distribution, the reduction of the RMR was significantly related to the visceral fat loss (r = 0.57, P < 0.05), but not to the modifications of total or subcutaneous fat area. The independent contribution of the modifications of FFM, FM, and visceral fat to the changes of RMR was analyzed by multiple regression analysis. In this model, both FFM and visceral fat changes resulted independently related to the RMR. (1) visceral fat accumulation was a significant predictor of RMR in the very obese woman; (2) visceral obese women lost more visceral fat than subcutaneous ones; (3) the reduction of the RMR observed during weight loss could partly be explained by a reduction of visceral fat mass.
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Seven-year trends in body weight and associations with lifestyle and behavioral characteristics in Black and White young adults: The CARDIA study
Article
Full-text available
  • May 1997
This study estimated the amount of weight change in a biracial cohort of young adults and the separate components attributable to time-related and aging-related changes, as well as identified possible determinants of weight change. In this population-based prospective study of 18- to 30-year-old African-American and White men and women, body weight and prevalence of overweight were measured from 1985/86 to 1992/93. Average weight increased over the 7 years, increases ranging from 5.2 kg (SE = 0.2, n = 811) in White women to 8.5 kg (SE = 0.3, n = 882) in African-American women. Significant time-related increases in weight, ranging from 2.0 kg (SE = 1.0) in White women to 4.8 kg (SE = 1.0, n = 711) in African-American men, accounted for 40% to 60% of the average total weight gain. Aging-related increases were also significant, ranging from 2.6 kg (SE = 0.8, n = 944) in White men to 5.0 kg (SE = 1.1) in African-American women. The prevalence of overweight increased progressively in each group. Decreased physical fitness was most strongly associated with weight gain in both sexes. The observed dramatic time-related weight gains, most likely due to secular (period-related) trends, are a serious public health concern.
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Accuracy of current, 4-year, and 28-year self-reported body weight in an elderly population
Article
  • Dec 1990
  • AM J EPIDEMIOL
Participants in the 1987–1989 recall of the Charleston Heart Study were asked to report their current weight and to recall their weight in 1984 and 1960. Reported weights were compared with weights measured in the respective time periods. Subjects included male and female blacks and whites between ages 62 and 100 years. Correlations between reported and measured weights over all subjects were 0.979 for current, 0.935 for 4-year, and 0.822 for 28-year recall. Subjects in the lowest body mass index quartile overestimated their weight, while subjects in the highest quartile underestimated their weight This tendency increased as the elapsed time increased. Deviations between measured and reported weights increased as performance on cognitive tests declined.
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Long-term weight loss maintenance
Article
  • Jul 2005
There is a general perception that almost no one succeeds in long-term maintenance of weight loss. However, research has shown that approximately 20% of overweight individuals are successful at long-term weight loss when defined as losing at least 10% of initial body weight and maintaining the loss for at least 1 y. The National Weight Control Registry provides information about the strategies used by successful weight loss maintainers to achieve and maintain long-term weight loss. National Weight Control Registry members have lost an average of 33 kg and maintained the loss for more than 5 y. To maintain their weight loss, members report engaging in high levels of physical activity ( approximately 1 h/d), eating a low-calorie, low-fat diet, eating breakfast regularly, self-monitoring weight, and maintaining a consistent eating pattern across weekdays and weekends. Moreover, weight loss maintenance may get easier over time; after individuals have successfully maintained their weight loss for 2-5 y, the chance of longer-term success greatly increases. Continued adherence to diet and exercise strategies, low levels of depression and disinhibition, and medical triggers for weight loss are also associated with long-term success. National Weight Control Registry members provide evidence that long-term weight loss maintenance is possible and help identify the specific approaches associated with long-term success.
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Obesity in older adults: Technical review and position statement of the American Society for Nutrition and NAASO, The Obesity Society
Article
  • Nov 2005
Obesity causes serious medical complications and impairs quality of life. Moreover, in older persons, obesity can exacerbate the age-related decline in physical function and lead to frailty. However, appropriate treatment for obesity in older persons is controversial because of the reduction in relative health risks associated with increasing body mass index and the concern that weight loss could have potential harmful effects in the older population. This joint position statement from the American Society for Nutrition and the NAASO, The Obesity Society reviews the clinical issues related to obesity in older persons and provides health professionals with appropriate weight-management guidelines for obese older patients. The current data show that weight-loss therapy improves physical function, quality of life, and the medical complications associated with obesity in older persons. Therefore, weight-loss therapy that minimizes muscle and bone losses is recommended for older persons who are obese and who have functional impairments or medical complications that can benefit from weight loss.
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Hyperinsulinemia in nonobese women reporting a moderate weight gain at the beginning of menopause
Article
  • Sep 2009
At menopause, the frequent weight gain excess could be related to insulin resistance. This study evaluated the prevalence of hyperinsulinemia in nonobese women reporting a moderate increase in weight at the beginning of menopause. Women who were postmenopausal for 1 to 5 years and reporting a weight gain of 5 to 15 kg were evaluated for weight, eating habits, physical activity, body circumferences, fasting blood glucose level, insulin level, and lipid profile. An oral glucose tolerance test was performed in subgroups of 21 hyperinsulinemic women and 21 normoinsulinemic women matched for age, weight, height, body mass index, and hysterectomy. Among 279 postmenopausal women reporting a weight gain of 8.7 +/- 4.4 kg, insulin level was increased in 49 (17.6%) women as compared with normoinsulinemic women (108.53 +/- 31.35 vs 58.96 +/- 14.52 pmol/L, respectively; P < 0.001). Differences were also found for glucose (5.24 +/- 0.37 vs 5.05 +/- 0.42 mmol/L, respectively; P = 0.003), insulin resistance as estimated by homeostasis model assessment HOMA-2-IR (2.01 +/- 0.53 vs 1.10 +/- 0.27, respectively; P < 0.001), weight (72.6 +/- 8.0 vs 69.9 +/- 7.1 kg, respectively; P = 0.023), body mass index (28.3 +/- 2.3 vs 27.2 +/- 2.3 kg/m2, respectively; P = 0.003), and waist circumference (89.8 +/- 5.8 vs 86.0 +/- 6.5 cm, respectively; P < 0.001). Triglyceride levels were higher (1.47 +/- 0.66 vs 1.17 +/- 0.61 mmol/L, respectively; P = 0.002) and high-density lipoprotein cholesterol level was lower (1.54 +/- 0.35 vs 1.72 +/- 0.42 mmol/L, respectively; P = 0.007) in the hyperinsulinemic and normoinsulinemic groups. Although insulin levels were higher in 21 hyperinsulinemic women at all times that oral glucose tolerance tests were performed, levels of glucose were also above those of 21 matched normoinsulinemic women at 1 and 2 hours and remained greater than 6.0 mmol/L at 2 hours. Because insulin resistance is frequently associated with weight gain in nonobese women at menopause, the measurement of fasting insulin, along with glucose, lipids, and waist circumference, may help to identify those who are at higher risk of developing glucose intolerance, metabolic syndrome, diabetes, and cardiovascular diseases and to implement early preventive measures.
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Stevens J, Keil JE, Waid LR, Gazes PCAccuracy of current, 4-year, and 28-year self-reported body weight in an elderly population. Am J Epidemiol 132: 1156-1163
Article
  • Jan 1991
  • AM J EPIDEMIOL
Participants in the 1987-1989 recall of the Charleston Heart Study were asked to report their current weight and to recall their weight in 1984 and 1960. Reported weights were compared with weights measured in the respective time periods. Subjects included male and female blacks and whites between ages 62 and 100 years. Correlations between reported and measured weights over all subjects were 0.979 for current, 0.935 for 4-year, and 0.822 for 28-year recall. Subjects in the lowest body mass index quartile overestimated their weight, while subjects in the highest quartile underestimated their weight. This tendency increased as the elapsed time increased. Deviations between measured and reported weights increased as performance on cognitive tests declined.
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Guo SS, Zeller C, Chumlea WC, Siervogel RM. Aging, body composition, and lifestyle: the Fels Longitudinal Study
Article
  • Oct 1999
Changes in body composition in men and women occur with age, but these changes are affected by numerous covariate factors. The study examined patterns of change in body composition and determined the effects of long-term patterns of change in physical activity in older men and women and in menopausal status and estrogen use in women. Serial measures of height, weight, body mass index (BMI), total body fat (BF), percentage BF, and fat-free mass (FFM) from underwater weighing of 102 men and 108 women enrolled in the Fels Longitudinal Study were analyzed. Physical activity levels and menopausal status were included as covariates. There were significant age-related decreases in FFM and height and increases in total BF, percentage BF, weight, and BMI. Physical activity was associated with decreases in total BF, percentage BF, weight, and BMI in men and were associated with increases in FFM and decreases in total BF and percentage BF in women. Postmenopausal women had significantly higher total BF and percentage BF than did pre- and perimenopausal women. The longer the time since menopause the greater were the increases in weight, BMI, total BF, and percentage BF; however, estrogen use attenuated these increases. Low FFM can be improved by increased physical activity. The effects of an intervention program on body composition can be masked if only body weight or BMI is measured. The effects of physical activity were more profound in postmenopausal than in premenopausal women, and estrogen use had beneficial effects on body composition.
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