Background

Obesity is a prevalent condition and a significant economic burden in Western countries. Among Australian women, 30 per cent are overweight and 22 per cent obese¹.

Australian women continue to gain weight, especially young women (~700grams per year) (www.alswh.org.au).

Obesity represents a major public health issue due to its association with impaired psychosocial health, increased insulin resistance (IR), reproductive implications including polycystic ovary syndrome (PCOS) and infertility, higher obstetric risks, gestational diabetes (GDM), prediabetes, type 2 diabetes (DM2), cardiovascular disease (CVD), osteoarthritis, sleep apnoea and breast and uterine cancer ^2,3.

The Australian Longitudinal Study on Women's Health shows that excess weight is now the primary cause of chronic disease in Australian women and the prevention of weight gain through lifestyle change is critical in disease prevention.

Author Professor Helena Teede MBBS, PhD, FRACP Research Director, The Jean Hailes Foundation for Women’s Health, and Chair, Women’s Health at Monash University.   With Dr Lisa Moran BSc (Hons), BND, PhD and Dr Dr Amanda Deeks BEd, ATCL, Grad Dip Psych, PhD, MAPS

Realistic Goals

Even modest weight loss (5-10%) through lifestyle intervention (a low fat diet, 150 minutes exercise per week and behaviour management strategies to improve diet and exercise and to sustain positive changes), provides many health benefits. These include improved psychological health⁴, improved reproductive health and reduced metabolic risk, despite subjects remaining clinically overweight or obese.

Modest weight loss reduces the risk of developing DM2 by 58 per cent in overweight individuals with prediabetes⁵. Also, exercise alone (40 minutes moderate exercise three times per week), without weight loss improves health outcomes.

Psychological and behavioural issues

Obesity impacts on psychological function and consequent behaviours. Mood disorders including depression, anxiety and social dysfunction are increased in women who are overweight and decrease with weight loss⁶. Mood and self efficacy are also important predictors in the success of weight control programs. Encouraging women to increase physical activity not only helps to decrease weight but also reduces stress, anxiety and depression⁷, which may motivate behaviours that reduce weight even further.

Women need to accurately perceive the health risks associated with obesity such as diabetes and CVD to motivate for healthier behaviours. 

Excess weight has both social and health implications. Using terms that may evoke emotionally charged, defensive responses in women (e.g obese) may be counterproductive. Empathetic advice can be delivered using terms including healthy, unhealthy and very unhealthy weight when focusing on the health rather than the social implications of excess weight.

Dietary advice

There is a plethora of information and misinformation available to both the public and health professionals. The general recommendation of a low fat diet (~30 per cent of energy, saturated fat ~10 per cent of energy, <300 mg cholesterol daily), moderate protein (~15 per cent) and high carbohydrate intake (~55 per cent), in conjunction with moderate regular exercise is widely recommended^8-11. It is generally accepted that fad short-term diets have little place in long-term disease prevention⁸.

Low GI diets

Many Australian women are adopting a low glycaemic index (GI) diet with emerging evidence that modifying the type of carbohydrate can offer additional benefits. The glycemic load (GL) can be reduced by decreasing the GI of the carbohydrate or by decreasing the amount with an increase in protein or fat¹²). In the general population or subjects with DM2, CVD or hyperlipidaemia, low GI diets reduce glucose levels, glycated haemoglobin, dyslipidaemia, and other risk factors for CVD^13-19. However, results are not consistent²⁰ as noted in a recent Cochrane Review²¹. There is conflicting evidence as to whether a low GI diet is more successful with regards to long-term weight maintenance ^22,23-25. Overall, there appears to be some benefit of a low GI or GL diet on weight loss, although more research is needed on the long-term sustainability of reduced GI compared to other dietary regimes.

Conclusion

Health practitioners are consistently nominated as the most respected and primary source of health-related information and have a role in preventing and treating the burden of adverse lifestyle-related diseases (box 1). Simply highlighting excess weight and providing simple brief advice can make a positive impact. Lifescripts can provide a simple tool to assist in this process. Prevention is likely to be more successful than treatment and advice on prevention of weight gain especially during at risk times (pregnancy, those with young children and menopause), can be useful. The challenge is to take advantage of all possible opportunities to support healthier lifestyles to avoid the overwhelming burden of disease that will otherwise ensue.

 Talking Women: Obesity and lifestyle (176.69 KB)

References

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Content Updated June 6, 2008