Introduction

Many women struggle to maintain a healthy weight throughout various life-stages. This is particularly apparent in young women who are gaining weight faster than other groups in the population.

In Australia, as in most other developed nations, the prevalence of overweight and obesity has increased rapidly over the past two decades. According to the Australian Diabetes Obesity and Lifestyle Study (AusDiab) data 44% of women are overweight or obese and the prevalence of obesity is greater in women (22%) than men (19%). This places women at greater risk of obesity related disease¹. The AusDiab study also showed that the youngest age group (25-34 years) had the most significant weight gain (3.5kg over 5 years).

Obesity, once established, is difficult and costly to treat and frequently requires intensive, contact, supervised exercise and dietary modification delivered by a multidisciplinary team. Even when all of these factors are present, attendance is often poor, drop-out rates are high and long term outcomes disappointing.

Health professionals need to rethink the approach to the gradual but sustained lifetime weight gain in women and optimise prevention strategies.

Figure 1: The continuum of lifestyle-related diseases in women.

Health implications

Obesity is a major issue in women due to its association with increased insulin resistance, reproductive implications including polycystic ovary syndrome and infertility, higher obstetric risks and gestational diabetes (Figure 1).

PCOS is now the most common cause of anovulatory infertility in Australia and affects 400,000 women and costs $400 million annually. ²  The severity and prevalence of PCOS is significantly exacerbated by obesity.

Even small increases in weight are associated with significant ill-health and increased risk of chronic disease. The Nurses Health Study shows increased risk of diabetes and cardiovascular disease (CVD) in women with weight gain from a BMI of 22 kg/m², well within the healthy weight range.³  In addition recent Jean Hailes Foundation research showed 30% of young women had unrecognised abnormal lipid levels, and mean fasting cholesterol and low density lipoprotein levels increased over a 12 month period even with a mean increase in weight of 0.8kg per year ⁴.

Prevention of weight gain

Prevention is likely to be easier, less expensive and more effective than the treatment of established obesity. There are critical life stages for weight gain in women where intervention has an important impact on weight and long term health. These are as follows:

Pregnancy

More women are now overweight or obese pre-pregnancy and excess weight gain increases the risk of complications including gestational diabetes, hypertension and labour complications and greater risk of metabolic disease in the offspring.⁵  Gestational diabetes prevalence has more than doubled in the last 6-7 years in parallel with the obesity epidemic. In addition breastfeeding rates remain low in Australia with around 14% of babies breast fed at 6 months of age.⁶  Together these factors increase the risk of obesity in mothers and their children.

Post-partum

Women of reproductive age present an important target group for the prevention of excess weight gain. Average weight gain in this group is approximately 0.60-0.70kg per year, due to changes in lifestyle.⁷  Women with young children are also an important group because they influence the lifestyle behaviours of family members such as partners and children.

Mid-life

The abdominal weight gain that occurs around the transition from pre- to post-menopause is another high risk life-stage.⁸ Although the overall weight gain is small, weight is gained centrally increasing diabetes and CVD risks (Figure 1).

Interventions

Despite a strong justification for prevention in preference to treatment of established obesity, there has been little research in this area.

The Jean Hailes Foundation for Women’s Health has developed an effective program for the prevention of weight gain in women. The program included a range of strategies and has been shown to be effective in a randomised controlled trial [3].  Some of these strategies are suitable to implement in clinical practice and others are for women to introduce at home: 

1. Systematically assess history of weight gain in all women even if they appear to be a healthy weight.
2. Use motivational interviewing to set priorities, set realistic expectations and prevent relapse.
3. Determine what skills your patient has and what the barriers are to changing behaviour e.g. is time management an issue, cooking skills, lack of support, or a lack of confidence.
4. Support women to introduce small achievable changes to eating and activity such as smaller portion sizes, regular meals, replacing some snacks with fruit and vegetables, incorporating an extra ten minutes of moderate activity into every day.
5. Encourage women to find a walking partner or group. Women rate walking as the most popular activity and they prefer to walk with friends.
6. Encourage women to use self monitoring and awareness techniques such as self-weighing and pedometers.
7. Provide regular support, and follow up

Summary

Preventing the annual weight gain reported by most Australian women requires early identification and intervention and simple advice especially at times in a women’s life when she may be more vulnerable to weight gain. This includes pregnancy where regular weighing and advice on optimal weight gain is important. Small consistent adjustments to physical activity and eating behaviors are achievable, but need to be facilitated through awareness and enhanced individual skills and on-going support.

 Talking Women - Women and weight gain  129.46 Kb

References

1. The Australian Diabetes Obesity and Lifestyle Study. International Diabetes Institute Melbourne Australia, 2005.   (Accessed August 10, 2007, at  http://www.diabetes.com.au/pdf/AUSDIAB_Report_Final.pdf.)

2. Teede, H, Stuckey B.  PCOS and abnormal glucose tolerance. Med J Australia, 2007, 187 (6): 324-325.

3. Willett WC, Manson JE, Stampfer MJ, et al. Weight, weight change, and coronary heart disease in women. Risk within the 'normal' weight range. Journal of American Medical Association 1995;273:461-5.

4. Lombard C, Deeks A, Jolley D, Ball K, Teede H. A low intensity, community based lifestyle programme to prevent weight gain in women with young children: cluster randomised controlled trial. BMJ 2010;341

5. Ramsay JE, Greer I, Sattar N. ABC of obesity. Obesity and reproduction. BMJ  2006; 333:1159-62.

6. The Aust Institute of Family Studies 2008, Growing Up in Australia: The Longitudinal Study of Australian Children, Annual Report 2006-7 http://www.aifs.gov.au/growingup/pubs/ar/ar200607/breastfeeding.html

7. Australian Women and their Weight- a growing problem. Newcastle University, 2005. http://www.alswh.org.au/Reports/achievements_reports.html.)

8. Ferrara CM, Lynch NA, Nicklas BJ, Ryan AS, Berman DM. Differences in Adipose Tissue Metabolism between Postmenopausal and Perimenopausal Women. J Clin Endocrinol Metab 2002;87:4166-70.

Content updated November 5, 2010