Midlife is a time of enormous change in a woman’s life, both good and bad. It’s a time for reaching professional peaks, gaining confidence, and discovering new passions. But midlife also brings about many less-than-savory hormonal shifts, which can lead to changes in our skin, hair, and weight.
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Changes to the skin and hair can be frustrating, but they’re not particularly dangerous. Weight gain, however, does pose a notable risk to a woman’s overall health. Obesity can increase the risk of disorders and diseases including hypertension and type 2 diabetes. It can also lead to heart disease, stroke, and all-cause mortality. Obesity has even been linked to ovarian, breast, and endometrium cancers.
A recent study published in the Annals of Internal Medicine by the Cedars-Sinai Medical Center sought to formulate new guidelines with the aim of preventing obesity in midlife. According to Kimberly D. Gregory, MD, MPH, the corresponding author of the clinical guidelines, “more than two-thirds of middle-aged women are overweight or obese. Given women’s increased risk for weight gain in midlife, there is a critical need for intervention aimed at preventing obesity and the host of serious health outcomes associated with it.”
While the research suggests it’s time we start shifting the national weight guidelines, how the study reached its conclusion is somewhat controversial.
What Are The New Guidelines?
The Women’s Preventive Services Initiative (WPSI) created the new obesity guidelines, which strongly encourage healthcare providers to begin addressing the issue of weight with their patients early. The WPSI guidelines suggest discussing these risks with all middle-aged women, even those who might be at a “healthy” weight.
This preventative treatment would involve behavioral counseling for women aged 40 to 60, which includes speaking to women about healthy eating and physical activity. These interventions, and the study itself, refer to the traditional BMI, or body mass index (more on that later).
The study included seven randomized clinical trials with over 50,000 patients aged 40 to 60. Participants went through various behavioral and counseling interventions. According to the study, “trials indicated favorable weight changed with interventions that were statistically different from the control groups.”
Interventions varied in intensity, frequency, and approach and, in turn, had varying degrees of effectiveness. The WPSI recognized that research studies might not answer all of the clinical questions regarding the efficacy of prevention rather than treatment. Nevertheless, this shift in perspective could be extremely positive.
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Focus On Prevention Rather Than Treatment Is A Welcome Approach
Western medicine has often approached healthcare from a treatment standpoint instead of prevention. These reactive measures have made great strides in the biomedical world, including the eradication of smallpox. But after the Affordable Care Act passed in 2010, the medical world shifted toward preventative health care.
Still, it’s difficult to provide preventative health care when you’re unsure of what, exactly, you’re preventing—or why. Popular health care often overlooks midlife women. Many doctors aren’t trained to understand perimenopause and menopause and other health issues that arise in this phase of life. If they don’t fully understand females’ changing hormones, then how can they counter, let alone prevent, its adverse side effects?
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This creates a cycle of frustration: a woman assumes her doctor won’t understand her needs and so doesn’t bother to share them. The doctor, none the wiser, continues to not treat her menopausal symptoms, either out of ignorance or lack of experience.
A shift toward preventative care could flip this narrative. Preventive care promotes research and proactive thinking instead of problem-solving and troubleshooting. According to the Mayo Clinic, there can be many contributing factors to midlife weight gain, both lifestyle and genetic. A preventative approach to treatment seeks to mitigate these causal factors before they do significant damage.
Is BMI A Reliable Measure?
In theory, the study sounds positive. However, many critics hesitate to use BMI to measure health. Not only was BMI originally used to describe entire populations, not individuals, but it’s based on a white European man as the “average,” which is decidedly unhelpful for American women of all races and ethnicities.
Consequently, the inaccuracies of BMI can put people at risk of being over or underdiagnosed for certain conditions. Today, traditional BMI classifies anything between 18.5 and 25 as a healthy weight. The index considers 25-30 as overweight and over 30 as obese.
But depending on your genetics and ethnicity, BMI will not always capture an accurate picture of your health. This can lead to distortion of health assessments and increases the risk of developing a negative body image. Moreover, BMI-specific treatment could produce little to no significant results.
Therefore, it’s critical to find an OBGYN or PCP who takes your personal history into account. Preventative treatment for obesity can certainly be beneficial to all body types and sizes, not just those who are currently overweight, but until western healthcare starts acknowledging each patient’s unique background, we still have a long way to go.