Preventing excess weight gain…
Most developed countries have seen an increase in the prevalence of overweight and obesity and the trend is accelerating. Obesity represents a major public health issue in women due to its association with altered sensitivity to insulin, negative implications for reproductive health, including polycystic ovary syndrome and infertility, higher obstetric risks, gestational diabetes, as well as type 2 diabetes, and cardiovascular disease.
Maintaining a healthy weight throughout the different stages of life involves a number of challenges for many women. Even within the healthy weight range, weight gain increases the risks to women’s health. The prevention of excess weight gain is therefore important in all women at all ages.
Preventing weight gain is as relevant to women who are within the healthy weight range as it is for those who are overweight or obese. No risk-factor or disease association is stronger than the link between obesity and type 2 diabetes. While rates of obesity and diabetes vary between rural and urban areas, wealthy and poor communities, and between ethnic groups, no population group is immune. There is a four-fold increased risk for type 2 diabetes in men who are overweight; women who are overweight are at a 14-fold increased risk. Adolescents and young adult women are of particular concern because of the widespread rapid weight gain at these life stages.
Preventing weight gain and maintaining a healthy weight is potentially easier, less expensive and more effective than managing established obesity. Successfully treating obesity involves complex, long-term, multidisciplinary care and support. In contrast, the effective prevention of excess weight gain is achievable for many with a small adjustment in energy balance. The Jean Hailes Foundation for Women’s Health therefore strongly advocates for a greater focus on preventing excess weight gain throughout life.
Reduced physical activity and excess energy intake are strongly linked to weight gain. The increased energy density of the Australian diet where processed foods, snacks and sweetened drinks prevail at the expense of fresh fruit and vegetables – is playing a central role in overall weight gain in the populations.
Not only are women more sedentary than men, their rates of leisure-time physical activity decline following significant life events.
Meanwhile, increasingly sedentary lifestyles have affected societies worldwide. A huge increase in the use of cars and urban planning that does not encourage pedestrians are principal factors in the recent and dramatic reduction in the amount people walk. The emergence of television and computers as popular leisure-time activities have reduced even further the levels of physical activity.
Who is gaining weight?
In many developed countries, weight gain in adult women averages between 0.5 kg and 0.7 kg per year – somewhere between 5 kg and 7 kg over a decade. Over several decades, this relatively small annual weight gain is likely to take women from the healthy weight range into the overweight or obese category. Furthermore, ethnicity-based differences exist in both total body fat and the distribution of body fat; women from some ethnic groups seem to be particularly prone to central obesity, increasing the risk of metabolic disorders.
Gestational diabetes has more than doubled in recent years in parallel with the global epidemic of obesity.
An Australian survey of women found over one-third were overweight and average pregnancy weight gain was 14.1 ± 6.7 kg. Few antenatal women know their recommended pregnancy weight gain range. During pregnancy, many women gain more weight than is recommended, increasing the risk of pregnancy-related complications, such as gestational diabetes – now a major public health issue. Gestational diabetes is closely related to obesity and its prevalence has more than doubled in recent years in parallel with the global epidemic of obesity. Furthermore, gestational diabetes is strongly associated with an increased risk for type 2 diabetes in mothers in the years following childbirth – up to 60% develop the condition within 4 years of childbirth, and up to 70% after 10 years.
Women in their 20s are an important target for the prevention of excess weight gain. In this group, average weight gain is approximately 0.70 kg per year. Furthermore, women with young children may be at increased risk because of the reported barriers to participate in daily physical activity.1 Also, women with young children are a key group in terms of their strong influence on the lifestyle behaviour of family members.
Mid-life weight gain
Weight gain at the time of the transition from pre- to post-menopause has been reported to be around 0.5 kg per year. It is not clear whether menopause itself causes weight gain or whether weight gain is provoked by further changes in lifestyle, particularly a reduction in physical activity. Of particular concern is the increase in abdominal fat at this time, leading to increased waist circumference and the associated risk for cardiovascular disease.
Up to 60% of women will eventually become overweight or obese, significantly contributing to deteriorating general levels of health.
Annual weight gain as described above has been calculated to involve an intake of between only 10 kcal and 50 kcal per day.2 However, actually preventing weight gain is more complex than it would seem. Many women of between 18 and 40 years-of-age within the healthy weight range do not experience immediate negative health consequences resulting from small annual weight gain, and therefore might not perceive weight management as a priority.
Yet population surveys indicate that up to 60% of women will eventually become overweight or obese, significantly contributing to deteriorating general levels of health. In order to avoid a potentially disastrous health burden, preventive efforts should be focussed on all women.
What can be done?
The Foundation has been working at various levels: national awareness and education, stakeholder engagement, policy change and in developing interventions to support lifestyle change and prevent excess weight gain. In a randomised controlled trial, we have demonstrated effective prevention of weight gain in women in the community through a simple self-management strategy to support behaviour change – involving clear messages for dietary and physical activity change, a few brief interactive sessions on self-management, followed by telephone support.3
Modest weight loss is sufficient both to improve reproductive health and reduce metabolic risk, despite overweight or obesity.
Finally, long-term sustained changes in lifestyle are most likely to be effective when small achievable steps are taken. These might include eating appropriately sized portions, keeping regular meal patterns, phasing out high energy dense foods- fatty, sugary snacks and replacing with fruit and vegetables, engaging in an extra 10 minutes of moderate activity every day.
Just 30 minutes of brisk walking each day will deliver immediate health benefits. Indeed, physical activity even without weight loss has been shown to improve health and psychosocial well-being.
Preventing excess weight gain requires early identification and intervention at times in a women’s life when she may be at increased risk. Small consistent adjustments to physical activity and eating behaviours are achievable but need to be facilitated through awareness-raising and educational campaigns, environmental change, enhanced individual skills and multidisciplinary support.
1 Brown W, Trost S. Life transitions and changing physical activity patterns in young women. Am J Prev Med 2003; 25: 140-3
2 Hill JO. Understanding and Addressing the Epidemic of Obesity: An Energy Balance Perspective. Endocr Rev 2006; 27: 750-61.
3 Lombard C, Deeks A, Jolley D, Teede HJ. Preventing weight gain: the baseline weight related behaviors and delivery of a randomized controlled intervention in community based women. BMC Public Health 2009; 9: 2.
4 Gill TP. Key issues in the prevention of obesity. Br Med Bull 1997; 53: 359-88.