Evidence and consensus-based clinical practice guidelines for management of overweight and obesity in midlife women: An AIIMS-DST initiative.

Weight gain is an independent risk factor for decline in cardiometabolic and overall health-related quality of life in midlife women. The AIIMS-DST initiative aims to develop and validate stepwise recommendations specific for weight management in midlife women. The key clinical questions specific to weight management in midlife women were finalized with the help of a multidisciplinary team of experts in the guideline development group. Phase I including a systematic and/or narrative review, grading of evidence, and expert opinion was sought to develop clinical practice recommendations for each clinical question. Phase II focused on validation of clinical practice recommendations using the peer-review, Delphi method, and GRADE approach. The guidelines provide clinical practice points to address challenges encountered by midlife women in their attempts to manage obesity via lifestyle modification techniques. The initiation of discussion would help the health-care provider to identify the weight management needs of the women, educate women on different modalities of weight management, and empower them to incorporate corrective lifestyle behaviors. Before initiating the management, a comprehensive assessment of clinical and lifestyle-related parameters should be completed. A personalized behavioral lifestyle modification program addressing the midlife-specific barriers for optimal metabolic, musculoskeletal, and mental health should be planned. A consistent follow-up is required for maintenance of corrective eating and activity habits by addressing midlife-specific barriers for sustenance of healthy weight. These recommendations will be useful in opportunistic screening and management of obesity in midlife women across health-care settings.

Executive summary of evidence and consensus-based Clinical Practice Guidelines for management of obesity and overweight in midlife women: An AIIMS-DST initiative

Obstetricians and gynecologists are well positioned to influence population health through maternity and women's health services. Obesity is common in women of reproductive age and the prevalence is rising in both low-/middle-income and high-income countries 1 . Obesity affects requirements for assessment, monitoring, and intervention and can impact maternal and child outcomes. Obstetricians and gynecologists require guidance on the care of women of reproductive age with obesity at all time points related to pregnancy, including how to address modifiable risk factors such as diet and physical activity. Many guidelines have been developed to date, although they vary in scope, methodology, and individual recommendations. FIGO's Committee Guideline for the Management of Prepregnancy, Pregnancy, and Postpartum Obesity (Table It serves as a practical resource to support obstetricians and gynecologists in the management of

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The mid-life period is a critical window for increases in body weight and changes in body composition. In this review, we summarize the clinical experience of the menopausal transition by obesity status, and examine the evidence regarding the menopausal transition and reproductive hormones effects on body weight, body composition, or fat distribution. Mid-life obesity is associated with a different menopausal experience including associations with menstrual cycle length prior to the final menstrual period (FMP), age at the FMP, and higher prevalence of vasomotor symptoms. The menopausal transition is associated with weight gain and increased central body fat distribution; the majority of evidence suggests that changes in weight are due to chronological aging whereas changes in body composition and fat distribution are primarily due to ovarian aging. Continuous and regular physical activity during mid-life may be an efficacious strategy to counteract the age-related and menopause-related changes in resting energy expenditure and to prevent weight gain and abdominal adiposity deposition.

Obesity is a global health concern with numerous comorbidities, including cardiovascular diseases, type 2 diabetes, and certain cancers. Carotenoids, found in a variety of natural sources like fruits and vegetables, are known for their potential health benefits. Emerging research suggests that certain carotenoids may play a major role in combating obesity through mechanisms involving inflammation, oxidative stress, and lipid metabolism. Understanding the influence of carotenoids on metabolic health could offer valuable revelation about obesity management strategies. To summarize the main findings on carotenoids that help in the management and prevention of obesity, exploring their potential benefits in weight management, metabolic health, and overall well-being. An extensive literature survey was done on the management of obesity using PubMed, Elsevier, ScienceDirect, and Springer. The results were then filtered based on the titles, abstracts, and accessibility of the complete texts. The search engine Google Scholar was accessed for the literature data mining. This review highlights the diverse functions of carotenoids, such as their antioxidant properties, antiinflammatory effects, and regulation of lipid metabolism, which contribute to their potential role in combating obesity. Studies suggest that carotenoids may help reduce adiposity, lipid accumulation, improve insulin sensitivity, and promote overall metabolic health, making them promising candidates for obesity management. Obesity is synonymous with the appearance of major diseases and an overall decline in physical and mental performance. Overall, the findings of this review endorse the possible application of carotenoids as a nutritional supplement for the management and prevention of obesity. Further research is needed to clarify the mechanisms underlying the beneficial impacts of carotenoids on obesity-related consequences and to optimize their utilization in clinical practice and public health campaigns.

Understanding the interplay between aging, hormonal changes, and lifestyle factors is crucial for effective obesity management in midlife and menopausal women. This review is timely given rising rates of obesity and associated comorbidities, the rapid evolution of pharmacologic interventions for obesity, and the growing recognition of the impact of midlife weight gain on women's long-term health. Weight gain in midlife women is primarily driven by age-related metabolic changes, with menopause contributing to unfavorable shifts in body composition and central adiposity. Obesity in menopause is associated with heightened risks of cardiometabolic disease, mood disorders, sleep disturbances, and impaired quality of life. Newer antiobesity medications have substantial efficacy in weight reduction and cardiometabolic risk improvement. Lifestyle interventions - resistance training and Mediterranean diet - remain foundational. Screening for comorbidities and attention to mental health are essential components of care. Management of midlife weight gain in women requires a multifaceted approach, integrating lifestyle modification, pharmacotherapy, and, when appropriate, surgical intervention. Clinicians should prioritize early identification of at-risk individuals, provide anticipatory guidance, and personalize interventions. Ongoing research is needed for evidence-based protocols for weight maintenance after initial loss, along with guidance on maintaining lean muscle mass while on incretin therapy.

Both baseline cardiorespiratory fitness and adiposity predict the risk of cancer mortality. However, the effects of changes in these two factors over time have not been evaluated thoroughly. The aim of this study was to examine the independent and joint associations of changes in cardiorespiratory fitness and body composition on cancer mortality. The cohort consisted of 13,930 men (initially cancer-free) with two or more medical examinations from 1974 to 2002. Cardiorespiratory fitness was assessed by a maximal treadmill exercise test, and body composition was expressed by body mass index (BMI) and percent body fat. Changes in cardiorespiratory fitness and body composition between the baseline and the last examination were classified into loss, stable, and gain groups. There were 386 deaths from cancer during an average of 12.5 yr of follow-up. After adjusting for possible confounders and BMI, change hazard ratios (95% confidence intervals) of cancer mortality were 0.74 (0.57-0.96) for stable fitness and 0.74 (0.56-0.98) for fitness gain. Inverse dose-response relationships were observed between changes in maximal METs and cancer mortality (P for linear trend = 0.05). Neither BMI change nor percent body fat change was associated with cancer mortality after adjusting for possible confounders and maximal METs change. In the joint analyses, men who became less fit had a higher risk of cancer mortality (P for linear trend = 0.03) compared with those who became more fit, regardless of BMI change levels. Being unfit or losing cardiorespiratory fitness over time was found to predict cancer mortality in men. Improving or maintaining adequate levels of cardiorespiratory fitness appears to be important for decreasing cancer mortality in men.

To document attitudes and current practices of Australian dietitians in the management of overweight and obesity, and to examine their training needs. Cross-sectional postal survey of a randomly selected sample of members of the Dietitians Association of Australia. 400 dietitians (66% of those surveyed). Questionnaire-based measures of dietitian's views of obesity, education and training in weight management, definitions and perceptions of success, professional preparedness, approaches to weight management, strategies recommended for weight management, and problems and frustrations experienced. Dietitians viewed themselves as potential leaders in the field of weight management, and saw this area as an important part of their role. While they considered themselves to be the best-trained professionals in this area, many felt that their training was poor and many were pessimistic about intervention outcomes. Despite this, most dietitians held views that were current, and regularly employed many of the elements of known best practice in management. However, important areas of weakness included: providing opportunities for long-term follow-up; providing a range of management interventions; promoting self-monitoring of diet and exercise; and promoting opportunities for social support. This study suggests that training in and advocacy for the management and prevention of overweight and obesity are priority areas for dietitians, and that formal studies to evaluate dietitians' effectiveness in management should be undertaken.

I. The Problem: Childhood Obesity—A Burgeoning Epidemic e490II. Childhood Obesity Research Summit.........e490III. Pathophysiology and Morbidity ofChildhood Obesity e490A. Pathophysiology of Obesity e490B. Medical Consequences of Childhood Obesity. . .e490C. Psychosocial and Societal Consequences ofChildhood Obesity e490IV. Current Healthcare Practices in ChildhoodObesity Prevention and Treatment e492A. Lifestyle Assessment: Diet and Physical Activity . . . .e492B. Clinical Assessment e493C. Psychosocial/Behavioral Assessment .......e493D. Implementing Effective Prevention andTreatment Options: Diet e494E. Implementing Effective Prevention and TreatmentOptions: Exercise and Sedentary Behaviors . . . .e495F. Implementing Effective Prevention TreatmentOptions: Family and Behavioral Approaches . . .e496G. Behavioral Management e497H. Medical and Pharmacological Management. . . .e497I. Surgical Management e498V. Barriers to Optimum Care e498A. Healthcare System Factors e4981. Preparedness of Providers e4982. Models of Coverage and Care e4993. Uninsurance and Underinsurance AmongChildren and Families e5004. Healthcare Providers and Settings asRole Models e500B. The Challenge of Behavior Change ........e5011. Motivational Interviewing for Pediatric Obesity. .e5012. Psychosocial Factors InfluencingBehavior Change e5023. Environmental Factors InfluencingBehavioral Change e503VI. Practice-Based Resources for Preventionand Management e503A. Models From Other Disciplines e5031. Adult Chronic Care Model e5032. Treatment of Heart Failure e5043. Treatment of Type 2 Diabetes Mellitus .....e5044. Treatment of Childhood Asthma.........e505B. Public Health Measures forChildhood Obesity e5061. Tobacco Control: Implications forChildhood Obesity e506C. Specific Research Issues e5061. Specifying Priorities in the Context of aComplex, Multifactorial Problem ........e5062. Taking a Developmental Approach .......e5073. Engaging Stakeholders e5074. Targeting the Appropriate Outcome .......e508VII. Research Challenges e509A. Research in the Busy Practice e509B. Bring Research Into Practices: Web-BasedAssessment for the PediatricObesity Clinic e509C. Research Agenda: NHLBI and thePediatric Heart Network e510D. Research Agenda: The Children’sOncology Group e510E. Research Agenda: CDC e511F. Research Agenda: Foundations e511VIII. Research and Policy: KnowledgeTranslation e512A. From Practice to Policy to Practice ........e512IX. Concluding Remarks e512Appendix A: Planning Committee e513Appendix B: Presenters e513

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