Review Article

Outcome Measures of Behavioral Weight Loss Programs in Perimenopause

Authors: Naira Zargarian, MSN, RN, Ruth Lindquist, PhD, RN, Cynthia R. Gross, PhD, Diane Treat-Jacobson, PhD, RN


Obesity and being overweight are associated with many comorbid conditions and are major contributing factors to cardiovascular disease. The increased proportion of overweight and obese people in Western societies has been attributed largely to behaviors that include sedentary lifestyle and dietary excess. Women are at particular risk during perimenopause, when hormones change and metabolism slows. The purpose of this review was to examine published studies of weight loss programs for perimenopausal women using behavioral change strategies of diet alone, regular physical activity alone, or both in combination to determine the range of potential outcomes and reduction of cardiovascular risks. Based on the findings from this review, practice applications and recommendations for future research are proposed.

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1. Liu J, Hay J, Faught B. The association of sleep disorder, obesity status, and diabetes mellitus among US adultsVThe NHANES 2009Y2010 survey results. Int J Endorcrinol 2013;2013:234129.
2. Bray GA. Medical consequences of obesity. J Clin Endocrinol Metab 2004;89:2583-2589.
3. American Heart Association (2009). Cardiovascular disease: women’s No.1 health threat. Accessed June 20, 2014.
4. Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics--2013 update: a report from the American Heart Association. Circulation 2013;127:e6-e245.
5. Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics--2011 update: a report from the American Heart Association. Circulation 2011;123:e18-e209.
6. Bassuk S, Manson J. Lifestyle and risk of cardiovascular disease and type 2 diabetes in women: A review of the epidemiologic evidence. Am J Lifestyle Med 2008;2:191-213.
7. Mosca L, Benjamin EJ, Berra K, et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women--2011 update: a guideline from the American Heart Association. Circulation 2011;123:1243-1262.
8. James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014;311:507-520.
9. Carroll S, Dudfield M. What is the relationship between exercise and metabolic abnormalities? A review of the metabolic syndrome. Sports Med 2004;34:371-418.
10. Lovejoy JC, Champagne CM, de Jonge L, et al. Increased visceral fat and decreased energy expenditure during the menopausal transition. Int J Obes (Lond) 2008;32:949-958.
11. Gohlke-Barwolf C. Coronary artery disease--is menopause a risk factor? Basic Res Cardiol 2000;95(Suppl I):I77-I83.
12. Crothers LM, Hughes TL, Morine KA. Theory and Cases in School-Based Consultation: A Resource for School Psychologists, School Counselors, Special Educators, and Other Mental Health Professionals, New York: Taylor & Francis, 2008.
13. Velicer WF, Prochaska JO, Fava JL, et al. Smoking cessation and stress management: applications of the transtheoretical model of behavior change. Homeost Health Dis 1998;38:216-233.
14. Deci EL, Ryan RM. Self-determination theory: a macrotheory of human motivation, development, and health. Can Psychol 2008;49:182-185.
15. Azadbakht L, Kimiagar M, Mehrabi Y, et al. Soy inclusion in the diet improves features of the metabolic syndrome: a randomized crossover study in postmenopausal women. Am J Clin Nutr 2007;85:735-741.
16. Stensvold D, Tjonna A, Skaug E, et al. Strength training versus aerobic interval training to modify risk factors of metabolic syndrome. J Appl Physiol 2010;108:804-810.
17. Eriksson KM, Westborg CJ, Eliasson MC. A randomized trial of lifestyle intervention in primary healthcare for the modification of cardiovascular risk factors. Scand J Public Health 2006;34:453-461.
18. Shai I, Schwarzfuchs D, Henkin Y, et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med 2008;359:229-241.
19. Frank LL, Sorensen BE, Yasui Y, et al. Effects of exercise on metabolic risk variables in overweight postmenopausal women: a randomized clinical trial. Obes Res 2005;13:615-625.
20. Nicklas BJ,Wang X, You T, et al. Effect of exercise intensity on abdominal fat loss during calorie restriction in overweight and obese postmenopausal women: a randomized, controlled trial. Am J Clin Nutr 2009;89:1043-1052.
21. Okada S, Hiuge A, Makino H, et al. Effect of exercise intervention on endothelial function and incidence of cardiovascular disease in patients with type 2 diabetes. J Atheroscler Thromb 2010;17:828-833.
22. Noakes M, Keogh JB, Foster PR, et al. Effect of an energy-restricted, high-protein, low-fat diet relative to a conventional high-carbohydrate, low-fat diet on weight loss, body composition, nutritional status, and markers of cardiovascular health in obese women. Am J Clin Nutr 2005;81:1298-1306.
23. Howard BV, Van Horn L, Hsia J, et al. Low-fat dietary pattern and risk of cardiovascular disease: the Women’s Health Initiative Randomized Controlled Dietary Modification Trial. JAMA 2006;295:655-666.
24. Foster-Schubert KE, Alfano CM, Duggan CR, et al. Effect of diet and exercise, alone or combined, on weight and body composition in overweight-to obese postmenopausal women. Obesity (Silver Spring) 2012;20:1628-1638.
25. Imayama I, Ulrich CM, Alfano CM, et al. Effects of a caloric restriction weight loss diet and exercise on inflammatory biomarkers in overweight/obese postmenopausal women: a randomized controlled trial. Cancer Res 2012;72:2314-2326.
26. Oh EG, Chu SH, Bang SY, et al. Effects of a therapeutic lifestyle modification program on inflammatory chemokines and insulin resistance in subjects with metabolic syndrome. Biol Res Nurs 2011;13:182-188.
27. Villareal DT, Miller BV 3rd, Banks M, et al. Effect of lifestyle intervention on metabolic coronary heart disease risk factors in obese older adults. Am J Clin Nutr 2006;84:1317-1323.
28. O’Rahilly S, Farooqi IS. Genetics of obesity. Philos Trans R Soc Lond B Biol Sci 2006;361:1095-1105.
29. Alfredo Martınez J, Enrıquez L, Moreno-Aliaga MJ, et al. Genetics of obesity. Public Health Nutr 2007;10:1138-1144.
30. Sanderson SC, Diefenbach MA, Streicher SA, et al. Genetic and lifestyle causal beliefs about obesity and associated diseases among ethnically diverse patients: a structured interview study. Public Health Genomics 2013;16:83-93.
31. Herrera BM, Keildson S, Lindgren CM. Genetics and epigenetics of obesity. Maturitas 2011;69:41-49.
32. Collins P, Rosano G, Casey C, et al. Management of cardiovascular risk in the perimenopausal woman: a consensus statement of European cardiologists and gynecologists. Climacteric 2007;10:508-526.
33. Mosca L, Mochari-Greenberger H, Dolor RJ, et al. Twelve-year follow-up of American women’s awareness of cardiovascular disease risk and barriers to heart health. Circ Cardiovasc Qual Outcomes 2010;3:120-127.
34. US Preventive Services Task Force. Screening for and management of obesity in adults. Published June 2012. Accessed October 24, 2013.
35. Ma J, Xiao L, Stafford RS. Adult obesity and office-based quality of care in the United States. Obesity (Silver Spring) 2009;17:1077-1085.
36. Fujioka K, Bakhru N. Office-based management of obesity. Mt Sinai J Med 2010;77:466-471.
37. Anderson D, Mizzari K, Kain V, et al. The effects of a multimodal intervention trial to promote lifestyle factors associated with the prevention of cardiovascular disease in menopausal and postmenopausal Australian women. Health Care Women Int 2006;27:238-253.