Central obesity: postmenopausal weight management

EXPERTS are divided on how doctors should manage patients with central obesity.

Professor Susan Davis, endocrinologist and Director of the Specialist Women’s Health Clinic at Alfred Health, was commenting on new research published in JAMA Open which found that postmenopausal women with normal body mass index (BMI) and central obesity – characterised by relatively high abdominal fat distribution – were at higher risk of cardiovascular disease mortality and cancer mortality than those with normal BMI without central obesity.

“There’s not much that’s that new in this particular study, but it reinforces what others have shown in smaller studies … at a population scale,” Professor Davis told InSight+.

The study was a prospective cohort study of 156 624 postmenopausal women enrolled in the Women’s Health Initiative at 40 clinical centres in the US between 1993 and 1998.

During the study period 43 838 deaths occurred, including 12 965 deaths from cardiovascular disease (29.6%) and 11 828 deaths from cancer (27.0%), the JAMA Open authors found.

“Compared with women with normal weight and no central obesity and adjusted for demographic characteristics, socio-economic status, lifestyle factors, and hormone use, the hazard ratio for all-cause mortality was 1.31 (95% CI, 1.20–1.42) among women with normal weight and central obesity, 0.91 (95% CI, 0.89–0.94) among women with overweight and no central obesity, 1.16 (95% CI, 1.13–1.20) for women with overweight and central obesity, 0.93 (95% CI, 0.89–0.94) for women with obesity and no central obesity, and 1.30 (95% CI, 1.27–1.34) for women with obesity and central obesity,” the study authors reported.

“Compared with normal weight without central obesity, normal weight central obesity was associated with higher risk of cardiovascular disease mortality (hazard ratio, 1.25; 95% CI, 1.05–1.46) and cancer mortality (hazard ratio, 1.20; 95% CI, 1.01–1.43).”

Professor Davis said Australians as a society had become “complacent” about overweight and obesity.

“We have just published a study of 6600 women aged 18 to 39 years, recruited from Victoria, Queensland and New South Wales – 46% of them are overweight or obese. They haven’t even hit their forties or menopause,” she said.

“We’re not coming down on this heavily enough in the guidelines – any central abdominal obesity, irrespective of your BMI, is problematic.

“It’s okay to tell your patients ‘you need to lose weight’ even if they’re just a bit overweight or even if they’re normal BMI but they’re carrying it centrally.”

Professor John Dixon, from the Baker Heart and Diabetes Institute, said the situation was more complicated.

“The problem is, how do we change where we distribute our weight,” he told InSight+.

“[In a postmenopausal woman] who is normal weight, we can’t advise them to lose weight if they are normal weight already.

“For an obese patient, we’d say if you have a 5% weight loss it’s going to be very helpful for you,” Professor Dixon said.

“[But if we said that to] someone who’s normal weight, we’re putting muscle at risk and we’re putting bone at risk.

“And in fact, when you’re postmenopausal, when you’re in your 60s and 70s, a little bit overweight is actually associated with a longer life.”

Professor Dixon said the key to reducing cardiometabolic risk in people with normal weight and central obesity was not weight loss, but modifying cardiovascular risk factors.

“We need to check that they haven’t got diabetes. We need to keep an eye on the blood pressure and the lipids, and we need to make sure that the diet is healthy and there is plenty of exercise,” he said.

“The most important thing for healthy ageing is a healthy exercise program – aerobic activities, resistance activities, balanced active core activities.

“We don’t need them to lose weight. We need them to eat well, be very fit, and to look after their cardiometabolic risk factors.”