Piyush Ranjan1, Naval K Vikram2, Ambuja Choranur3, Yashodhara Pradeep4, Maninder Ahuja5, Manju Puri6, Anita Malhotra7, Archana Kumari8, Sakshi Chopra9, Achla Batra10, Geetha Balsalkar11, Deepti Goswami12, Kiran Guleria13, Siddharth Sarkar14, Garima Kachhawa8, Aditi Verma9, M Krishna Kumari15, Jagmeet Madan16, Anjali Dabral17, Sandhya Kamath18, Asmita Muthal Rathore19, Raman Kumar20, Srikumar Venkataraman21, Gaurishankar Kaloiya22, Neerja Bhatla23, S Shantha Kumari24, Upendra Baitha25, Anupam Prakash26, Mangesh Tiwaskar27, Kamlesh Tewary28, Anoop Misra29, Randeep Guleria30. 1. Department of Medicine, All India Institute of Medical Sciences, New Delhi, India. Electronic address: drpiyushdost@gmail.com. 2. Department of Medicine, All India Institute of Medical Sciences, New Delhi, India. Electronic address: navalvikram@gmail.com. 3. President, Indian Menopause Society, Former Professor and Head, Department of Obstetrics and Gynaecology, Osmania Medical College, Hyderabad, India. 4. Era Medical College and University, Ex Prof. and Head Department of Obstetrics and Gynaecology, RML Institute of Medical Sciences, KGMU, Lucknow, Vice President Elect, FOGSI, Ex Vice President, IMS, India. 5. President, Society of Meaningful Life Management, Associate Editor, Journal of Midlife Health, India. 6. Head, Department of Obstetrics and Gynaecology, LHMC and SSK Hospital, New Delhi, India. 7. Food and Nutrition, Department of Home Science, Vice-principal, Lakshmibai College, University of Delhi, New Delhi, India. 8. Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India. 9. Department of Home Science, University of Delhi, New Delhi, India. 10. President, Association of Obstetricians & Gynaecologists of Delhi (AOGD), Professor, Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi, India. 11. Department of Obstetrics and Gynaecology Seth G. S. Medical College, Mumbai, India. 12. Director Professor, Department of Obstetrics and Gynaecology, Maulana Azad Medical College, New Delhi, India. 13. Department of Obstetrics and Gynaecology, University College of Medical Sciences, New Delhi, India. 14. Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, India. 15. Apollo Medical College, Hyderabad, India. 16. National President, Indian Dietetic Association, India. 17. Head, Department of Obstetrics and Gynaecology, VMMC and safdarjung Hospital, New Delhi, India. 18. Ex-Professor of Medicine and Dean, Seth G S Medical College and KEM Hospital, Mumbai, and LT Municipal Medical College and General Hospital, Mumbai, India. 19. Director Professor and Head, Department of Obstetrics and Gynaecology, Maulana Azad Medical College, New Delhi, India. 20. President, Academy of Family Physicians of India, India. 21. Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India. 22. Clinical Psychology, Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India. 23. Head, Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India. 24. President, The Federation of Obstetric and Gynaecological Societies of India, India. 25. Department of Medicine, All India Institute of Medical Sciences, New Delhi, India. 26. Department of Medicine, LHMC and SSK Hospital, New Delhi, India. 27. Secretary, Association of the Physicians of India, India. 28. President, Association of the Physicians of India, India. 29. Chairman, Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, Chairman, National Diabetes, Obesity and Cholesterol Foundation (N-DOC) and President, Diabetes Foundation (India), New Delhi, India. 30. Director, All India Institute of Medical Sciences, New Delhi, India.
Abstract
BACKGROUND AND AIMS: 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. METHODS: The key clinical questions specific to weight management in midlife women were finalised with the help of a multidisciplinary team of experts in the guideline development group (GDG). Phase I included a systematic and/or narrative review to gather evidence, 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. RESULTS: -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 healthcare 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 behaviours. Before initiating the management, a comprehensive assessment of clinical and lifestylerelated parameters should be completed. A personalised behavioural 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. CONCLUSION: These recommendations will be useful in opportunistic screening and management of obesity in midlife women across healthcare settings.
BACKGROUND AND AIMS: 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. METHODS: The key clinical questions specific to weight management in midlife women were finalised with the help of a multidisciplinary team of experts in the guideline development group (GDG). Phase I included a systematic and/or narrative review to gather evidence, 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. RESULTS: -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 healthcare 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 behaviours. Before initiating the management, a comprehensive assessment of clinical and lifestylerelated parameters should be completed. A personalised behavioural 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. CONCLUSION: These recommendations will be useful in opportunistic screening and management of obesity in midlife women across healthcare settings.