JK SCIENCE EDITORIAL Postmenopausal Obesity Sudhaa Sharma, Rupali Bakshi, Vishal. R. Tandon, Annil Mahajan
The prevalence of obesity is increasing world wide
Table-1 Health Benefits of Exercise/Weight Reduction (7-10)
and is reaching epidemic proportions. Majority of adults
• Fall of 10mm of Hg in systolic BP & diastolic BP
are becoming increasingly overweight and one of the sub-
in hypertensive patients• Fall upto 50 % in fasting blood glucose in DM patients
populations in which this prevalence is growing most
rapidly is postmenopausal women. 8.3 million population
is forecasted to be obese in age of 50 years or
• Fall of 10% of TC,15% LDL,30%TG & 8 % rise in HDL•
Postmenopausal women have an increased tendency
• 40 % fall in deaths related to obesity
for gaining weight. It is as yet unclear whether the
• Improve in muscle strength and endurance• Increase in walking endurance
menopausal transition itself leads to weight gain, but is
known that the physiological withdrawal of estrogen brings
• Increase in flexibility and co-ordination
about changes in fat distribution (2), together with physical
inactivity, are probably the major causes of this
• Decrease in incidence of estrogen dependent cancers• Reduction in hot flashes
phenomenon. Other contributing factors include ethnicity,
• Increase in central endorphin activity
reduced lean mass, resting metabolic rate and treatment
• Increase in bone mineral content and/or Decrease in
with certain drugs, e.g. steroids, insulin, glitazones (3).
bone turnover• Decrease in exercise induced ischemia
Moreover, estrogen withdrawal during menopause has a
• Decrease in depression and anxiety scores
detrimental effect on metabolism and bring changes in
body fat distribution from a gynoid to an android pattern,
lack of energy (5,6). BMI > 21 in women increases
reduced glucose tolerance, abnormal plasma lipids,
risk of CVS diseases, DM, Muskloskelton disorders.
increased blood pressure, increased sympathetic tone,
WC > 88cm, in women, caries great vascular and
endothelial dysfunction and vascular inflammation.As a
result postmenopausal obesity compounds the situation
A sustained weight loss of 5-10 % in obese patients
leading to increased rates of hypertension, diabetes
confers marked health benefits (7, 8, 10). The metabolic
mellitus, coronary artery disease and mortality. Additional
and vascular benefits of even modest reduction of weight
consequences of obesity may include hormone-dependent
are well described. A reasonably balanced approach to
cancer, gallstones, nephrolithiasis, and osteoarthritis with
regular exercise can generate similar benefits as HRT
and usually without unnecessary risks. There is irrefutable
Women with abdominal obesity compared to other
evidence of the effectiveness of regular physical activity
women have, high vasomotor scores, personal life
in the primary and secondary prevention of several chronic
dissatisfaction , nervousness, memory loss, depression,
diseases (e.g., cardiovascular disease, diabetes, cancer,
flatulence, muscle and joint pains, sleeping disorders,
hypertension, obesity, depression and osteoporosis) and
From the Editorial Team of JK Science, Journal of Medical Education and Research Correspondence to : Dr Sudhaa Sharma, Editor In General, JK Science, Journal of Medical Education and Research JK SCIENCE Table: 2 Lifestyle Interventions to Prevent Weight Gain During Menopause
• Dietary Interventions
Caloric restriction, maintaining a healthy balanced diet, eating pattern consisting of 1,300 kcal/day (25% total fat, 7%
saturated fat, 100 mg of dietary cholesterol),eating calcium, flavonoid and antioxidant rich diet. But eating right food withgood intake of fiber, spinach, kale, cabbage, broccoli, tomatoes, beans, lentils and citrus fruits will be of immense value. Onecan avoid of fatty diet, and black coffee. All the excess sugars, salt, even honey should be avoided. Vitamins (B2,B6,B12 andfolic acid) should be suplemented (5,6,7).
• Exercise/Physical Actiity
Major recommendation is to exercise regularly, for at least 30 min on at least 5 days of the week or increased their physicalactivity expenditure (1,000-1,500 kcal/week).Controlled yoga and mindful exercises like meditation under supervision oftrainer.Strength, Resistance & stretching exercise training.Aerobic like walking, jogging, swimming, cycling, dancing, stepups and downs, brisk walking, lawn mowing are recommended by all. High-impact aerobic exercises, ie jumping, skippingshould be avoided by people with osteoporosis and other joint disorders (7-9) .
premature death.Treatment of postmenopausal obesity
2. Dubnov-Raz G, Pines A, Berry EM.Diet and lifestyle in
is very simple logically, but incredibly difficult - eat less
managing postmenopausal obesity. Climacteric 2007;10(Suppl 2) :38-41.
and exercise more. Pharmacotherapy available for the
3. Samat A, Rahim A, Barnett A. Pharmacotherapy for
treatment of obesity are amphetamines, dexamphetamine,
obesity in menopausal women.Menopause Int
benzphetamine, phendimetrazine, phentermine,
diethypropion, mazindol, orlistat, sibutramine and other
4. Rosano GM, Vitale C, Marazzi G, Volterrani M.
Menopause and cardiovascular disease: the evidence.
investigational antiobesity agents are rimonabant,
Climacteric 2007; 10 (Suppl 1):19-24.
zonisamide, somatostatin analogs, leptin agonists, gherelin
5. Khajuria V, Chopra VS, Raina AS. Dietary supplement in
antagonists etc. Only three drugs, sibutramine, orlistat
Menopause. JK Science 2008;10(1):2-4.
and rimonabant are approved by US FDA for long term
6. Dubnov G, Brzezinski A, Berry EM. Weight control and
the management of obesity after menopause: the role of
use (3). But no convincing data is available recommending
physical activity. Maturitas 2003 ;44 (2):89-101
their use in postmenopausal obesity as such.
7. Simkin-Silverman LR, Wing RR, Boraz MA, Kuller
Hence, presently life style modification at the transition
LH.Lifestyle intervention can prevent weight gain during
of menopause will go long way in preventing weight gain
menopause: results from a 5-year randomized clinical trial. Ann Behav Med 2003;26(3):212-20.
during this metabolically vulnerable period which will help
8. Carroll S, Borkoles E, Polman R. Short-term effects of a
in primary and secondary prevention of several chronic
non-dieting lifestyle intervention program on weight
diseases (e.g., cardiovascular disease, diabetes, cancer,
management, fitness, metabolic risk, and psychological well-
hypertension, obesity, depression and osteoporosis) and
being in obese premenopausal females with the metabolic
premature death beside keeping women physically and
syndrome.Appl Physiol Nutr Metab 2007;32(1):125-42.
9. Kruk J.Physical activity in the prevention of the most
frequent chronic diseases: an analysis of the recent evidence. References Asian Pac J Cancer Prev 2007;8(3):325-38.
1. Wang YC, Colditz GA, Kuntz KM. Forecasting the
10. Darren E R W,Crytal WN, Shannon SDB. Health benefits
obesity epidemic in the aging US. Population.
of physical activity: The evidence. CMAJ 2006 14;
Obesity (Silver Spring) 2007;15:2855-65
Editorial Board proudly shares that JK Science, Journal of Medical Education & Research is now also under Indexing Coverage with MedLine LocatorPlus, IndexCopernicus International -IC Value 4.75 (2007), Directory of Open Access Journals (DOAJ) ,OpenMed@NIC and many E-Indexing Agencies beside being indexed in Excerpta Medica EMBASE, Indian Science Abstract
Prolotherapy Prolotherapy is a technique directed at treating the underlying cause of many pain problems. Although the technique has been around for almost 30 years, it has only recently been widely used. Ligaments are the “ropes” that hold your bones together. Tendons are the structures that attach the muscle to the bones. Both are made of material which is both strong and elastic. Howev