Weight Loss Linked to Improvements in Hot Flushes in Overweight, Obese Women

From Medscape Medical News

Laurie Barclay, MD

July 12, 2010 — Weight loss is linked to improvements in hot flushes in overweight and obese women, according to the results of a randomized controlled trial reported in the July 12 issue of Archives of Internal Medicine.

"Higher body mass index is associated with worse hot flushes during menopause but the effect of weight loss on flushing is unclear," write Alison J. Huang, MD, from the University of California, San Francisco, and colleagues from the Program to Reduce Incontinence by Diet and Exercise investigators. "Hot flushes are among the most common concerns of women during menopause and persist for five or more years past menopause in as many as one-third of women."

Women who were overweight or obese and had urinary incontinence (n = 338) were randomly assigned to an intensive behavioral weight loss program (intervention) or to a structured health education program (control) for 6 months.

The intensive intervention, which included weekly 1-hour group sessions with experts in nutrition, exercise, and behavior change, was intended to result in an average loss of 7% to 9% of baseline weight by 6 months. By brisk walking or similarly intense activities, participants were encouraged to increase physical activity to at least 200 minutes per week. A reduced-calorie diet (1200 - 1500 calories) was also recommended, and women were offered sample meal plans with appropriate food choices and meal-replacement products.

Hot flushes were evaluated with use of self-administered questionnaires, and weight, body mass index, abdominal circumference, physical activity, caloric intake, blood pressure, and physical and mental function were evaluated at baseline and at 6 months. Effects of the intervention on bothersome hot flushes and potential mediating factors were determined with use of repeated-measures proportional odds models.

At baseline, hot flushes were slightly bothersome in nearly half of women (n = 154). Compared with control, the intervention improved bothersome flushes in more than twice as many women (odds ratio [OR] for improvement by 1 Likert category, 2.25; 95% confidence interval [CI], 1.20 - 4.21). After adjustment for multiple potential mediators, the effect of the intervention on flushing was modestly decreased (OR, 1.92; 95% CI, 0.95 - 3.89).

Weight loss was associated with improvement in hot flushes (OR, 1.32; 95% CI, 1.08 - 1.61; per 5-kg decrease), as were body mass index (OR, 1.17; 95% CI, 1.05 - 1.30; per 1-point decrease) and abdominal circumference (OR, 1.32; 95% CI, 1.07 - 1.64; per 5-cm decrease). However, changes in physical activity, calorie intake, blood pressure, and physical and mental functioning had no effect on hot flushes.

"Among women who were overweight or obese and had bothersome hot flushes, an intensive behavioural weight loss intervention resulted in improvement in flushing relative to control," the study authors write.

Limitations of this study include inability to determine the effects of specific nutrient components or the timing of meals, limited generalizability to women without incontinence, assessment of hot flushes by a single self-report, and a greater proportion of women lost to follow-up in the control group vs the intervention group.

"From a clinical perspective, our findings suggest that women who are overweight or obese and have bothersome hot flushes may be counseled that behavioral weight loss efforts may decrease the burden of their symptoms," the study authors conclude. "Further research is needed to assess for other biophysiologic factors associated with weight loss that may influence these symptoms in women who are overweight or obese. It should also evaluate whether women's perceptions of self-management success while attempting to change their lifestyle or lose weight may modify their experience of these symptoms."

The National Institute of Diabetes and Digestive and Kidney Disease, the Office of Research on Women's Health, and the National Center for Research Resources, a component of the Clinical and Translational Science Award for Medical Research at the National Institutes of Health supported this study.