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Current Topics in Menopause, 2013, 143-162 143 CHAPTER 7 Management of Obesity in Menopause: Lifestyle Modification, Medication, Bariatric Surgery and Personalized Treatment Yosefa Avraham * and Sapir Nachum Department of Human Nutrition and Metabolism, Braun School of Public Health, Hebrew University Hadassah Medical School, Jerusalem, Israel Abstract: Postmenopausal women are at a higher risk to develop obesity. Forty four percent of postmenopausal women are overweight while twenty three percent of whom are considered obese with a body mass index (BMI) above 30 kg/m 2 . Large increases in weight have been shown to amplify the risk of: coronary artery disease, cerebrovascular disease, hypertension, hyperlipidemia, type II diabetes, cholelithiasis, pulmonary embolism, sleep apnea, gynecological problems, osteoarthritis, and psychiatric illness. Obesity leads to a higher risk for gynecologic cancer, cardiovascular disease, venous thromboembolism, osteoarthritis, and chronic back pain. Decline in estrogen levels associated with depression and physical inactivity are the major causes of the postmenopausal obesity. Thus, lifestyle modification including weight loss and physical activity is necessary to prevent these diseases by reducing the use of medications and by prolonging survival. In the present study we review current information about postmenopausal obesity, its origin and consequences and try to provide strategies for its treatment. Weight gain during the menopausal transition may be inevitable and unpreventable, but lifestyle alterations may help to minimize it. It must also be noted that these treatments may or may not be effective for every person; obesity may now need "personalized treatment". Keywords: Menopause; Obesity; Energy Expenditure; Breast Cancer; Cardiovascular Disease; Diabetes; Hypertension; Osteoporosis; Depression; Lifestyle Modification; Medications; Hormone Replacement Therapy (HRT); Bariatric Surgery; Physical Activity; Polyunsaturated and Monounsaturated Fatty Acids; Estrogen; Progesterone; Leptin; Ghrelin; Personalized Treatment. DEFINITIONS Menopause Send Orders of Reprints at bspsaif@emirates.net.ae Menopause is defined as the permanent termination of menstruation as a result of *Address correspondence to Yosefa Avraham: Department of Human Nutrition and Metabolism, Braun School of Public Health, Hebrew University Hadassah Medical School, Jerusalem, Israel; Tel: 972-2- 6757547; Fax: 972-2-6431105; E-mail: yosefa@md.huji.ac.il Volodymyr Dvornyk (Ed) All rights reserved-© 2013 <strong>Bentham</strong> <strong>Science</strong> Publishers
144 Current Topics in Menopause Avraham and Nachum cessation of ovarian activity in middle-aged women. While men will continue to produce sperm for their entire lifetime, women have a limited supply of eggs. The number of eggs is around four hundred, and one egg leaves the body during each monthly menstrual cycle. That being said, it is evident that at some point, the body is no longer able to release eggs. When this point is reached, a woman is said to be in the menopause. The menopause transition, also referred to as perimenopause, is, essentially, the change from a reproductive to a nonreproductive, or infertile, life stage [1]. Perimenopause lasts approximately four years, and is defined as the time period during which the menstrual cycle does not follow any discernible pattern. In the endocrine system, an increase in both follicle stimulating hormone (FSH) and luteinizing hormone (LH) is evident during perimenopause; however steroids, such as estradiol and progesterone, show decreased concentrations. As perimenopause progresses, concentrations of FSH continue to increase, and the irregular intervals of the menstrual cycle are marked by periods of amenorrhea, or the absence of the menstrual cycle, and hypoestrogenism, a deficiency of the estrogen hormone [1]. On average, women reach menopause at the age of fifty [2]. Obesity Twenty percent of the adult world population is obese, yet forty four percent of postmenopausal women are overweight, twenty three percent of whom are considered obese. These figures vary with geographic location and socioeconomic status. People are said to be obese if they have a body mass index (BMI) above 30 kg/m 2 . Large increases in weight have been shown to amplify the risk of several diseases such as coronary artery disease, cerebrovascular disease, hypertension, hyperlipidemia, type II diabetes, cholelithiasis, pulmonary embolism, sleep apnea, gynecological problems, osteoarthritis, and psychiatric illness, among others [3]. Specifically in women, obesity leads to a higher risk for gynecologic cancer, cardiovascular disease, venous thromboembolism, osteoarthritis, and chronic back pain [4]. Although obesity may have genetic causes in rare cases, it is more likely to be caused by unbalanced feeding and exercise patterns promoting a positive energy balance. An obesogenic environment, such as in the developed countries in the
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