Middle-aged women's decisions about body weight management: needs assessment and testing of a knowledge translation tool

Women transitioning to menopause are at risk for central fat mass gain and associated health problems caused by hormone-related changes in appetite, energy expenditure, and body fat distribution.1-3 Health problems associated with central fat mass, especially abdominal fat, in obese postmenopausal women include chronic diseases such as heart disease, hypertension, type 2 diabetes, cancers, and osteoarthritis.4,5 Women can minimize weight gain and body fat distribution changes, especially gains in abdominal fat, by ensuring healthy nutrition and/or increasing physical activity.6-9 Greater weight loss often occurs when exercise and dietary approaches are combined.10 In addition to daily cardiovascular activities, early postmenopausal women also seem to benefit from resistance training twice a week.11 Other benefits of resistance training include minimizing potential decreases in lean body mass and bone density during weight loss.1 However, only 52% of Canadian women aged 45 to 54 years are physically active during their leisure time,12 and only 48% meet daily dietary recommendations of five or more servings of fruits and vegetables.13 Little is known about how much women consider the influence of menopausal changes on body composition and body fat distribution when making decisions about body weight management. Women want to be involved in decisions relevant to their health.14 Compared with men, women are involved in making more health decisions and decisions of greater complexity.15,16 Those who were younger and had higher education were more likely to take an active role in decision-making. Decisions are of higher quality when they are informed by evidence on options and aligned with the relative priority women place on outcomes of options.17 To date, studies assessing middle-aged women’s decision-making indicate that they experience uncertainty about choosing the best course of action18 and are limited to examining decisions about the use of natural health products for menopausal symptoms.19,20 Factors interfering with women’s decision-making included difficulty in finding reliable information, reluctance of physicians to discuss natural health products, and conflicting opinions of others. Knowledge translation (KT) tools present evidence in user-friendly ways to enhance understanding and use of the evidence for making decisions.21 Systematic reviews of KT tools, such as decision aids, have demonstrated enhanced knowledge, more realistic expectations, higher consumer participation in decisions, and reduced factors contributing to decisional conflict.22 However, little is known about the effects of KT tools on middle-aged women facing lifestyle decisions about body weight management during the menopausal transition. The objective of this study was to assess middle-aged women’s needs when making body weight management decisions and to evaluate a new KT tool for addressing their needs.