What it is
Behavioral weight loss means losing excess body fat through changes to diet and physical activity. Women who are obese are more likely to report frequent and severe hot flashes than women of normal weight. Losing weight may reduce vasomotor symptoms, particularly for women earlier in the menopause transition (perimenopause and early postmenopause).
How well it works
A 6-month randomized controlled trial by Huang et al. (n=338 overweight or obese women with urinary incontinence) found that, among the 154 women bothered by hot flushes at the start, an intensive behavioral weight loss program improved bothersome hot flushes compared to a health education program, with an odds ratio of 2.25 (95% CI 1.20-4.21) for improvement. Each 5 kg of weight lost was associated with greater improvement. A pilot RCT by Thurston et al. (n=40) found that behavioral weight loss reduced questionnaire-reported hot flashes more than a wait-list control (a reduction of 63 hot flashes over two weeks vs 28, p=0.03), though the difference did not show up in other hot flash measures.
The NAMS 2023 position statement lists weight loss as a Levels II-III recommendation, noting that the available studies are small pilot studies, nonrandomized trials, or post hoc analyses, and that larger, rigorously designed RCTs are needed. The evidence suggests weight loss may have greater effects on VMS when women are earlier in the menopause transition.
Side effects and cautions
A U.S. Preventive Services Task Force review of 30 trials of behavioral weight loss programs found no serious harms, and most trials saw no difference in adverse events between intervention and control groups; three trials had mixed results for musculoskeletal problems. The hot flash trials enrolled women who were overweight or obese, so the evidence does not apply to women at a normal weight or underweight.
Where to get it
You can pursue weight loss on your own or with support. Trials of behavioral weight loss programs used group, individual, technology-based, and print-based formats, led by people such as registered dietitians, behavioral therapists, exercise physiologists, and lifestyle coaches. Marketplace health plans and many other plans must cover obesity screening and counseling without a copayment. If hot flashes persist despite weight loss, other non-hormonal options on this site may help.
