**Background:** Obesity is a clinical and public health epidemic, with women contributing more to its prevalence than men. The menopause transition is a high-risk period for weight gain due to biopsychosocial changes, including hormonal shifts, altered lifestyle habits, and increased menopausal symptom severity. Midlife women often receive generic weight management advice that fails to address their specific barriers, such as prioritizing family roles, poor musculoskeletal health, and psychological distress. This underscores the need for evidence- and consensus-based recommendations for diet, physical activity, and behavior management that can be implemented by clinicians and healthcare providers across various settings.
**Methods:** The guidelines were developed in two phases using standardized methodology per the National Health and Medical Research Council (NHMRC). Phase I involved a systematic review of evidence, grading, and expert opinion to formulate recommendations for key clinical questions. Phase II involved peer-review and validation using the Delphi method, with grading via the GRADE approach. The Guideline Development Group (GDG) included multidisciplinary experts from medicine, gynecology, psychology, psychiatry, physical medicine, nutrition, and exercise physiology, along with representatives from national organizations like FOGSI, IMS, API, and IDA. Key clinical questions were identified through focus group discussions, a cross-sectional survey of 504 midlife women, and an exhaustive literature review. Nineteen key clinical questions were prioritized across four domains: initiation of discussion, screening and risk assessment, management, and follow-up. Evidence was sourced from PubMed, Wiley, and Cochrane databases, including practice guidelines, systematic reviews, RCTs, and observational studies. The quality of evidence was graded as High (I), Moderate (II), Low (III), or Expert Opinion (IV), and the strength of recommendations as Strong (A), Moderate (B), or Weak (C).
**Key Results:** The guideline provides 44 specific clinical practice recommendations. Key findings include: (1) Initiation: Opportunistic screening should occur across a woman's lifespan, with intensive counseling starting in the early 40s (Grade II A). (2) Screening: For Asian Indians, BMI cut-offs are 23-24.9 kg/m² for overweight and ≥25 kg/m² for obesity; waist circumference cut-offs are >72 cm for risk and >80 cm for intensive management (Grade I A). (3) Dietary Management: An energy deficit of 500 kcal/day is recommended for 0.5 kg weight loss per week, with a target of 5-10% weight loss over 6 months (Grade I A). A restricted carbohydrate, good quality fat, and high protein diet is advised, with fiber intake of 20-30 g/day and salt limited to <5 g/day (Grade I A). (4) Physical Activity: Women should aim for up to 300 min/week of moderate-intensity or 150 min/week of vigorous-intensity aerobic activity, ideally 60 min/day combining aerobic, strengthening, and balance exercises (Grade I A/B). (5) Behavioral Modification: Techniques such as realistic goal setting, motivational interviewing, self-monitoring, problem-solving, and cognitive restructuring should be used (Grade II B). (6) Menopausal Hormone Therapy (MHT): MHT is not indicated solely for weight management (Grade II A). (7) Follow-up: Bimonthly contact initially, reducing to monthly, with a combination of face-to-face and technology-supported modalities (Grade II A).
**Clinical Implications:** These guidelines provide a practical, protocolized weight management module for healthcare providers, enabling opportunistic screening and management of obesity in midlife women across various clinical settings, including resource-constrained environments. The recommendations emphasize a multidisciplinary team approach but are designed to be actionable by any healthcare worker. By addressing midlife-specific barriers—such as menopausal symptoms, psychological distress, and musculoskeletal health—the guidelines aim to improve adherence and long-term weight maintenance. The protocolized treatment plan, supplemented with health education material, can help primary care providers initiate optimal obesity care even with limited resources. The guideline promotes preventive obesity care and proactive management of obesity-related comorbidities, with the goal of reducing the growing burden of obesity and associated cardiometabolic diseases in India. Policy makers are urged to disseminate these recommendations at medical, curricular, and public health levels, and to establish 'women wellness clinics' for multidisciplinary management.