Optimal Dietary Patterns for Lower Weight Gain and Risk of Obesity Surrounding Menopause.

Importance: Weight gain is common during menopause, and healthy dietary patterns are key to its management. However, effectiveness of different diets for weight management during this period remains unclear. Objective: To examine and compare associations of multiple dietary patterns with weight gain and obesity risk in the years surrounding menopause. Design, Setting, and Participants: This prospective, population-based cohort study included women observed over a 12-year period surrounding menopause in the Nurses' Health Study II (1989-2019). Data analysis was performed between November 2024 and May 2025. Exposures: Diet was assessed every 4 years using validated food frequency questionnaires. Dietary scores included the plant-based diet index (PDI), healthy PDI, unhealthy PDI, Mediterranean diet, Dietary Approaches to Stop Hypertension, Planetary Health Diet Index (PHDI), low-carbohydrate diet (LCD), healthy LCD, unhealthy LCD, empirical dietary inflammatory pattern, empirical dietary index for hyperinsulinemia (EDIH), and ultraprocessed food intake. Main Outcomes and Measures: The outcomes were annual changes in self-reported body weight (kilograms per year) and incident obesity. Generalized estimating equations were used to estimate annual weight change across dietary patterns. Cox proportional hazards models were used to estimate risk of obesity across dietary patterns. Results: Among 38 283 women (mean [SD] age, 45.6 [3.0] years), the mean (SD) weight gain was 0.80 (1.00) kg per year. During 340 122 person-years of follow-up, 5214 women developed obesity. After adjusting for age, race and ethnicity, marital status, income, postmenopausal hormone therapy use, parity, smoking, alcohol, energy intake, physical activity, and baseline body mass index, the reverse EDIH (quintile 5 vs 1) was associated with the largest reduction in weight gain (mean, -0.28 kg/y; 95% CI, -0.30 to -0.26 kg/y). For incident obesity, the lowest risk was observed for the PHDI (hazard ratio, 0.46; 95% CI, 0.42 to 0.51) and reverse EDIH (hazard ratio, 0.51; 95% CI, 0.46 to 0.56). EDIH showed the largest positive correlations with red or processed meats, sodium, and French fries. PHDI showed the largest positive correlations with nuts, unsaturated fats, whole grain carbohydrates, and vegetable protein. Conclusions and Relevance: In this prospective cohort study of women during menopause, adopting low-insulinemic and planetary health diets, low in red and processed meats, sodium, potatoes, and French fries and rich in nuts, legumes, fruits, vegetables, and whole grains, was associated with optimized weight management.