Women, weight and menopause

"No matter what I do, I can't seem to stop gaining weight ..." Frustrated with her expanding waist, this former athlete, like others who are approaching menopause, is frightened about runaway weight gain.

She started dieting and exercising harder to counter the flab and, over the din of the exercycle, asked, "Are women doomed to gain weight midlife?"

Here are the answers to some questions middle-aged women (and their husbands, children and family members) commonly ask about weight and menopause.

Question: Do women inevitably gain fat with menopause?

No! Women don't always gain weight with menopause. Yes, women commonly get fatter and thicker around the middle as the fat settles in and around the abdominal area. But the changes are due more to lack of exercise and a surplus of calories than to a reduction of hormones. Young athletes with amenorrhea (and reduced hormones) don't get fat ...

In a three-year study with more than 3,000 women (initial age 42 to 52 years), the average weight gain was 4.6 pounds. The weight gain occurred in all women, regardless of their menopause status. (Sternfeld, Am J Epidemiol, 2004).

Question: If weight gain isn't due to the hormonal shifts of menopause, what does cause it?

Here are a few culprits:

Menopause occurs during a time of life when women may become less active. That is, if your children have grown up and left home, you may find yourself sitting more in front of a TV or computer screen, rather than running up and down stairs, carrying endless loads of laundry.

A less active lifestyle not only reduces your calorie needs, but also results in a decline in muscle mass. Because muscle drives your metabolic rate, less muscle means a slower metabolism and fewer calories burned. (That is, of course, unless you wisely preserve your muscle by lifting weights and doing other strengthening exercises.)

Sleep patterns commonly change in midlife. Add on top of that sleep-disrupting night sweats and a husband who snores, and many women end up feeling exhausted most of the time. Exhaustion and sleep deprivation can easily drain motivation to routinely exercise.

Sleep deprivation is associated with weight gain. Adults who sleep less than seven hours per night tend to be heavier than their well-slept counterparts.

When you're sleep deprived, your appetite grows. That is, the hormone that curbs your appetite (leptin) is reduced and the hormone that increases your appetite (grehlin) become more active. (Taheri, PLoS Med, 2004) Hence, you can have a hard time differentiating between "Am I tired?" or "Am I hungry?" You hear the cookie monster answer "You're hungry and need many cookies ...!"

Menopause coincides with career success, including business meals at nice restaurants, extra wine, plush vacations and cruises. Read that as more calories and less exercise.

By midlife, most women are tired of dieting and depriving themselves of tempting foods; they may have been dieting since puberty! The "No, thank you" that prevailed at previous birthday parties now becomes "Yes, please."

Tips for preventing midlife weight gain and optimizing health

The best way to prevent weight gain is to exercise and maintain an active lifestyle. Research suggests women who exercise don't gain the weight and waist of their non-exercising peers (Sternfeld, Am J Epidem 2004).

The exercise program should include both aerobic (to enhance cardiovascular health) and strengthening exercise (to preserve muscle strength and bone density). The book Strong Women Stay Thin, by Miriam Nelson, is a good resource for developing a health-protective exercise program.

Despite popular belief, taking hormones to counter the symptoms of menopause doesn't contribute to weight gain. If anything, hormone replacement therapy may help curb midlife weight gain. (DiCarlo, Menopause, 2004)

Menopausal women need a strong calcium intake: 1,200 to 1,500 mg calcium/day, or the equivalent of a serving of milk or yogurt at each meal.

If you're tempted to take a supplement instead of consuming low-fat dairy foods, think again. One supplement doesn't replace the whole package of health-protective nutrients in low-fat milk and yogurt. Also, recent research suggests women who drink three or more servings of milk or yogurt a day tend to be leaner than milk-abstainers. Milk can help you lose -- not gain -- weight.

If you have gained undesired fat, don't diet. If you have been dieting for 35 to 40 years of your adult life, you should have learned by now that dieting doesn't work. Rather, you need to learn how to eat healthfully.

This means, fuel your body with enough breakfast, lunch and afternoon snack to curb your appetite (and energize your exercise program). Then, eat a lighter dinner. Think small calorie deficit. That is, consuming 100 fewer calories after dinner (theoretically) translates into losing 10 pounds of fat per year.

Find peace

To find peace with food and your body, meet with a registered dietitian (R.D.) who specializes in sports nutrition. This professional can develop a personalized food plan that fits your needs. To find a local R.D., go to www.eatright.org and enter your zip code into the referral network.

Also ask yourself: Am I really overweight? Maybe there is just more of you to love. Your body may not be quite as perfect as it once was at the height of your athletic career, but it can be good enough. I encourage you to focus on being fit and healthy, rather than being thin at any cost. No weight will ever do the enormous job of creating midlife happiness.