Ask a Doctor: Menopause and weight gain

Question: I am going through change of life. Fortunately, I do not have hot flashes or cold sweats. I lead a very disciplined life routine. I play tennis once a week and go for a walk frequently. My routine has been the same for many years. I cannot understand why I am gaining weight suddenly. — Kaycee, Indianapolis

It seems you are going through menopause. Many women transition smoothly through the menopause. But several others have common symptoms like hot flashes, cold sweats, difficulty with sleep, irregular periods and mood changes. Weight gain before or at menopause is one of the significant changes which may affect health.

The average weight gain is gradual, about 10 to 15 pounds starting during the years before natural menopause and averaging to about a pound a year. Weight gain can be at an even more accelerated pace starting after surgical menopause.

In a healthy body, the pituitary gland works like the supervisor that regulates the hormonal functioning of most of the hormonal producing glands of the body.

During perimenopause, progesterone levels decline slowly and steadily, while estrogen levels fluctuate greatly from day to day and even within the same day.

In the years before menopause, the ovaries often produce extremely high amounts of estrogen. This is due to impaired feedback signals between the ovaries, hypothalamus and pituitary gland. Some studies suggest that high estrogen levels may promote fat gain.

Later, in the years before menopause, menstrual cycles become more irregular and the ovaries produce extraordinarily little estrogen. They produce even less during menopause.

The hormonal changes of menopause might make you more likely to gain weight around the abdomen rather than hips and thighs.

But hormonal changes alone do not necessarily cause menopausal weight gain. Instead, the weight gain is usually related to aging. The metabolism slows down as we mature. Lifestyle and genetic factors also play a role.

For example, muscle mass typically diminishes with age while fat increases. Losing muscle mass slows the rate at which your body uses calories. When we use muscles, we spend calories. So, muscles spend more calories than fat. This can make it more challenging to maintain a healthy weight. If you continue to as you always have and do not increase your physical activity, you are likely to gain weight.

Women must be more active around menopause to build muscle mass to keep burning more calories.

Genetic factors might also play a role in menopause weight gain. If your parents or other close relatives carry extra weight around the abdomen, you are likely to do the same.

Other factors — such as a lack of exercise, unhealthy eating and not enough sleep — might contribute to menopause weight gain. When people do not get enough sleep, they tend to snack more and consume more calories. People who sleep late tend to gain more weight because they are going against their circadian rhythm. A circadian rhythm is a natural, internal process that regulates the sleep-wake cycle and repeats on each rotation of the Earth roughly every 24 hours. Your circadian rhythm helps control your daily schedule for sleep and wakefulness. This rhythm is tied to your 24-hour body clock, and most living things have one. Going to sleep around 9 or 10 is in synch with the rhythm.

From puberty until perimenopause, women tend to store fat in their hips and thighs as subcutaneous fat. Although it can be hard to lose, this type of fat does not increase disease risk as much.

Menopause weight gain can have serious implications for your health. During menopause, low estrogen levels promote fat storage in the belly area. Weight gain around the belly increases brown fat inside the belly. Fat under the skin is yellow but inside the abdomen is brown. Brown fat release chemicals that damage the pancreas, liver, the heart and other organs. Excess weight, especially around your midsection, increases your risk of many issues, including breathing problems, heart and blood vessel disease including hypertension, type 2 diabetes and various types of cancer, including breast, colon and endometrial cancers.

The large study showed that despite its favorable influence on body fat distribution, menopausal hormone therapy cannot be recommended as a treatment for central obesity in midlife women.

There is no magic formula for preventing — or reversing — menopause weight gain. Simply stick to weight-control basics.

• Move more. Physical activity, including aerobic exercise and strength training, can help you shed excess pounds and maintain a healthy weight. As you gain muscle, your body burns calories more efficiently — which makes it easier to control your weight. When you exercise you are not only burning calories while exercising but building muscles that help you maintain the weight loss. Because the muscles burn more calories than fatty tissues.

For most healthy adults, it is recommended to have moderate aerobic activity, such as brisk walking, for at least 150 minutes a week or vigorous aerobic activity, such as jogging, for at least 75 minutes a week. You have to do the exercise that suits you best.

In addition, strength training exercises are recommended at least twice a week.

• Portion control and healthier food choices. To maintain your current weight — let alone lose excess pounds — you might need about 200 fewer calories a day during your 50s than you did during your 30s and 40s.

Pay attention to what you’re eating and drinking. Choose more fruits, vegetables and whole grains, particularly those that are less processed and contain more fiber.

In general, a plant-based diet is healthier than other options. Legumes, nuts, soy, fish and low-fat dairy products are good choices. Meat, such as red meat, or chicken should be eaten in limited quantities. Replace butter, stick margarine and shortening with oils, such as olive or vegetable oil.

Mediterranean diet is a good example of such a diet.

• Reduce sweets. Most of the precooked food products have sugar added to them. Added sugars account for nearly 300 calories a day in the average American diet. About half of these calories come from sugar-sweetened beverages, such as soft drinks, juices, energy drinks, flavored waters, and sweetened coffee and tea. Drinking more water is advisable. It is better to eat home-cooked meals cooked fresh.

Other foods that contribute to excess dietary sugar include cookies, pies, cakes, doughnuts, ice cream and candy. Snacking makes it harder to lose weight.

• Limit alcohol. Alcoholic beverages add excess calories to your diet and increase the risk of gaining weight. Did you notice that most of the alcoholic beverages do not mention the calorie content? When people do not see calorie content of alcoholic drinks, they think it is calorie free. For starters, know that alcohol itself is 7 calories per gram. This is slightly less than fat (9 calories per gram), but almost double carbs and protein (both contain 4 calories per gram). One standard drink contains around 14 grams of alcohol.

• Join a group. Surround yourself with friends and loved ones who support your efforts to eat a healthy diet and increase your physical activity. Better yet, team up and make the lifestyle changes together. Go for a walk together or bicycle together.

Remember, successful weight loss at any stage of life requires permanent changes in diet and exercise habits. Diets that are advertised for quick weight loss are not in your best interest. Commit to term lifestyle changes and enjoy a healthier you.

You can lose weight at menopause.

Dr. Suman Kumar Mishr at his office in Cridersville. Craig J. Orosz | The Lima News

Women should increase exercise as they age

Suman Kumar Mishr MD, Fellow of American College of Endocrinology, Cridersville

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