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MenoPause Blog

Obesity and Menopause: A Growing Concern

by JoAnn Pinkerton | Dec 14, 2016

We're pleased to have a guest post from Dr. Gloria A. Richard-Davis.










Gloria A. Richard-Davis, MD, FACOG, NCMP
NAMS Board Member

Obesity is an epidemic and a serious US public health concern. The prevalence of obesity, which is closely associated with cardiovascular risk, increases significantly in American women after they reach age 40; the prevalence reaches 65% between 40 and 59 years, and 73.8% in women over age 60.

According to the Healthy Women Study, the average weight gain in perimenopausal women was about five pounds; however, 20% of the population they studied gained 10 pounds or more. Not only is the weight increase from a drop in estrogen but it’s also because of a decrease in energy expenditure. Some women may notice an overall weight gain, whereas others may not see a difference on the scale but may notice that their pants aren’t buttoning as easily. Both are surprising to many women because they may not notice a difference in their dietary intake or activity.

The reasons for increasing obesity in menopausal women are not clear. Some researchers argue that the absence of estrogens may be an important obesity-triggering factor. Estrogen deficiency enhances metabolic dysfunction predisposing to type 2 diabetes mellitus, the metabolic syndrome, and cardiovascular diseases. Estrogen plays a vital role in fat storage and distribution. Before perimenopause, estrogen deposits fat in your thighs, hips, and buttocks. During and after menopause, the drop in estrogen leads to an overall increase in total body fat but now more so in your midsection. Studies have consistently shown that this waistline increase is different from when you were younger. An increase in visceral (abdominal) fat is linked to an increase in insulin resistance, diabetes, and inflammatory diseases.

Another factor contributing to weight gain in perimenopause may be the increased appetite and calorie intake that occurs in response to hormone changes. In one study, levels of the “hunger hormone” ghrelin were found to be significantly higher in perimenopausal women compared with premenopausal and postmenopausal women.

The low estrogen levels in the late stages of menopause may also impair the function of leptin and neuropeptide Y, hormones that control fullness and appetite. Therefore, women in the late stages of perimenopause who have low estrogen levels may be driven to eat more calories and store fat.

Make weight gain a modifiable risk factor

So, you may be thinking—I’m destined for failure! But this isn’t true. Although the risk of weight gain as a middle-aged woman is higher, this does not mean that it is required. It does mean that we may have to work a little harder to prevent this from happening. It is important to keep in mind that many of the health risks found in the menopause transition are also affected by weight. If we are able to keep a healthy weight, or at least minimize any weight gain, then we are likely to minimize these additional health risks. Now that you know the risks, here are some ways to stay healthy during this midlife transition and avoid a midlife crisis:

  • Reduce calories. During menopause, our energy expenditure decreases even if our activity level and nutrient intake stays the same. This is secondary to the hormone changes with menopause as well as the natural muscle loss that is occurring. We need about 200 fewer calories in our 50s than we did in our 30s and 40s. This means that we’ve got to move more and eat less to keep our healthy weight. To help decrease portion sizes, try splitting your meals with a friend, ordering the lighter portion when available, or put half in the takeout box right away. Swap out dessert for fruit or yogurt.
  • Reduce carbs. Cut back on carbs in order to reduce the increase in belly fat, which drives metabolic problems
  • Add fiber. Eat a high-fiber diet that includes flaxseeds, which may improve insulin sensitivity.
  • Work out. Engage in strength training to improve body composition, increase strength, and build and maintain lean muscle. The American Heart Association recommends 150 minutes of moderate exercise per week. Add ANY activity to your day. Strength and resistance training help maintain bone mass. This will help to prevent osteoporosis, which is bone loss that can lead to easy fractures.
  • Rest and relax. Try to relax before bed and get enough sleep in order to keep your hormones and appetite under control.
  • Get support and learn to cope without food. Many women (and men) admit to eating under stress. And, let’s face it, middle age can bring some tough times. Children are often departing from the home, and some are returning. Your parents now need more help and guidance. This can be disruptive to our everyday lives. Focus on using nonfood stress relievers. Try going for a walk, deep breathing, or scheduling some “me” time with your favorite book to unwind. Seek out support from friends and loved ones who may have gone through a similar situation.

 Get moving and stay healthy through menopause and in later life!




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JoAnn V. Pinkerton, MD, NCMP
Executive Director

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