Menopause and Weight Gain
The results of a number of medical studies indicate that menopause is associated with a progressive increase in weight, and a redistribution of body fat to the abdominal region. Although being overweight is a risk factor alone, the redistribution of fat tissue further increases the risk of cardiovascular disease and diabetes.
COULD YOU EXPLAIN ABOUT THE REDISTRIBUTION OF FAT TISSUE?
Prior to menopause the majority of most women have their body fat concentrated in the area of their hips and thighs giving them a pear-shaped body. This is good because women who have pear-shaped bodies are at a lower risk of heart disease and diabetes. Following menopause, many women tend to undergo a redistribution of their body fat to the abdominal region, which increases their risk of heart disease and diabetes.
DOES HRT CAUSE WEIGHT GAIN AND THE CHANGE IN THE DISTRIBUTION OF FAT TISSUE?
No it doesn’t. In fact, it seems to help prevent weight gain and the redistribution of fat. This is substantiated by the results of studies published in a number of respected medical journals.
In study published in November 1998, in Maturitas, The Journal of The International Menopause Society, the researchers found that in the patient population studied, HRT was actually associated with a small reduction in body weight. This seems to be related to the affect of HRT on leptin, a hormone produced by fat tissue cells. It has recently become evident that Leptin, may be an important determinant of body fat and this is a subject of research at this time.
A study published in the American Journal of Obstetrics and Gynecology, published in January 1998 studied the relationship between HRT and body size. In this study the researchers found that HRT users were leaner that nonusers, had less abdominal fat and a lower percentage of total body fat.
WHAT FACTORS INFLUENCE WEIGHT GAIN IN MENOPAUSAL WOMEN?
In order to maintain the same weight, it is necessary to take in the same number of calories as you burn. If you take in less, you lose weight and if you take in more, you gain weight. This balance is influenced by a number of interrelated factors, including the aging process, hormone deficiency and lifestyle issues.
As a part of aging process our metabolism slows and we burn fewer calories. One often hears, "I can’t understand it, I’m eating the same as I ever did and I’m gaining weight." Unfortunately, every year we live our daily caloric requirements diminish. If we don’t change our diet and reduce the amount of calories we take in, we gain weight.
Being hormonally deficient appears to increase weight gain by a number of pathways.
Estrogen deficiency seems to interfere with the normal action of leptin to control appetite and increase the amount of calories burned.
Testosterone deficiency results in a loss of muscle tissue or lean body mass. The lower the levels of testosterone, the greater the potential for loss of lean tissue. Lean body mass burns calories at a higher metabolic rate and any reduction reduces caloric requirements and enhances weight gain. This loss of lean tissue was long thought to be an inevitable accompaniment of the aging process. However, the relationship of testosterone deficiency to loss of muscle mass has become apparent in more recent years.
The worst deficiencies occur when the ovaries have been removed or compromised by surgery. Accordingly, many of these women experience significant weight problems. This appears to be related to the incurred deficiency of both testosterone and estrogen.
Lifestyle issues are important as well and are influenced by hormone levels. Exercise and diet play an important role in preventing weight gain and the maintenance of muscle tissue.
Diet obviously affects weight and any intake of calories in excess of those burned results in weight gain.
Exercise increases caloric expenditure and is a requirement for preserving muscle mass. However, regular exercise may be difficult for hormonally deprived women. Low hormone levels, especially low testosterone levels are associated with lack of energy. In addition, many estrogen deficient women are chronically fatigued from sleep deprivation associated with frequent nighttime flushing episodes.
The hormone deficiency associated with menopause may induce psychological changes, such as a lowered sense of emotional well being and a diminished self-esteem. These factors may decrease the motivation to exercise and follow a healthy diet.
IS THERE ANYTHING I CAN DO TO PREVENT MENOPAUSAL WEIGHT GAIN?
Yes, there are a number of strategies that can make a significant difference.
Appropriate Hormone Replacement Therapy
HRT users experience fewer problems with weight gain and redistribution of body fat. Estrogen replacement appears to enable leptin to perform its normal function of weight control. Leptin appears to help by making you feel full so you eat less and increasing the rate at which you burn calories.
The positive affects of estrogen replacement on emotional well being are well recognized. Enhanced self esteem and a positive attitude are motivating factors for adhering to a healthy lifestyle.
Testosterone replacement maintains lean muscle mass and energy levels. This enhances energy expenditure and the exercise potential.
A program of regular exercise is an important part of preventing postmenopausal weight gain. It raises caloric expenditure and promotes maintenance and formation of lean body mass. Ideally, a program of regular exercise should begin early in life, but it is never too late. Walking is one of the best forms of exercise for most people. It is low impact, can be done almost anywhere and as it is weight bearing, helps protect against osteoporosis.
When choosing a form of exercise, keep your health status and personal safety foremost in your mind. It’s important to speak to your physician first. With this in mind, any aerobic exercise program that raises energy expenditure above resting levels for at least 30 minutes, 3 or 4 times a week would be appropriate. Remember to start gradually.
A healthy diet is important. You knew I would get to this, didn’t you? In fact the women who seem to experience the least problem with weight gain at menopause are those who have adhered to a program of a healthy diet and regular exercise throughout their lives.
You can’t get around it. In order to maintain your present weight, you need to take in the same number of calories you use. If you take in less, you loose weight, if you take in more, you gain. In today’s world of tempting high calorie foods and oversized portions, controlling caloric intake is not easy. Many patients seem oblivious to the amount of their caloric intake.
SO WHAT'S THE SOLUTION TO NOT GAINING WEIGHT?
Well, one of the first tenets of diet-speak is to avoid high fat and sugar laden carbohydrate foods. This makes sense, these foods are high in calories. So, it helps if you choose low fat foods and limit carbohydrates to reasonable levels. A diet rich in whole grain foods, vegetables and fruit is desirable.
Next, it helps to be aware of exactly how many calories are in everything you put in your mouth. Start by reading labels. One brand of low fat ice cream may contain 140 calories and 2 grams of fat per ½ cup and the real stuff may contain 375 calories and 21 grams of fat for the same size portion. The same principle applies to all the foods that you eat. A tablespoon of mayonnaise contains 100 calories and 11 grams of fat. A tablespoon of yellow mustard contains no calories and no fat. Read the labels, it makes it a lot easier.
It is important to learn to recognize and manage portion size. A particular brand of breakfast cereal may contain 110 calories and 2 grams of fat per ¾ cup serving before adding milk. Unless you have learned to recognize what ¾ of a cup of cereal looks like, it is easy to underestimate your serving size. If you know the portion size and caloric content of the foods that are available to you, then you can determine the number of calories you want to put in your body.
A traditional, (at least in the United States), breakfast of 2 fried eggs, toast and butter, orange juice and 3 strips of bacon contains 700 calories and 45 grams of fat. In contrast a breakfast of 1 serving of dry or hot cereal, ½ cup of skim milk and a piece of fruit is around 250 calories and 1 or 2 grams of fat.
A fast food lunch consisting of "2 all beef hamburger patties, special cheese and special sauce", a small order of fries and a soft drink, is in the range of 930 calories and 43 grams of fat. In contrast a sandwich consisting of 2 slices of whole grain bread, 3 ounces of white meat of turkey, sliced tomato and mustard, and a piece of fruit is in the range of 350 calories and 3 grams of fat.
There are a great number of hidden calorie sources to sabotage your efforts to manage your calorie intake. Liquid intake, is an often unrecognized source of calories. Alcoholic beverages, milk, soft drinks, fruit juices and soups, be aware of exactly how many calories and grams of fat each contain.
If you like to eat, controlling your weight isn’t easy. In fact for some people it’s almost impossible. If you’re reading this now, you’re thinking about it. That’s a good start. Fad diets, when they are successful at all, will not work in the long run. Everyone wants the miracle diet or pill that allows you to eat what makes you happy and get and stay thin. Unfortunately, the miracle doesn’t exist.
It’s no secret, what does work is a healthy lifestyle. A balanced diet, rich in whole grain foods, vegetables and fruit. A judicious program of regular exercise, suited to your age and health status. If you’re a menopausal woman, in addition to its other benefits appropriate HRT appears to help prevent weight gain.
If you can’t do it by yourself, get help. Go to meetings, join Weight Watchers, ask your physician for help, do whatever it takes. A few years ago, I saw a friend at a health club. She looked great, she had lost weight and really firmed up. I said, "Sue, how did you do it? You look great!" Her answer was, "Diet and exercise." I was disappointed that she didn’t have any "magic" to share with me.
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