Weight gain is common in women during perimenopause and after menopause, but the physical changes underlying it start much earlier in adulthood. Daniela Hurtado Andrade, M.D., Ph.D., an endocrinologist and obesity expert at Mayo Clinic in Jacksonville, explains why it is important to start counteracting those changes before perimenopause arrives.
“Weight changes are not only characteristic of midlife or menopause. Data have shown that weight gain starts early in adulthood,” Dr. Hurtado says. “Around age 30, your muscle mass starts decreasing gradually as part of the natural aging process, and this is exacerbated in midlife due to menopause.”
The decreasing muscle mass will lead to a lower metabolism, a risk factor for weight gain, Dr. Hurtado says.
Adding to the challenge of achieving a healthy weight before and after menopause are many of the features of modern life, Dr. Hurtado says. For example, an abundance of processed foods high in sugar and fat; technology such as escalators, elevators and cars that allows people to move from place to place without walking; and the difficulty of unplugging from devices that keep people connected to work and sedentary for longer hours, with less time spent on physical activity.
Being aware that weight-related physical changes start earlier than midlife may help people be mindful about the importance of establishing and maintaining a healthy lifestyle, including adequate diet and exercise (at least 150 minutes per week), well ahead of menopause, Dr. Hurtado says. It may help to track what and how much you eat, to understand how much you need to eat to feel satisfied and avoid overeating, she adds.
To mitigate muscle mass loss that occurs with aging, a healthy diet should include enough protein and exercise should include resistance training and possibly high-intensity interval training, Dr. Hurtado says.
“And this is even more important if we are engaging in a weight-loss intervention because we know that weight-loss interventions are also associated with muscle mass loss, which can have a significant impact on the weight-loss outcomes,” she says. “One of the reasons why we hit a plateau when we are losing weight is because we are losing muscle mass and our metabolism slows down.”
While a healthy lifestyle is essential, it may only get someone so far in pursuit of a healthy weight, Dr. Hurtado says. The body is genetically programmed to survive, so losing weight is perceived as negative and our bodies will try to fight it. Some people can sustain low-calorie diets for a period of time and lose weight, but eventually they may start feeling hungry, eating more and gaining weight.
“As soon as some people even think about losing weight or restricting their calories, their brain overrides those thoughts: ‘No, you’re actually hungry, so you’re going to eat as much as you need to make sure that you do not lose weight,’” Dr. Hurtado says. “There is a proportion of people in whom diet and exercise alone will work, but for the majority, they will not due to the complex regulation of energy balance.”
Many people who live with overweight or obesity will need a tool such as a medication, an endoscopic bariatric procedure or bariatric surgery to help them achieve sustained weight loss, Dr. Hurtado says. In addition to nutritional and behavioral support, they also may benefit from physical therapy or occupational therapy to help them find ways to become physically active, she adds.
In the early 40s, and perhaps even earlier, it is important for women and their healthcare team to start discussing aging-related weight changes that are happening and will happen, Dr. Hurtado says.
“Every visit with a doctor is an opportunity, especially in these times when overweight and obesity are so highly prevalent,” she says. “We want to prevent rather than treat something that may be more difficult to treat for several reasons. Lifestyle interventions are the core of all weight management interventions. While we need to understand that there is no magic pill, there are tools that can facilitate adhering to lifestyle changes.”
Dr. Hurtado emphasizes that obesity is a disease.
“Starting the conversation about weight management with that message may help people have a different perspective: ‘OK, so they are talking about something that is not my fault, but actually has a biological basis,’” Dr. Hurtado says. “Realizing that weight problems are a disease and not a character flaw can help them think about it differently and could be very impactful on the outcomes of weight loss interventions.”