Hormone imbalances and insulin resistance are high risk for progressive weight gain in women, resulting in active, performance driven women finding themselves struggling to maintain lean muscle mass and energy. Thousands of women each year flood my office with the same complaints of despair - "Why am I gaining weight?" Doctors typically dismiss these women by telling them they are stressed, need to eat less carbohydrates and workout. Unfortunately this advise fails to recognize that weight gain in women is a consequence of low circulating estrogen levels due to progressive loss of ovarian function. These changes in hormones are typically signs of polycystic ovarian syndrome, perimenopause and menopause. A staggering 80% of women experience hormone imbalances, yet are left with minimal guidance from their doctors. Nearly 400 million perimenopausal women in our country will be predisposed to risk of menopausal obesity by 2026! Moreover, aging, decline in physical activity, coupled with westernized dietary patterns, increase alcohol consumption in women, poor sleep, genetics, recurrent emotional eating episodes, engaging in the wrong type of workouts, gut health inflammation, psychological factor all contribute to an increase in total body fat and waist circumference.
The good news is as a hormone specialist I have devised a women-centric weight management module to address the burden of obesity in order to enhance longevity and vitality.
HORMONE TESTING
All women should have their gynecologist test their hormones. The key blood test include thyroid, testosterone, DHEA, estrogen, progesterone vitamin D and FSH.
HgAic is essential to rule out diabetes. Estrogen promotes muscle mass, and muscle mass affects metabolism – which is how your body uses energy. Less estrogen means less muscle mass, so you’re more likely to develop a slower metabolism during perimenopause and after you reach menopause. With a slower metabolism, you don’t need as many calories to maintain the same weight. Decreased estrogen can also cause your body to start storing more fat in your abdomen compared to other areas of your body – some people refer to this as the “menopause belly.” Together with decreasing muscle mass, this can lead to higher levels of body fat and a heavier appearance, even without a change in weight.
INSULIN RESISTANCE
Insulin is a hormone secreted by the pancreas that is crucial for converting food into energy, or storing that energy for later. When your blood glucose levels rise after a meal, the pancreas responds by producing insulin. The insulin, in turn, helps cells use the sugar and brings the amount of glucose in your bloodstream back to a normal range.
When you are insulin resistant, your body does not respond to insulin after meals as effectively as it should. This means your cells don’t take in enough glucose. The pancreas then produces more insulin to help the process along. Eventually, the pancreas becomes unable to keep up.
Insulin resistance is extremely common though many women are still shocked to learn they already have it, or even prediabetes. Experts estimate that more than 80 million of us already have insulin resistance though we believe the percentage is much higher among perimenopausal women.
All women with PCOS, perimenopause and menopause exhibit insulin resistance. Treatment of insulin resistance includes daily activity, weight loss, and nutritional intervention. Avoiding refined carbohydrates is essential.
WEIGHT LOSS MEDICATIONS
Pharmacotherapy has emerged as an impactful component of a comprehensive approach designed to achieve sustainable weight loss in patients with obesity. It is an effective intervention to support behavioral changes and dietary intervention, which alone may achieve limited weight loss that is difficult to maintain due to adaptive physiologic responses.
In my practice I prescribe a combination of multiple modalites targetting hormone support such as testosterone cream, bioidentical hormone replacement, and semaglutides. Semaglutides such as ozempic, mounjaro, zepbound work by stimulating the pancreas to produce more insulin which in turn will help lower blood sugar. These medications also lower the "food noise" and result in delayed gastric emptying. This allows my patients to minimize binging, develop a healthier relationship with food and even curb alcohol and sugar cravings. The main concern with semaglutides is the simultaneous loss of muscle mass, requiring all patients to be mindful about increasing their protein and weight bearing exercise regimen.
NUTRITION
There are no shortcuts with weight management. I prefer to use the word lifestyle change than diet. I recommend eating a diet high in:
- Vegetables
- Fruits
- Whole grains
- Beans
- Nuts and seeds
- Olive oil
- Seasoning with herbs and spices
The main steps to follow the diet include:
- Each day, eat vegetables, fruits, whole grains and plant-based fats.
- Each week, have fish, poultry, beans, legumes and eggs.
- Enjoy moderate portions of dairy products.
- Limit how much red meat you eat.
- Limit how many foods with added sugar you eat.
The Mediterranean diet has been shown to lower the risk of cardiovascular disease, metabolic syndrome, osteoporosis, dementia and certain cancers, in addition to supporting a healthy balance of gut flora to help with digestion. The plant-forward diet, filled with anti inflammatory food, limits sugar, sodium, processed carbohydrates, trans and saturated fats, and processed foods. It includes whole foods rich in nutrients, fiber and antioxidants that work together to optimize health and maintenance of a healthy weight.
ALCOHOL
Recent studies cast doubt on the notion that even a little alcohol may be good for the heart.
Alcohol can be a dangerous combination with perimenopause and menopause, as it can increase the risk of certain health conditions and worsen menopause symptoms:
Alcohol can increase the risk of heart disease, stroke, osteoporosis, breast cancer, and colorectal cancer. Heavy drinking can also lead to type 2 diabetes and organ system damage, such as heart muscle damage, nerve damage, cirrhosis, and possibly brain damage.
ALCOHOL and WEIGHT GAIN
Alcohol can contribute to weight gain in a number of ways, including:
- Calories
Alcohol has similar calories per gram as fat, and these calories are considered "empty" because they provide energy but not nutrition. Some mixed drinks can contain as many calories as a meal.
- Hunger
Alcohol can trigger the part of the brain that makes people feel hungry.
- Fat burning
Alcohol can temporarily inhibit the body's ability to burn fat, known as lipid oxidation.
- Food choices
Alcohol can lead to cravings for salty and greasy foods, and people may make poor food choices while drinking.
- Digestion
Alcohol can impair digestion and nutrient absorption, which can affect the metabolism of organs that play a role in weight management
EXERCISE
Research highlights that menopause is a vulnerable period for the loss of muscle mass, which is inversely associated with the risk of early death.
Loss of muscle mass (MM) is part of the aging process. MM in men and women has been shown to decrease by 3 to 8% per decade after the age of 30, and by 5 to 10% after age of 50.
This reinforces the importance of focusing on strength training during this stage of life.Late perimenopausal and postmenopausal women were also overwhelmingly more likely to have sarcopenia (involuntary muscle loss) than premenopausal or early perimenopausal women.
Strength training engages your muscles to push, pull or support weight. It builds muscle mass, which helps offset the loss of metabolism caused by aging and decreased estrogen. Strength training also slows age-related bone loss and can be a big part of preventing postmenopausal osteoporosis. It’s recommended that adults do strength training activities at least twice a week.
The best exercise is the one you do, but I recommend 45 minutes of moderate-intensity physical activity and three days of muscle strengthening per week. A combination of yoga, Pilates and walking is my personal favorite regimen. The biggest bang for your effort is weight-bearing exercises, like Pilates. It focuses on core strength, which is where menopausal weight deposits. If Pilates isn’t your thing, weightlifting, tennis and high-intensity interval training all work, too. You can’t exercise your way out of a bad diet and you can’t eat your way out of no exercise. It’s got to be a combination of both. Especially in midlife and beyond.
