Why can't I lose those last 15 pounds after menopause?
Why are the last 15 pounds so difficult to lose after menopause?
Menopause can be miserable. The hot flashes, the night sweats, the mood swings. Of all the menopausal symptoms, for some people the WEIGHT GAIN is the worst! Not only do menopausal women gain weight, they gain around the middle instead of in the bust, bum or hips. Women who used to have a pear shape, now have an apple shape and apple shaped women have a higher risk of cardiovascular disease and diabetes than their pear counterparts.
Can I blame my hormones?
It happens partly because at menopause our ovaries stop making estrogen, the “female” hormone. No worries, your fat cells make estrogen too, but not in the amounts that your ovaries did when they were working. When there is less estrogen around, you deposit fat more like men do, the proverbial beer belly. By the time you have gone through menopause your testosterone is also pretty low. Testosterone levels peak in your late 20s and early 30s. After that they start to decline ultimately leading to more fat and less lean body mass (muscle). Testosterone helps build muscle mass, and muscle burns more calories than fat even when you are just sitting around. Declining levels of estrogen and testosterone around the time of menopause play a role in making it hard to lose those last 15 pounds.
Insulin plays a role too.
Weight gain is not only about your reproductive hormones. During menopause, women are more likely to have an increase in insulin resistance. This means it takes more insulin to get glucose into our cells. Our pancreas starts making extra insulin and insulin helps our body deposit fat. The more fat we have, the more insulin resistant we may become, which leads us to become more overweight or even obese. It can be a vicious cycle, and it is a difficult cycle to break.
Your genes aren’t helping you.
Furthermore, our body is evolutionarily programmed to keep weight on. Every time we restrict calories and lose weight, our body becomes more efficient at putting it back on. When we lose weight, the amount of energy it takes just to live decreases. This is part of the reason why many women, despite eating low numbers of daily calories, still can’t lose the last 15! When you are losing weight by restricting your intake, your body also responds by increasing a hormone called ghrelin. Ghrelin makes you feel hungry. Studies show that if you have lost weight in the past and gained it back, your ghrelin levels will be higher than they were if you had never lost weight, making you feel even more hungry!
7 things you can do about it.
1. Eat a healthy diet.
Eat whole foods, with adequate protein, and minimal amounts of processed foods. The amount of protein you need depends on your size and your exercise level. Protein also helps keep your insulin levels in check. If you eat a high carbohydrate meal, your insulin will rise much more than if you eat a protein + carbohydrate meal or a protein rich meal.
2. Exercise!
Exercise decreases insulin resistance and helps to build muscle mass. Building muscle mass raises your resting metabolic rate(RMR). RMR is the amount of calories you burn just being alive. When you restrict your calories, your RMR decreases which slows down weight loss or stops it altogether. Building muscle mass through exercise can increase your RMR. At Evora, we measure your RMR scientifically with a specialized device called the Breezing Pro that calculates your exact RMR. This helps us develop a personalized weight loss plan just for you.
Exercise is hands down the best thing you can do for your body - not just for your weight. Exercise burns calories, builds muscle mass, keeps your bones strong, improves your moods, increases your metabolic rate, decreases brain fog and decreases your risk of a host of medical problems - including decreasing your risk of breast cancer! No excuses here - you have to exercise. If you hate exercising, try making it social. Find something you like to do with a friend - even a Zoom friend.
3. Consider your triggers.
Are you an emotional eater? Does stress make you head to the kitchen? Sit down and make a list of situations that lead you to overeat. Then think of ways to avoid or change the situations. Learn to overcome thoughts that give you permission to overeat like, “I had a tough day at work, so I deserve to eat this box of cookies” or “I can’t lose weight anyway, I might as well not even try”. Consider seeing a behavioral therapist who can teach you strategies to manage triggers and negative thoughts.
4. Set small goals.
If you decide you are going to eat 500 calories a day the next six months, you may be setting yourself up to fail. Try shooting for 1200-1500 calories a day for a week. Then the goal seems reachable and reasonable in your mind. You are much more likely to set yourself up for success. Consider seeing a registered dietician for help with creating a well-balanced low-calorie program.
5. See a registered dietician.
Women often ask which diet is the best diet. The answer is the diet that you can stick to. There are many choices, from the Mediterranean diet to the Keto diet to intermittent fasting. They have all proven to help people lose weight, but if you can’t live without bread in your diet, maybe the Keto diet is not the one for you. A dietician can help you formulate a well-balanced program that you can follow.
6. Consider weight loss medicines.
Weight loss medicines like phentermine or naltrexone/buproprion are not for everyone but for some women they work very well. Depending on how much weight you have to lose, and what other medical problems you have, sometimes these medicines can help you control your cravings or give you a jump start to losing weight.
7. Consider using hormones.
Hormones are not specifically indicated for weight loss, but we know your hormonal milieu plays a role in weight management. Estrogen can help improve how your body responds to insulin. Testosterone helps to build muscle mass and muscle burns more calories than fat. Like any medicine, they have many benefits, but they also have risks and side effects. Before starting anything, talk to your provider. Find a provider who is well-versed and up to date with the recommendations and research.
Go to the North American Menopause Society (NAMS) website for more science backed information on hormone therapy or to find a NAMS certified menopause provider.
Dr. Becky Kaufman Lynn is a gynecologist and the founder of the Evora Women’s Health. She is a North American Menopause Society Certified Physician who has been treating menopausal women for over 20 years. Her practice is located in St. Louis, Missouri. Dr. Lynn offers a comprehensive midlife health program including helping women lose those pesky last 15 pounds! Go to evorawomen.com for more information about her practice or to schedule an appointment or send us an email at info@evorawomen.com
