by Bianca Garilli, ND, IFMCP
A common concern in peri- and postmenopausal years is weight gain, typically 1.5 pounds per year during the fifth and sixth decades of life and shown to be independent of a woman’s initial body size or race/ethnicity. It was previously believed that the increase in weight coincided with the onset of menopause most likely due to the drop in estrogen levels. Although declining estrogen levels has, in fact, been shown to lead to an increase in total body fat, it also results in a decrease in lean body mass thus creating little to no net gain in total weight. A more accurate theory on this midlife weight gain includes a combination of aging and lifestyle influences such as the following factors:
- Aging results in a decline in lean body mass which lowers the resting metabolic rate
- Aging may lead to less physical activity, decreased lean body mass, and lowered resting metabolic rate; without compensatory reduction in caloric intake, weight gain is common
- Aging often results in sleep disturbances, which may lead to daytime fatigue and further decreases in physical activity
Menopause and its associated reduction in estrogen levels, does influence location of weight gain deposition. Weight gain in mid-life is typically associated with an increase in central and visceral adiposity when compared to premenopausal age- and BMI-matched women. Studies indicate visceral fat depots may increase to 15-20% of the total body fat; more than double the percentage in premenopausal women whose total body fat is comprised of approximately 5-8% of visceral body fat.
The changes seen during peri- and postmenopausal years – including an increase in total body weight, change from lower fat (gynoid) to central fat (android) deposition pattern and an increase in visceral fat percentage – are all also warning signs of increased cardiovascular disease (CVD) risk. Knowing that CVD is the leading cause of death in women after menopause and that obese postmenopausal women have a higher overall mortality rate than their non-obese counterparts, it’s clear that supporting optimal body weight, composition and fat distribution is extremely important. These interventions not only help reduce risk of CVD but also its associated chronic disease states including metabolic syndrome, type 2 diabetes (T2D), dyslipidemia and hypertension. Weight reduction may also curb risk for obesity related diseases and conditions including breast and uterine cancers and vasomotor related symptoms.
Effective weight reduction programs are comprised of a multi-faceted approach supporting nutritional and eating changes, physical activity and psychological considerations. It has been shown that utilizing a team-based approach with a wide variety of specialists such as medical practitioners, behavioral psychologists, dietitians, exercise specialists and lifestyle coaches also leads to improved outcomes.
Nutrition: Although many dietary protocols have been studied as supporting weight loss, the Mediterranean diet routinely stands out as helpful not only for weight loss but also in decreasing cardiovascular disease risk. Other dietary approaches have also been found to be helpful although it is suspected that the underlying component in all of these other diets is the reduction in caloric intake and not necessarily the macro-nutrient composition.
Physical Activity: The American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Obesity Society recommend 150 to 175 minutes of brisk walking or similar aerobic exercise per week for weight loss. It is recommended that this physical activity be coupled with caloric restriction in order to optimize weight loss outcomes. Resistance exercise is endorsed as well as this form of training improves lean body mass leading to an increase in basal metabolic rate and energy expenditure while also decreasing abdominal fat accumulation.
Behavioral Support: Key to sustainable weight loss is support in identifying barriers, problem solving challenging situations or thought processes and creating a supportive social network. Identification and treatment of mental and psychological health issues such as depression and anxiety are also crucial to successful and long term weight loss management.
Other: Beyond lifestyle approaches, menopausal hormone therapy (MHT) has also been shown to help with long-term health after menopause. Although MHT does not result in weight loss, it does help with improving body composition improving lean body mass and decreasing central adiposity leading to possible reduction in CVD risk. Beyond these measures, some practitioners may recommend weight loss medications, bariatric surgery and endoscopic bariatric therapies for certain individuals.
Why is this Clinically Relevant?
- Healthcare practitioners should routinely include screenings of peri- and postmenopausal women for obesity and obesity related health risks such as CVD
- Women experiencing weight gain in peri- and postmenopause should be educated on the increase in CVD risk associated with weight gain and central/visceral adiposity deposition
- Lifestyle approaches are helpful in reducing weight gain in this population and should be implemented in primary care settings as a routine part of care
- Kapoor E et al. Weight gain in women at midlife: a concise review of the pathophysiology and strategies for management. Mayo Clin Proc. 2017:92(10):1552-1558.
Bianca Garilli, ND, IFMCP is a former US Marine turned Naturopathic Doctor (ND). She works in private practice in Northern California as well as running a consulting company working with leaders in the natural and functional medicine world such as the Institute for Functional Medicine and Metagenics. She is passionate about optimizing health and wellness in individuals, families, companies and communities- one lifestyle change at a time. Dr. Garilli has been on staff at the University of California Irvine, Susan Samueli Center for Integrative Medicine and is faculty at Hawthorn University. She is the creator of the Veterans for Health Initiative and is the current Past-President of the Children’s Heart Foundation, CA Chapter.