Does anyone else feel like maintaining a healthy weight as you age gets harder and harder?! What is going on? I used to be able to be super disciplined during the week with food and exercise, on the weekend kind of do whatever I wanted, and still maintain my weight. I wasn't ever really trying to lose weight, but I wanted to be able to have a pizza and a few beers on a Saturday night with no real side effects to my waistline. Once I turned 40, it seemed like I couldn't really do that anymore without my pants feeling snug on Sunday. Outside of my 9th grade health education class and the occasional chat with my OBGYN, I never took the time to learn how things like hormones, water retention, body changes and more, impact healthy weight management. To find out more about all of this and what we women can do to stay healthy throughout all stages of our lives, I went to the experts at The Christ Hospital Health Network. Sarah Bartlett, MD, from The Christ Hospital Physicians – Obstetrics & Gynecology, took the time to answer some of the questions I had and several questions from our Q102 Jeff and Jenn Morning Show listeners.
At what age do my hormones start impacting my weight loss/gain?
Dr. Bartlett: Hormones can, and do, impact weight at all ages, but that can be a normal process such as with puberty and pregnancy. When hormones are imbalanced, with something like Polycystic Ovarian Syndrome in young women or as women approach menopause later in life, a slowing metabolism and subsequent weight gain can result. These imbalances can be treated by gynecologists.
How many calories a day are recommended per age group?
Dr. Bartlett: The idea of counting calories is largely outdated. Yes, excess calorie consumption and reduced physical activity lead to weight gain, but it is far more complex than that. We know not all calories are created equal and our bodies handle foods in different ways. That is why people respond differently based on age and stage of life, and no one particular diet is effective for all people.
What are some suggested foods to eat to help maintain my weight the older I get? Is there a special diet I should be following to maintain hormone levels?
Dr. Bartlett: Since there is really not one magic diet that works for all people, we have to looks at trends in what works for most people in certain categories and look at the latest science out there.
Most diets do involve decreased caloric intake, but many people see better results when they eat higher fiber foods and reduced sugars and processed foods (this frequently includes carbs). A lot of people are getting results from different forms of intermittent fasting, especially when combined with low glycemic index diets. There is data to support the benefits to weight management and overall health when a Mediterranean diet is followed.
There is no diet to specifically fight off the changes of menopause but using the tools above can help counter the slowing metabolic rate that normally comes with menopause and aging.
Why is it so challenging to lose weight the older I get?
Dr. Bartlett: Weight gain with age is common, even normal. Most of us will never see our 18-year-old weight again. That has to do with changes in overall body composition and a slowing metabolism with aging. We also acquire bad food habits, poor lifestyle choices, and often become less active. Poor sleep and chronic stress can also have an impact. Some people also develop health issues that can lead to weight gain (things like hypothyroidism) or start taking medications that have the side effect of weight gain (like certain kinds of birth control, or certain antidepressants).
How do I know if my hormones are out of whack?
Dr. Bartlett: Patients of all ages come to me every day with the concern that they might have a hormone imbalance. This can be the teenager with problem periods, the college student with weight gain and acne, or a 30-year-old with difficulty becoming pregnant. It is frequently women in their 40's who have begun to gain weight and experience diffuse menopausal-type symptoms. Gynecologists are hormone experts and, as such, we can address the diffuse symptoms and issues in a comprehensive way. Sometimes there is truly something wrong that must be treated. But sometimes the symptoms are a normal but unpleasant or bothersome part of that stage of life. Either way, I can help women sort through this by asking the right questions and doing the right tests, ultimately helping them to feel happier, healthier, and more like themselves.
Questions from Q102 listeners…
I've seen a lot of advertisements about probiotic supplements that supposedly help with the "meno belly". I know it sounds too good to be true, but is there any truth in their claims?
Dr. Bartlett: "Meno belly" is what a lot of women experience as "central" weight gain, or specifically around the middle. This is common at menopause due to changes in body composition including decreased muscle tone and increased fat in general. It is also particularly dangerous in terms of health risks. No, there are no supplements that specifically target that problem area, but general weight loss approaches and improved fitness can fight this.
What tips do you have for how to deal with emotional weight gain? My mom passed away in July. I took care of her for her last two weeks. During those two weeks I ate very little and gained eight pounds. I have continued to gain since. Someone said emotional stress can cause your body to release a stress hormone. What do I do about that?
Dr. Bartlett: As you have suspected, significant stress can affect metabolism and contribute to weight gain. Sleep disturbances also play a role. This is complex, having to do, in part, with a stress hormone called "cortisol." It affects most systems of the body and how they perform. You will hear people talk about "adrenal fatigue," which has to do which a metabolic slowing from chronic stress. There is likely something to this, but it is difficult to precisely diagnosis in generally healthy people, and ever harder to specifically treat. The most effective thing you can do is minimize chronic stress and improve coping mechanisms (exercise, meditation, etc.).
Emotional overeating is also a big issue many of us face. It is a part of our culture. We use food as reward. We overeat to push down feelings. We eat too fast and miss the signals for fullness. The trick is mindfulness – being aware of actual hunger, which can sometimes be confused with things like thirst, or anxiety, or fatigue. People who struggle least with emotional eating seem to be those who recognize these things, and really see food as fuel for their bodies.
Acknowledging the triggers to emotional eating is useful. Recognizing the physical discomfort from overeating as well as the resulting feelings of shame can be powerful. One helpful tool is keeping a food diary, at least for a specific period of time. Track everything you ate, when and how much, what feelings led to that behavior, and what feelings resulted from it. This is mindful eating.
What supplements are best to take for women?
Dr. Bartlett: I do not think most healthy women need supplements, generally speaking, though there are exceptions based on certain conditions. In general, if you are eating a colorful, varied, diet with enough vegetables, fats, and different kinds of proteins, supplements should not be necessary.
What is best way to handle monthly water retention issues?
Dr. Bartlett: Water retention related to menstrual cycle can be improved with different kinds of birth control, as well as simply reducing intake of salt and processed foods. There are other medications, but these are rarely necessary. Exercise helps.
Can you exercise too much?
Dr. Bartlett: Yes, you can exercise excessively but that is unusual. Most people struggle to get the minimum 150 minutes per week of recommended exercise. What is considered excessive depends on age, overall fitness, metabolic needs, etc. It is excessive when it is creating an obsessive cycle and distressing sense of addiction, if it is overly tolling on the body with no time for recovery, or otherwise interfering with one's life and mental health.
I've tried dieting, pills, exercise, missing meals, slowing down on pop and fast food/junk food. I'm 46 and cannot lose weight. I'm healthy, but I also have a thyroid problem. What can I do?
Dr. Bartlett: Thyroid dysfunction, along with age and perimenopause, can absolutely cause issues with weight gain. The first thing is to make sure you are talking to your PCP or Endocrinologist about options to adequately treat your thyroid levels, and that you are taking the medication correctly. Gynecologists, like myself, frequently work with Endocrinologists and PCPs as part of a team to address situations like yours where there are multiple contributors to consider. It is not unusual that we refer to nutritionists/dieticians for additional insight and, at times, bariatric specialists for possible surgical options.
What are key steps or foods to eat for a healthy gut?
Dr. Bartlett: Signs of an unhealthy gut include bloating, irregular bowel habits, heartburn, and can even include things like fatigue and skin changes. Some foods are known to be inflammatory and can cause issues in susceptible individuals.
High sugar and processed foods can contribute to this. So can chronic stress and certain medications. Eating whole foods counters this. Clean-eating, stress reductions, improved sleep habits, as well as pre- and probiotics can help. Some of these symptoms, however, can also indicate a serious underlying gynecologic or gastrointestinal issue. As a gynecologist, I work with GI doctors and PCPs to sort through this with my patients.
Lately, I have seen a lot of ads for food-sensitivity testing. This and the science about microbiome (bacterial balance in intestines can influence overall health including immunity, mental health, and even cancer) appear to be emerging topics in healthcare. There is much still to be learned about both.
I'm 58 and have been on a low carb diet since June and have lost over 30 pounds, but have stalled for the past three months. Should I stay low carb or start focusing more on calories only?
Dr. Bartlett: Reaching a plateau with weight loss is common and expected. It is easier to lose more when you weigh more. This is why we generally recommend a goal weight loss percentage instead of set number of pounds. Additionally, our bodies are constantly adapting making it harder to sustain earlier success. It is in our genetic makeup. It might be that you have to change the type of diet you are following, or the amount and kind of exercise you are doing (there is some evidence that high intensity interval training is more effective than just sustained cardio). People who found success with intermittent fasting sometimes have to change their windows for fasting. You should talk to your doctor about it to see where there is room for adjustment and to be sure nothing is missing. Most importantly, though, is having patience with yourself. Stay focused on the big picture of wellness, and the idea that weight management is a life-long goal, with ups and downs, and not just a short-term diet. And it is not just about the number on the scale. The goal is to improve your health and your relationship with food, to find balance, and hopefully feel better in the process.
There are a lot of components to healthy weight management for women as we age, that's for sure. But, the most important thing I learned from Dr. Bartlett is the importance of having a conversation with your doctor if you need help in this area. Everyone's body, experiences, and hormones are different, and there are many things we can do to be our healthiest selves throughout all stages of our lives! Learn more about women's health at The Christ Hospital or schedule an appointment online with a women's health expert near you.