by Patricia Yarberry Allen, MD | bio

Women who take estrogen often complain to me that it makes them fat. Women who are menopausal and who have chosen not to use hormone therapy complain that loss of hormones has made them fat. My usual response, assuming the patient has no underlying health problem, is that eating too much of the wrong foods and not exercising are the main reasons that women over age 40 gain weight and have trouble taking it off.

The relationship between female hormones and weight gain is a popular research topic, however, and patients often ask about studies they see in the news. Some studies can unfortunately leave the wrong impression.

For instance, researchers at the University of Texas Health Science Center at San Antonio recently hypothesized that a depletion of estrogen may trigger the development of high blood pressure and obesity.

The researchers conducted a study using 24 aged female rats — a very small number — and removed the ovaries of two-thirds of the rats. Half of those rats were given estrogen, while the other rats remained
estrogen deprived. The aged rats that received no estrogen replacement had higher rates of hypertension, weight gain and blood sugar.

The study was presented earlier this month at
the Sex and Gender in Cardiovascular-Renal Physiology and Pathophysiology Conference in Austin, Texas, and has received some media attention.

I e-mailed Dr. Phyllis August, an internationally known expert on hypertension, about this study and the ongoing controversy about menopause and obesity. She wrote that although there is an unquestionable increase in weight gain, insulin resistance and hypertension as we get older, "to conclude that estrogen deficiency is the direct cause overlooks a significant body of epidemiological, clinical and experimental data."

She continues:

Indeed, insulin resistance is in fact more common in men, and the prevalence increases in older men, just as in older women. Additional studies of the role of the sympathetic nervous system, cytokines, inflammation and hormones will hopefully shed more light on the complex pathways responsible for these conditions.

For now, there is overwhelming evidence to suggest that a strategy of healthy diet and exercise, rather than hormonal supplementation, is the most rational approach to preventing and treating the weight gain
associated with aging.

I couldn’t agree more. My suggestion is that we approach menopause with a clear understanding of how our bodies change and what we can do to maintain our health. The beginning of the menopausal transition (around age 40) is the perfect time to begin new patterns of self-care and self-awareness.

If we arrive at 50 with 25 extra pounds to shed, hormonal change may make it harder to get that weight under control. But if we start taking care of our health at age 40, then we enter the menopausal transition
in better physical shape — and better prepared to assume direction over other aspects of our lives as well.

* * * * *
Dr. Patricia Yarberry Allen,
director of the New York Menopause Center, is a gynecologist affiliated with New York-Presbyterian Hospital and a board certified fellow of the American College of Obstetrics and Gynecology.
Have a question about sex, women’s health or the menopausal transition? Write to [email protected].

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  • Dr. Cecilia Ford July 19, 2008 at 11:33 am

    Comment on menopause and weight loss
    It can be very discouraging to be as diligent as you are, Coni, and not see results, but there are some changes that make it harder to shed pounds in menopause. I have found that the methods that have worked for my clients just a few years earlier are no longer automatically effective for them.
    There’s no question that while menopause is not an inevitable slide to weight gain, but we do metaboloiize food diffrently and our bodies and habits change in ways that are subtle and important. Dr. Allen points out, however , that there is no reason to give up, but you may need to reevaluate your strategy.
    Keeping a journal is an excellent way to do this. It is a positive move not only because it helps keep you mindful of what you are eating, but also because it helps you see exactly what you are doing—which can be very surprising when put down on paper. It’s sort of like a budget-when written down, what you spend can be painful to see, but it can be the first step to reigning in your habits and getting under control.
    One last thing: evaluate your goals and make sure you are aiming for a healthy, reasonable weight. Many women I work with cling to the ideal of remaining model thin into their 50’s and 60’s, not acccepting that it is actually no longer flattering at this age. The Duchess of Windsor was wrong—after a certain age, it is possible to be too thin, (and as Leona Helmsley has made clear, some people are too rich!)

  • Dr. Patricia Yarberry Allen July 16, 2008 at 11:34 pm

    Dear Coni,
    It is difficult to respond to a comment when there is so much information missing. It would be helpful to know your age, your family history and your past history of weight gain and loss.
    No one has a perfect weight loss plan that works for every patient. However, I find the following ideas helpful with patients that I work with. Perhaps these ideas will help you move along in your laudable goal to lose weight and be healthier.
    Weigh daily. How do you know what impact yesterday had on your weight if you don’t know today’s weight? I understand that many experts feel that weighing daily is emotionally difficult. I believe that if you become determined to lose weight, the scale becomes your cheerleader.
    Become mindful: Do not put any thing in your mouth unless you are aware of why you are eating and what you have chosen to eat. Recognize when you are full. Stop. Eating. Then.
    Work on a way to look at food as fuel and not as an object of desire.
    Separate eating from comfort and emotional issues.
    Set a reasonable weight goal for 3 months and design a diet that has small portions of vegetables, salads, and protein. Have 3 snacks in between that are rigorously controlled for portion and calories. Low salt, high fiber V-8 has 70 calories in a 11.5 oz can and is both filling and does not produce the roller coaster of elevated blood sugar then a decrease in blood sugar that so many foods cause. Have a V-8 twice a day as a snack. 2% fat cottage cheese in snack size container with an apple and a bottle of water are an excellent calorie controlled snack. At the end of 3 months, review your goals and make new ones.
    Avoid alcohol entirely if you want to lose weight. It is converted to sugar and then causes an increase in insulin which increases belly fat.
    A low calorie diet does work if you spread the food out over the day. Often patients need 2 oz of turkey one hour before bed on a calorie restricted diet.
    Identify the saboteurs that are preventing you from achieving your weight loss goal and do everything you can to change them. Saboteurs often include a spouse or friend who wants an eating and drinking partner. Find new ways to spend your time than in the kitchen or in restaurants.
    Exercise is terrific for toning and building muscle mass while you are losing weight. Exercise also increases the metabolism in some patients. But, exercise almost never produces weight loss unless you are doing 2 hours of intense aerobic activity a day.
    Get a buddy to join you in your weight loss program. Write down everything that you eat, how much, and when. Share your diet diary with your buddy. Studies show that weight loss is easier when you have support.
    I wish you much success.
    Dr. Pat

  • coni July 16, 2008 at 3:06 pm

    you state that not eating healthy choices and no exercise are the true culprits of wght gain as we get older…well, I eat a healthy diet (no sweets, just special b’days etc) i exercise every day,,,,either bike ride outside for 45-60 min or on a recumbant bike,also do wght exercies 3 zx a week…..i still can’t lose about 15 lbs, all in the midriff area. any suggestions? only meds i’m on are nexium and blood pressure 25 mg altenolol)