Ask Dr. Pat · Menopause

What Causes Midlife Weight Gain
and Strategies To Control It

Patricia Yarberry Allen, M.D. is a Gynecologist, Director of the New York Menopause Center, Clinical Assistant Professor of Obstetrics and Gynecology at Weill Cornell Medical College, and Assistant Attending Obstetrician and Gynecologist at New York-Presbyterian Hospital. She is a board certified fellow of the American College of Obstetrics and Gynecology. Dr. Allen is also a member of the Faculty Advisory Board and the Women’s Health Director of The Weill Cornell Community Clinic (WCCC). Dr. Allen was the recipient of the 2014 American Medical Women’s Association Presidential Award.

Dear Dr. Pat,

I am in my late 40s and completed menopause at 47.  I could not take hormones since I had stage zero breast cancer at 44. It was found early and treated with a lumpectomy. I am lucky that my menopausal symptoms were reasonably mild.

I was always fit and found time for a run four mornings a week and daily weight workouts at home.  I wore a size four in dresses and skirts. I never paid much attention to my actual weight, just how my clothes fit.  It took me three months to get back to exercise after the hysterectomy, and truth be told, I haven’t ever returned to the daily strength training I used to do. I have twin 17-year-old sons who just graduated from high school and want food all the time, including lots of carbs, and no matter what I say, deserts. My work and home life are stressful, just as it is for all my friends.   I always have a glass of wine to unwind after the work day while making dinner and my husband and I have a glass of wine with dinner.  He and the boys clean up after dinner so I could go down to the basement and lift weights or use the treadmill but I just don’t seem to have the drive to exercise I had two years ago. I stay up later than I used to, since it is my only way to have some quiet time and I often head into the kitchen and make a snack around 11 p.m. even though I am not actually hungry. I used to get seven hours of sleep every night but now I am lucky if I get five.  I am so depressed that none of my clothes fit.  I now wear a size 6 or 8 and I have a belly for the first time in my life.  I know I should count my blessings that I don’t have breast cancer and that I no longer have the severe problems I had from the endometriosis that were eradicated by the hysterectomy and removal of my ovaries and tubes.  But, I am not eating more than I did before the surgery, though I do have two glasses of wine instead of one.

Did menopause make me gain this weight?  And, what can I do to get back to my former shape?

Kiki

 

Dear Kiki,

These two questions: “Did menopause make me fat?” and “What can I do to lose weight now that I am in menopause?” are among the most frequently asked questions in my practice. The answer to both of these questions is “It’s Complicated.”.

You can lose weight in any decade with determination, unless you have a medical problem that makes this almost impossible. The tips that I offer to all patients are:

  1. No booze. Alcohol is converted to sugar and sugar is laid down as belly fat
  2. No carbs and no deserts.  Ditto to the belly fat
  3. Stress reduction:  Identify the sources of stress and ask for help from your partner, teenage sons, friends and peers at work. If you need more support for stress reduction, look for a therapist who can help you make small changes in your life that often reduce stress.
  4. Find a meditation group and practice this technique of proven stress reduction as stress hormones increase appetite and weight gain.
  5. Get enough sleep. Inadequate sleep is associated with weight gain.
  6. Get to bed earlier. This period of your life where there are adolescent sons present will end and you will be able to have more awake “me time.” Inadequate sleep increases weight gain.
  7. No late night eating. You are having that late-night snack even though you know you aren’t hungry.  It is easier to control the random kitchen foraging if you are sleeping.
  8. Find friends to exercise with.  Go back to your gym and find a friend who will make you accountable for showing up and slowly getting back to your old routine.
  9. Hang in there. Recognize that you are in a transition from a child centered life (in spite of your work life and your marriage) to a life that will soon allow you more time for self-care. Your sons are off to college in three months. You will have much more control over your evening routine, your choice of foods to prepare and much more time for exercise in the fall.  Redesign your life with you and your health in mind.

I’ve asked Rekha B. Kumar, M.D. for a thoughtful explanation about the causes of midlife weight gain and medical strategies to control it. Dr. Kumar is a member of our Medical Advisory Board.  She is an Assistant Professor of Medicine, Weill Cornell Medicine/New York Presbyterian Hospital and a member of the team of The Comprehensive Weight Control Center at Weill Cornell Medicine.

Dr. Pat

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