Menopause: Weight or Wellbeing?
By Emily Gause, MA, RDN, LDN
Menopause involves hormonal changes leading to a gradual loss of menstruation and coincides with a host of physiological symptoms. Questions and recommendations about weight and weight loss are often centered in peri- and post-menopausal spaces due to assumptions that weight loss and prevention of weight gain can improve health, but is that the full picture?
Menopause often brings about a host of physiological and psychological concerns. Women who have never worried about their weight or health suddenly experience a gradual tightening of their clothes, resulting in a host of new body image concerns. Those who have dealt with lifelong weight concerns feel their weight loss efforts are agonizing and futile. Others may be less concerned with body size and shape changes and more focused on the uncomfortable physiological symptoms associated with menopause such as hot flashes, poor sleep patterns, and increased concerns about overall health.
The Science of Menopause
Understanding some of the physiology behind menopausal changes can help provide greater body awareness and compassion. As Dietitian Val Schonberg states,
“Menopause is a normal process, NOT a disease.”
Menopause occurs in stages typically between 45-55 years of age. Symptoms associated with perimenopause include irregular bleeding, hot flashes, altered sleep patterns, and mood shifts. Health concerns associated with menopause can include increased risk of cardiovascular disease, insulin resistance, loss of muscle mass, loss of bone density, and, of course, weight gain.
Pursuing Weight Loss Comes with Risks
Weight loss is often the first recommendation for improving health outcomes during menopause; however, intentional weight reduction strategies that result in sustainable weight loss are EXTREMELY rare for ANYONE – including pre- and post-menopausal women. In fact, most long-term studies show that 95% of people who diet end up re-gaining the weight they lost, and more than 30% of those individuals will gain MORE weight than they lost!
Worse, weight loss recommendations typically involve creating a caloric deficit, but eating fewer calories than the body requires can WORSEN menopausal health risks. A recent study showed that menopausal women who slightly restricted their caloric intake to lose weight saw a decrease in bone density, and those who followed very low-calorie diets saw a DRASTIC decrease in bone density. Those losses continued even after the women resumed their normal diet, and sadly, bone density is nearly impossible to replete once lost.
…menopausal women who slightly restricted their caloric intake to lose weight saw a decrease in bone density, and those who followed very low-calorie diets saw a DRASTIC decrease in bone density.
Intentional weight loss has also been linked to “weight cycling” – the process of losing and then re-gaining weight through engaging in consecutive diets. Weight cycling has been associated with loss of muscle mass, increased insulin resistance, and increased cardiovascular disease risk factors such as high blood pressure and elevated cholesterol. Menopausal women are already at some risk for these occurrences, and intentional weight loss can worsen those risks.
Flipping the Weight Loss Script
Given the emphasis our society places on weight loss, it may be surprising to hear that weight gain during menopause may be protective! Research has shown that a gradual increase in weight of around 17-22 pounds throughout menopause may offer cardioprotective benefits, perhaps due to the increased estrogen in fat cells.
Responding to your body with kindness, respect, and care rather than with behaviors that may increase overall risk (via dieting/caloric restriction) may help build greater body trust and autonomy, as well as improve health! Consider the following lifestyle factors that can safely be incorporated to help mitigate some of the health risks associated with menopause, WITHOUT worsening overall health.
6 Tips for Effective Menopause Management
Ensure adequacy: Aim for 3 meals and 2-3 snacks daily, spaced about 2-4 hours apart. Include something from each food group (protein, carbohydrate, fat, and fruit/veggie) along with a source of dairy.
Reduce bone density losses: Emphasize foods high in calcium, vitamin D, phosphorus, and magnesium. Food sources that can improve bone density include dairy products (or fortified alternatives), spinach, broccoli, eggs, salmon, and nuts and seeds. If you’re able, consider adding a strength-training program.
Reduce loss of muscle mass: Along with adequacy, work on aiming for about 1-1.2 grams of protein per kilogram of body weight in combination with your strength-training program. Remember: If you are under-eating and over-exercising, you will accelerate muscle loss!
Work on heart health: Emphasize healthy fats and oils such as olive oil, canola oil, nuts and seeds, avocado, and fish oil. Increase fiber intake in the form of fruits, veggies, whole grains, and complex carbs. Increasing intake of healthy fats and fiber can help improve both heart health and digestion.
Manage possible iron losses: If you are experiencing significant and/or irregular bleeding during early menopause, get your iron levels checked. You may need an iron supplement and/or to emphasize iron-containing or fortified foods such as red meat and iron-fortified cereals.
Build body image resilience: Our bodies are dynamic, and despite the discomfort we commonly and understandably experience as a result, body changes are natural throughout the lifespan. If you are struggling with body image distress at any point in life, working on body acceptance and neutrality can help normalize body changes and improve overall confidence.
For individualized recommendations related to menopause or for support in navigating body image concerns, reach out to the Registered Dietitians at Memphis Nutrition Group.