Nutrition and exercise can mitigate patient weight gain during the transition to menopause.

As women age, it becomes more difficult to maintain pre-menopausal weight. Weight gain in women has been shown to begin during perimenopause, and weight gain continues through menopause. In fact, women gain, on average, 1.5 pounds a year during midlife.¹ Obesity and menopause appear to be connected, with close to two-thirds of 40-59 year old women and three-fourths of women aged 60 or older meeting the criteria for being overweight (BMI of > 25 kg/m²); nearly half of the women in these age groups are women with obesity (BMI of > 30 kg/m²).¹

Although weight gain during menopause is a common occurrence, there are a number of actions and strategies that can be adopted to reduce the weight gain associated menopause and perhaps alter the relationship between obesity and menopause. One such strategy is offering health education for menopausal patients so that they are aware of the mechanisms that foster weight gain and behavioral strategies to mitigate their effects.

Causes of Menopausal Weight Gain

There are several causes for menopausal weight gain that function only to strengthen the relationship between obesity and menopause. Decreasing levels of estrogen play a role in weight gain during menopause. Research has shown that estrogen is implicated in blocking the body’s hunger signal.² When the hunger signal is not blocked, the inclination is to eat beyond the point of satiety. For women transitioning into menopause, the weight gain tends to occur around the abdomen. For five years, researchers tracked perimenopausal women who were at a healthy weight. Among the group of women who entered menopause in year three of the study, higher abdominal fat and visceral fat were observed relative to the start of the study. Increases in visceral fat puts menopausal women at a greater risk metabolic complications, cancer, and compromised cardiovascular health, particularly hypertension, insulin resistance, and pro-atherogenic lipid profile.²

Obesity and menopause are also connected via sarcopenic obesity. Sarcopenic obesity is characterized by the loss of lean mass (muscle) and the increase of fat mass.³ Losing lean mass as we age is problematic because muscle is metabolically active. Muscle mass increases are resting metabolic rate, which results in caloric expenditure even when at rest. It’s estimated that adults lose three to eight percent of their muscle mass each decade after age 30. After age 60, the loss of muscle increases.⁴

The relationship between obesity and menopause is evinced again through disrupted sleep. During menopause, women experience hot flashes, increased anxiety, and night sweats — all of which can contribute to sub-optimal or fragmented sleep. The importance of quality sleep for overall health⁵ and the implications for weight gain⁶ are well documented. Because of the poor sleep quality during menopause, women are at risk of experiencing increased hunger⁶, which is especially problematic because as noted above, estrogen levels decline during menopause, which can lead to eating beyond the point of fullness. Menopausal women can find themselves seemingly trapped in a loop of poor sleep followed by increased hunger and then eating beyond satiety.

Strategies for Managing Menopausal Weight Gain

Health education for menopausal patients is a critical component of their treatment plan. Conversations focused on the importance of following a healthy diet and getting enough exercise are key to helping menopausal patients productively manage the challenges of menopause.

Nutrition

A caloric deficit is needed to achieve weight loss. Current recommendations⁷ suggest that reducing calories by 500-750 kcal per day, equivalent to 1200-1500 kcal, should result in a weight loss of .5 – .75 KG/wk.⁸ To avoid overly restrictive and impractical diets, patients should be educated on the benefits of nutritionally formulated meal replacements, which have been found to support healthy weight loss⁹ while providing patients with the nutrition they need. Combining nutritionally formulated meal replacements with a Low Calorie Diet (LCD) or a Very Low Calorie Diet (VLCD) — depending on a patient’s needs — can jumpstart weight loss. Following a well-balanced diet that includes fruits, vegetables, and lean protein while limiting or avoiding ultra-processed foods will help patients reduce fat mass and mitigate the metabolic and cardiovascular risks of that can be compounded during menopause.

Exercise

Current recommendations suggest 150 minutes of moderate to intense exercise for weight loss.¹⁰ It’s important for menopausal patients to couple aerobic exercise such as walking, cycling or swimming with weight training or resistance training. Aerobic exercise will increase cardiovascular health while weight or resistance training will help build lean mass, which will facilitate caloric burn. Exercise coupled with a healthy eating plan is a tried and true approach for managing weight loss and living at a healthy weight.

The Importance of Health Education for Menopausal Patients

Certainly at all stages of life it is important to counsel your patients on making healthy food and exercise part of their daily routine. For menopausal women, this advice is especially salient; beyond the relationship between obesity and menopause, there is an increased risk for type 2 diabetes, cancer, and impoverished cardiovascular health associated with living at an unhealthy weight. A LCD or VLCD, paired with nutritionally formulated meal replacements and an exercise program for sustainable weight loss and maintenance, should be part of the health education for menopausal patients.

Sources:

1 Weight gain in women at midlife: A concise review of the pathophysiology and strategies for management

2 Weight management module for perimenopausal women: A practical guide for gynecologists

3 Sarcopenia and obesity

4 The effect of menopausal transition on body composition and cardiometabolic risk factors: A Montreal-Ottawa New Emerging Team group study

5 Sleep is essential to health: an American Academy of Sleep Medicine position statement

6 Sleep-obesity relation: Underlying mechanisms and consequences for treatment

7 American College of Cardiology / American Heart Association Task Force on Practice Guidelines

8 Management of obesity

9 A systematic review and meta‐analysis of the effectiveness of meal replacements for weight loss

10 American Heart Association Recommendations for Physical Activity in Adults and Kids