I had always been a lean bean. Stick legs, no butt and not much in the way of a chest. How I envied the other girls who wore bras with cups. There wasn’t much point in me getting one when the cup was going to be empty.
But then something happened.
A natural transition that occurs in every woman’s life – menopause.
Seemingly overnight, I developed batwings, heavy thighs with multiple veins, crepey skin, a turkey neck and midriff expansion that clearly wasn’t due to being pregnant and a bigger chest. Good heavens, I now needed a proper bra.
Fitted dresses now groaned from being overstretched. I felt uncomfortable and bloated. Loose flowing tops hid the tightness of my trousers. Was I destined for shapeless sacks for the rest of my life?
In a previous life, cutting down on food and doing a bit more exercise was enough to trim down any excess.
But now the rulebook had changed. Eating less just left me hungry and fatigued. Doing more exercise added to the hunger.
Sigh.
But this is the common scenario I see in countless other women, who, like me, have seen their body shape morph into something that can feel alien, uncomfortable, and surprisingly resistant to change.
It’s more than hormones.
Yes, menopause is the time of hormone change. Our ovaries have run out of eggs, and our oestrogen levels drop. With oestrogen receptors in virtually every organ of our body the falling levels are associated with some of the visible changes we notice.
But it’s not just our hormones that are changing. Our metabolism has changed too, which has a significant impact on our heart and metabolic health. Our blood pressure rises, along with cholesterol levels and blood glucose and it’s not because you’re doing anything differently. It’s this cardiometabolic transition that shifts the goal posts, pushing women towards a higher risk of heart disease and/or developing type two diabetes, as well as the altered distribution of body fat.
Welcome to middle age spread!
Help is at hand.
If you’ve noticed these changes too and felt frustrated that whatever you try, nothing shifts the weight and belly fat, welcome to the club.
However, all is not lost, so let’s look at what can help and what doesn’t.
This is where adhering to lifestyle as medicine principles can make all the difference. This is not about trying to look as you did in your twenties, rather it’s about understanding the changes taking place in your body and to focus on what keeps you well.
1. Ditch the diet and focus on good metabolic health
Cutting down on calories is not the way to go. Rather than thinking, “What can I stop eating?”, ask, “What do I need to include to ensure I’m getting all the essential nutrients I need to stay fit and strong?”. Humans, as omnivores, can enjoy a wide range of carbohydrates, fats and proteins.
Declining oestrogen levels trigger the body to store more abdominal fat around your tummy. At the same time, a decrease in the basal metabolic rate, means you’re not burning energy at the same rate as before, or as efficiently.
Other contributing factors include reducing muscle mass or sarcopenia, which occurs with aging. We need muscle to burn energy and maintain insulin sensitivity and glucose metabolism. Less muscle mass predisposes menopausal women to the increased risk of developing insulin resistance and eventually type two diabetes.
You’ve probably heard about the ‘dangers’ of abdominal fat around our organs. This is because this type of fat is metabolically active and pro-inflammatory.
Rather than looking at all the hyped-up fad diet messages on social media, note what suits your body. Any diet can help you lose weight, now it’s important to eat well by looking for good sources of protein as found in meat, fish, dairy and eggs, a wide range of fruit, berries and vegetables to provide the antioxidants, carbs and fibre, seeds and nuts that are excellent sources of good fats, legumes which are great sources of fibre to help keep your gut microbiome healthy, whole grains, lashings of olive oil and plenty of water.
Doing this along with watching your alcohol intake, ditching the ‘crap’ and added refined sugar wherever possible is a great way to know you’re eating well for your body and mind.
2. Ensure you’re getting enough sleep.
The mid-life is often accompanied by changes in our sleep pattern. Hot flushes aside, we still need the same amount of sleep as before but now you may find that you wake more frequently during the night.
The reason you’re wide awake at 3 am is because of another hormone, cortisol. Cortisol is commonly associated with being a ‘stress’ hormone, but it’s also linked to controlling our sleep-wake cycle. Lower levels of progesterone in menopause means less of the calming neurotransmitter GABA is produced, so you’re less relaxed. We also produce less melatonin needed to help us maintain sleep while fluctuating sugar levels can also trigger greater cortisol release promoting more fat storage. Just one bad night can reduce insulin sensitivity by up to 25%!
Lack of or poor sleep is a metabolic disaster for weight management. It alters the production of two hormones, ghrelin and leptin. Ghrelin is associated with hunger (I remember it as the hormone associated with a rumbling tummy) which rises in sleep deprivation. Now you’re tired, grumpy and hungry, especially in the early afternoon when that attack of the munchies can be overwhelming and difficult to ignore. You had lunch but now your tummy is demanding a muffin or chocolate bar.
It’s estimated we consume an addition 300+ calories a day because of this effect compounded by the altered level of leptin available – the satiety signal that tells you to stop eating and the hedonic effect of a tired sleep-deprived brain demanding a reward.
Over time, that mid-afternoon snacking of high sugar/fat/carb food adds to the muffin top and love handles.
The solution? Get your sleep sorted pronto. Talk to your GP to see what would work best for your circumstances. There are some excellent programs like CBT-1 that work well.
3. Keep moving.
The temptation as we get older and struggle with aching joints, dodgy knees and hips and less energy is to do less. Unfortunately, this sets up a vicious cycle. The less you do, the less you want to do, or feel capable of. Increasing time spent being sedentary compounds everything else mentioned here.
Exercise alone won’t help you to lose weight. Disappointing, yes, I know. However, staying as active as possible will help you to maintain a healthy weight and reduce the risk of weight creep.
This is not about signing up to run a marathon. It is about ensuring you can fulfill all the activities associated with daily living, like getting up the stairs without getting puffed, or being able to get up off the floor after playing with your grandchildren.
Again, this is where working with a lifestyle medicine practitioner or health coach can assist you to reach your physical activity goals slowly and safely and stay strong. Start low and build up gradually to increase your stamina and endurance and add in some resistance exercises and weight training to reduce your risk of further muscle loss and sarcopenia.
4. Stress less.
Yes, suggesting you should stress less is a bit like telling a drowning man to take swimming lessons. However, effective stress management at this time is critical to avoid ending up with chronically elevated levels of cortisol, which as you now know, contributes to greater fat storage.
What counts is recognising when your stress level is no longer in the manageable zone so you can take the appropriate action to reduce the impact it is having on you. This is where having a toolbox of activities you’ve learnt from experience is ideal. Walking in nature, meditation, doing something creative to distract you from those worries are all good. But don’t just keep them for a rainy day. Scheduling in regular time for you to rest and play helps to keep stress in check.
If weight creep is something that’s bothering you and you want to get back into shape, or at least to be a grape tomato rather than an heirloom tomato, now is the time to get cracking.
The final reminder here is that working with a lifestyle medicine practitioner and or health coach will provide you the support and information you need to take back control and be the fit and healthy person you want to be.
Lifestyle as medicine is the future of healthcare – putting you in the driver’s seat for better health and well-being.
