Weight Management Strategies

One of the most common complaints during the menopausal transition is weight gain. Many women find that they haven’t changed anything about their diet or exercise patterns, but still are dealing with an increase in weight. Some women may not experience a change in weight but notice their clothes fitting tighter around the waist. As estrogen and progesterone levels decrease, fat distribution shifts to a male pattern, accumulating in the abdomen and increasing the risk of inflammation and disease. This abdominal fat is called visceral fat. Visceral fat is fat that surrounds the organs and acts as an endocrine organ secreting harmful inflammatory substances into the body. It is more harmful than subcutaneous fat stored in the hips and thighs and is inflammatory and disease causing. It increases the risk of cardiovascular disease, diabetes, sleep apnea, and certain cancers.

The decline in estrogen accompanying menopause plays a crucial role in this metabolic shift. Estrogen helps maintain muscle mass, and as it decreases muscle mass decreases, slowing metabolism. Additionally, lower estrogen levels contribute to insulin resistance, promoting fat storage, and influencing hunger and fullness signals, leading to increased cravings and appetite. Although this is both frustrating and potentially harmful, there are steps you can take to help manage the weight gain and protect your health.

Increase Protein Intake

Protein helps preserve and increase lean muscle mass in the body to support healthy metabolism. Muscle is important in combating weight gain. It is recommended that women at this stage of life consume 1.5-2 grams of protein per kilogram of body weight. An easy way to manage protein intake is to aim for about 25 grams of quality protein per meal. Focus on foods such as lean meats, Greek yogurt, cottage cheese, legumes, nuts, seeds, and eggs. If you struggle to get enough through the diet, a protein powder can be helpful. Try to find a protein powder without added sugars and fillers. Whey protein is a good option. If you are vegan you can get a powder made of peas, grains, or seeds. 

Optimize Your Insulin Response

As estrogen levels drop, insulin sensitivity decreases. Reducing carbohydrate intake, especially refined carbs like white flour, white rice, and sugars, can help manage insulin spikes and promote weight management. Newer research suggests obesity is linked to blood glucose levels rather than just calorie and exercise balance. Focus on whole foods that are rich in fiber accompanied by healthy fats and protein. Make sure every meal and snack includes fiber, fat, and protein to better manage your body's response to insulin.

Taking a 10 minute walk after every meal is also a helpful tool. When we eat a meal, especially one containing carbohydrates, blood glucose levels rise. Walking after eating helps lower the post-meal glucose response by increasing the uptake of glucose to the muscles. Taking action to lower blood glucose levels indirectly reduces the amount of insulin needed to manage blood sugar.

Follow the Mediterranean Diet

Known for its anti-inflammatory properties, the Mediterranean diet can help reduce the risk of cardiovascular disease, obesity, high blood pressure, insulin resistance, and high cholesterol. It has also been shown to reduce overall inflammation and improve cognitive function. Research shows that it can help reduce menopausal weight gain. Focus on minimally processed fruits, vegetables, whole-grains, nuts, legumes, extra virgin olive oil, seafood, eggs, and poultry. Limit red meat, dairy, and sweets.

Try Time-Restricted Eating/Intermittent Fasting

Some women find that by restricting their eating window or by regularly fasting, they are able to avoid weight gain or sometimes lose weight. While potentially helpful, caution should be taken by those with a history of eating disorders or insulin sensitivity issues. Additionally cortisol levels can be quite high during menopause which can disrupt sleep and increase anxiety. Fasting may exacerbate this. For those with high cortisol, stick with regular eating patterns and stop eating at least three hours before bedtime. Women who struggle with fasting may be able to build up to it if effort is made to decrease and manage cortisol levels and increase fasting tolerance.

Improve Your Gut Microbiome

A healthy, diverse gut microbiome may be helpful for weight management and better health overall. You can improve the gut microbiome through exercise, stress reduction, increasing fiber intake, and eating fermented foods. A probiotic supplement may also be helpful. Look for a probiotic supplement with at least 40-50 colony forming units. In addition, try to eat 30 different plant foods per week. This would include grains, seeds, nuts, legumes, fruits and vegetables. Variety is key. These foods contain important fibers and nutrients that feed the gut as well as improve health. Add fermented foods to your diet at least once per day. These can be foods such as unsweetened yogurt, kefir, kimchi, refrigerated sauerkraut, and kombucha. 

Engage in Strength Training

Maintaining muscle mass through strength training is crucial for mitigating weight gain and preventing sarcopenia (age-related muscle loss). Creatine supplementation (5g daily, especially on training days) along with resistance training can increase lean muscle mass, protect bones, and prevent frailty.

Prioritize Sleep

Poor sleep can contribute to weight gain and metabolic disorders, while adequate sleep aids in weight management. Achieving quality sleep can be challenging during menopause due to hot flashes, high cortisol, and hormonal changes. If you are like me, being told to prioritize sleep can induce rage. I am desperate for good sleep and during the menopausal transition the odds are often stacked against us. But, there are ways to improve sleep during this phase of life. 

Managing cortisol is key. Often high cortisol can cause an increase in hot flash frequency, difficulty calming down and falling asleep, and difficulty staying asleep. Diet can contribute to increases in cortisol  as well. Avoid added sugars and refined carbohydrates. Make sure your meals are balanced and include healthy protein, fats, and fiber. Eat vegetables at the beginning of every meal if possible. Avoid caffeine later in the day and avoid eating within three hours of bedtime. Alcohol can also contribute to poor sleep, especially as women age.

Manage Stress

High stress levels can increase cortisol production in the body promoting abdominal fat accumulation. Yoga, meditation, exercise, and social connections are all useful in reducing stress. Following the Mediterranean diet, management of insulin response, and adequate protein intake can all help improve cortisol and stress levels.

Exercise

Regular exercise benefits overall health, weight management, sleep, stress management, and insulin response. Because exercise increases cortisol levels, some women at this stage may find that high intensity exercise actually hampers weight loss. While higher intensity exercise can be very beneficial, if you find yourself exercising hard, but still gaining weight, you may need to switch to a lower intensity form of exercise. Walking, yoga, and strength training can help facilitate weight loss. If cortisol and stress can be reduced overall, the body’s tolerance for higher intensity exercise may improve.

Sources:

1. Photo by Alora Griffiths on Unsplash

2. Barrea L, Pugliese G, Laudisio D, Colao A, Savastano S, Muscogiuri G. Mediterranean diet as medical prescription in menopausal women with obesity: a practical guide for nutritionists. Crit Rev Food Sci Nutr. 2021;61(7):1201-1211. doi: 10.1080/10408398.2020.1755220. Epub 2020 Apr 24. PMID: 32329636. Accessed April 25, 2024. 

3. Pasiakos SM, Lieberman HR, Fulgoni VL 3rd. Higher-protein diets are associated with higher HDL cholesterol and lower BMI and waist circumference in US adults. J Nutr. 2015 Mar;145(3):605-14. doi: 10.3945/jn.114.205203. Epub 2015 Jan 21. PMID: 25733478. Accessed April 25, 2024. 

4. Erdélyi A, Pálfi E, Tűű L, Nas K, Szűcs Z, Török M, Jakab A, Várbíró S. The Importance of Nutrition in Menopause and Perimenopause—A Review. Nutrients. 2024; 16(1):27. https://doi.org/10.3390/nu16010027. Accessed April 25, 2024. 

5. Wilkinson MJ, Manoogian ENC, Zadourian A, Lo H, Fakhouri S, Shoghi A, Wang X, Fleischer JG, Navlakha S, Panda S, Taub PR. Ten-Hour Time-Restricted Eating Reduces Weight, Blood Pressure, and Atherogenic Lipids in Patients with Metabolic Syndrome. Cell Metab. 2020 Jan 7;31(1):92-104.e5. doi: 10.1016/j.cmet.2019.11.004. Epub 2019 Dec 5. PMID: 31813824; PMCID: PMC6953486. Accessed April 25, 2024.

6. 7. Forbes SC, Candow DG, Ostojic SM, Roberts MD, Chilibeck PD. Meta-Analysis Examining the Importance of Creatine Ingestion Strategies on Lean Tissue Mass and Strength in Older Adults. Nutrients. 2021 Jun 2;13(6):1912. doi: 10.3390/nu13061912. PMID: 34199420; PMCID: PMC8229907. Accessed February 15, 2024.

7. Papatriantafyllou E, Efthymiou D, Zoumbaneas E, Popescu CA, Vassilopoulou E. Sleep Deprivation: Effects on Weight Loss and Weight Loss Maintenance. Nutrients. 2022 Apr 8;14(8):1549. doi: 10.3390/nu14081549. PMID: 35458110; PMCID: PMC9031614. Accessed April 25, 2024. 

8. Hewagalamulage SD, Lee TK, Clarke IJ, Henry BA. Stress, cortisol, and obesity: a role for cortisol responsiveness in identifying individuals prone to obesity. Domest Anim Endocrinol. 2016 Jul;56 Suppl:S112-20. doi: 10.1016/j.domaniend.2016.03.004. Epub 2016 Mar 31. PMID: 27345309. Accessed April 25, 2024. 

9. Hill EE, Zack E, Battaglini C, Viru M, Viru A, Hackney AC. Exercise and circulating cortisol levels: the intensity threshold effect. J Endocrinol Invest. 2008 Jul;31(7):587-91. doi: 10.1007/BF03345606. PMID: 18787373. Accessed April 25, 2024. 

10. Caplin A, Chen FS, Beauchamp MR, Puterman E. The effects of exercise intensity on the cortisol response to a subsequent acute psychosocial stressor. Psychoneuroendocrinology. 2021 Sep;131:105336. doi: 10.1016/j.psyneuen.2021.105336. Epub 2021 Jun 18. PMID: 34175558. Accessed April 25, 2024. 

11. Haarhuis JE, Kardinaal A, Kortman GAM. Probiotics, prebiotics and postbiotics for better sleep quality: a narrative review. Benef Microbes. 2022 Aug 3;13(3):169-182. doi: 10.3920/BM2021.0122. Epub 2022 Jul 11. PMID:35815493. Accessed November 16, 2023.