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The truth about menopause and weight gain

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Menopause and weight gain seem to go hand in hand.


“I went to sleep and I woke up the next day, and I promise you, I’ve gained 20 pounds.” That’s the complaint Dr. Monica Christmas hears all the time as director of the menopause program at University of Chicago Medicine, where she is also an associate professor of obstetrics and gynecology.


This phenomenon isn’t limited to her patients, Christmas told CNN Chief Medical Correspondent Dr. Sanjay Gupta on his recent podcast. “I looked around at my own family members or maybe other people that I knew that were in that age range, and it did seem like, wow, they did seem to gain a lot of weight in a short period of time,” she said.


Women do gain about 1½ pounds per year during their 40s and 50s. And a lot of that extra weight seems to land in the midsection, setting the stage for metabolic problems including high blood pressure, high blood sugar and high cholesterol, all of which increase the risk of cardiovascular disease.


But is menopause really to blame for women’s midlife weight gain? As with so many health issues, it’s complicated.


Christmas said it’s impossible to talk about weight gain around menopause without talking about the other elephant in the room: aging. “Menopause is inextricably tied to the aging process,” she said.


“Aging in general is associated with weight gain, more so because of lifestyle changes: being more sedentary, not as active as we once were,” Christmas said.


She said it usually doesn’t happen all at once. Instead, changing life circumstances, such as more job and parenting responsibilities, conspire to rob us of time for leisure pursuits that used to keep us active. “We started slowly realizing … ‘I didn’t make time for those types of things,’” she said.


And there’s at least one more factor that contributes to weight gain as we age. “The reality of it is that our metabolism slows as we get older,” she said. One oft-cited study found that it remains fairly stable between the ages of 20 and 60 but then declines.


But it is far from a lost cause, Christmas said. “The weight gain doesn’t happen with everybody; people that are really active, that are meticulous about exercise, that are intentional about what they fuel their bodies with, it’s probably a minimal change.”


So, what can you do to mitigate middle-age spread? Christmas has these five tips.


Your body, your temple


Christmas believes in treating your diet like you treat your bank account: Be meticulous about what you choose to put into it and how you spend your calories.


“My friends and family refer to me as a ‘food snob.’ If it can live in a vending machine for years and still be considered fresh, I don’t put it in my body,” she said via email.


Christmas also advises against going too heavy on the meat. “Michael Pollan said it best: ‘Eat real food, not too much, and mostly plants.’ He’s so right,” she said. “Whenever we think of people as ‘aging backwards,’ they are usually vegetarians or close to it. Adhering to a plant-forward diet, filled with anti-inflammatory foods (like those found in the Mediterranean diet) and avoiding highly processed foods containing sodium, sugar and trans fats is the best gift you can give yourself.”


This doesn’t mean that you can’t ever have a treat. “If you do indulge in something decadent, scale back later,” she said.


Make physical activity a way of life


Exercise is key to maintaining a healthy weight and combating the muscle loss that comes with aging and can put older adults at higher risk of disability.


“The adage ‘use it or lose it’ could not be truer during the menopause transition,” Christmas said.


“Specifically, what we are losing: our muscle tone, flat tummy, trim waistline — I’ll stop here because I’m depressing myself,” she said. “Experts recommend 150 minutes of moderate-intensity physical activity and two days of muscle strengthening per week.”


She is often asked what the best type of exercise is. “My response is always the same: ‘the one that you will do,’” she said. “I love walking with a combination of yoga and Pilates. However, the options are endless: hip-hop aerobics, spin class, biking, hiking, tennis, swimming, step class, Jazzercise, lining dancing, boxing, pole dancing, weightlifting, barre. The point is to be intentional; find something you like, take a friend, and go often.”


Put a cork in it


Limit alcohol or avoid it altogether.


“Outside of the extra calories, alcohol can disrupt sleep, exacerbate or trigger depression and often decrease our inhibition,” Christmas said. “Most people tend to eat more — and it’s usually not more veggies — when they drink alcohol.”


Heed the siren song of Hypnos


Prioritize sleep.


“Research has shown that not getting enough sleep is associated with weight gain,” Christmas said. “People that don’t get enough sleep often snack more and indulge in all the high-calorie foods we should avoid.”


Practice self-care and self-love


Menopause is a natural phase of life that may be associated with bothersome symptoms including weight gain — but don’t let that extinguish your joy.


“It’s important to be intentional about engaging in regular exercise and adhering to a healthy diet; however, it is equally as important to create space for self-care,” Christmas said. “For some — not all — the menopause transition can be frightening. Making time to do things that bring us joy and peace are important to overall well-being.”


She added that sadness, irritability, increased anxiety and decreased motivation are very common during the transition to menopause. “Consultation with a mental health specialist and, in some cases, medical treatment can be helpful, especially if depression is contributing to overeating or lack of exercise,” she said.

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