Battling Midlife Weight Gain: The “Perfect” Problem

“Life, Liberty and the Pursuit of Happiness” is an unalienable right we Americans have. For many women experiencing midlife weight gain, the pursuit of happiness seems to have been replaced by the “prison of perfection.”

I’m often asked by women who are experiencing symptoms of the menopause transition what’s the secret to the “battle of the bulge” – you know that increasing waistline that never used to be a problem? My answer is that the key to success is about making appropriate lifestyle changes that manage the effects of aging and declining hormones (keep reading to learn more about those). I know, I know! Not a very sexy answer, especially for the woman who is desperate and has already made significant attempts at “eating well” and “exercising regularly.”

The problem, I learn after more questions, is not just about what she needs to do to stay healthy through her midlife transition, but really this: “what’s the perfect diet to get thin/stay thin (you know like I was in my 20’s)… and remain ageless?” After all, we’ve been bombarded by messages from media, marketers and society that have seemingly convinced us that “healthy and happy” is found in perfection – the perfect body, job, husband, house, kids, food, skin…

Consider the fact that the number of cosmetic procedures using Botox (botulinum toxin which is a neurotoxic protein produced by the bacterium Clostridium botulinum) have increased a whopping 750% from 2000 to 2014, according to a report from the American Society of Plastic Surgeons. Somehow, cosmetic surgery and these types of procedures have become “normalized” for remaining ageless. We’ve become convinced that challenging the imperfection of aging is the key to happiness.

In fact, the battle with midlife weight gain may actually be a “perfect” problem, as well. The struggle many midlife women have over gaining a few pounds during the menopause transition can become quite intense; resulting in restrictive eating, diet cycling, disordered eating and excessive, compulsive exercise…if not a pathological eating disorder.

“The perfect problem,” according to Margo Maine, PhD, in her book Pursuing Perfection: Eating Disorders, Body Myths and Women at Midlife and Beyond, “promotes the myth that we can find life’s meaning and the answer to every challenge in the shape of our bodies.” Dr. Maine’s book eloquently points out that midlife women are not immune to the cultural pressure to attain a perfect body and may mistakenly underestimate the power of dabbling in pathological behaviors like these. She challenges the reader to many questions, but this one stood out to me:

“When was the last time we were part of an all-woman conversation where no one brought up weight, food, or personal appearance?”

Okay, time out. I’m a born and raised perfectionist, so I’m not here to throw any stones. In fact, my perfectionism has been a gift in many ways – pushing me to academic achievement, career success, and fiscal and financial stability. But, sadly it also got me into a lot of trouble (a prison as Dr. Maine refers to in her book), especially in my 20’s and 30’s as I sought out to have the perfect body, house…you know the list. I was desperate. Desperate to fit in at a time when I didn’t really know who I was. Without going into the gory details, the point is that no matter how hard I tried, it never felt “good enough”.  Someone else always had “it” better. Let’s just say my 30’s didn’t end well.

I’ve come a long way since those days (with a lot of hard work, therapy, faith, and good family and friends), thus the reason I am passionate about helping women of all ages feel confident and at peace with food, exercise and weight – no matter what their size. I want women to know it’s okay to age imperfectly! You are not your body. Wrinkles are normal. Skin will sag. Fat prefers to be stored in the belly after menopause… and, this: “There is no greater power in the world today than the zest of a postmenopausal woman.” ~ Margaret Mead.

So, do we just need to surrender to mediocrity?  Absolutely NOT!

Don’t get me wrong. I want to age as healthfully and gracefully as I can. I want to be strong, energetic and healthy enough to bike the country, travel the world, and chase grandchildren around. The difference is that the pursuit of health is different that the pursuit of perfection. Getting sucked into following the latest trends with food, exercise, skincare, surgery, etc. actually contributes to more stress and anxiety. There will always be something better. Something more “right” and the cycle just continues. Ultimately, none of these behaviors will help you achieve those important life-long goals.

So, the point is this: Do we need to give in to the multi-billion dollar diet, supplement and cosmetic industries – who are working hard to convince women we aren’t good enough the way we are, by the way – to be happy?

No, we don’t! But, what can we do?

Most people I know and work with want to feel in control. Life often feels out of control, so, it’s helpful to know what we CAN control and know it  will make a difference. Spoiler alert: The following list is not “sexy.” You’ve probably heard all this before. But, here’s the deal. These behaviors DO matter. When done consistently, you can be and feel strong, healthy, confident and energetic.

Stay active. Find things you enjoy doing and participate in those activities daily – hiking, gardening, biking, running, golfing, playing volleyball, and lifting something heavier than a soup can!

Cook at home. As we get older, have more money or even more time, eating out can become an all-too-frequent pastime. Change it up. Invite your friends over, explore new recipes, cook with new foods, or just learn to cook if you need to. We know that eating more nutrient dense (versus calorie dense foods) provides more vitamins, minerals, antioxidants, etc. and helps with weight management and overall health. Eating at home provides more control over what you are eating – saves money and can be a lot of fun too!

Eat more fruits and vegetables. I know this point may sound cliche, but the reality is that over 80% of Americans do NOT get the recommended five servings a day of fruits and vegetables, while 60 to 75% of Americans eat more than the recommended servings of grains and protein. So, it wouldn’t hurt to work on eating more of these wholesome nutrient dense foods which will naturally replace over-consumption of other foods. (What We Eat in America, NHANES 2007-2010.)

Eliminate restrictive eating and diet cycling. I can’t say enough about this. But whether intentional or unintentional, restrictive eating sends a powerful message to the body to become very efficient with metabolic processes; use less energy; and, store more fat to protect the body from a state of famine. Thus, although weight loss may happen initially, anything you can’t sustain will backfire with weight regain and likely even more weight stored as fat – in the abdomen! Thus the feeling midlife women have that “their old tricks don’t work anymore.”

Drink less alcohol. Any of the reported benefits associated with alcohol intake are based on drinking in moderation or less than one serving of wine or beer per day and less than three servings at a time. Research demonstrates that women who drink heavily are more prone to central obesity while increasing the risk of breast cancer and cardiovascular disease. Additionally, women at menopause are especially vulnerable to depression, and heavy drinking can just make that worse.

Get good quality sleep. This can be tough for midlife women experiencing shifting hormones that may interfere with sleep. Maintaining a regular bedtime routine and practicing good sleep hygiene (i.e. turn off electronics one hour before bed) may be helpful.

And, let us not forget:

• Don’t smoke – ever. Enough said.
• Brush and floss your teeth regularly.
• Wear sunscreen daily

There is a strong psychological association between taking important steps to take care of yourself and improving body image. For many women, just a week of eating well and regular exercise promotes positive thoughts about their body – even if they didn’t lose weight. There are many reasons for this, but the challenge is to remember that behavior change takes time. Getting support from friends or even a professional, such as a Licensed Psychologist or Registered Dietitian, may be critical to declaring your freedom.

You have a “right” to life, liberty and the pursuit of happiness. Don’t let the “prison of perfection” take that away!

“Evidence-Based” Diets: Sound Science or Practically Impractical

True or False: Popular Diets (such as Paleo, Atkins/Low carb, and Intermittent Fasting) are all based on evidence-based research.

The answer is TRUE!  There really is some interesting research that demonstrates how each of these nutrition interventions can result in weight loss, fat loss and even improved health and cognitive functioning.

But, does that mean these diets should get a “seal of approval” as an appropriate intervention for weight loss or achieving optimal health?  Let’s chat about that…

Recently I watched a TED Talk by the Chief of the Laboratory of Neuroscience at the National Institute on Aging, Mark Mattson. He is also a professor of Neuroscience at The Johns Hopkins University and a leading researcher in understanding the mechanisms behind neurogenerative disorders, such as Parkinson’s and Alzheimer’s disease. Mark and his team from John Hopkins have published several papers that discuss how fasting twice a week could lower the risk of developing these types of neurogenerative diseases.

Pretty impressive, right? I mean that’s a big deal!

Then, there’s The Paleo diet, based on years of research conducted by Loren Cordain, PhD who bases his nutrition recommendations on the premise that there are some fundamental characteristics of our hunter-gatherer ancestors that will “optimize your health, minimize your risk of chronic disease and lose weight.”

I’ve also been learning more about the research behind Intermittent or Alternate Day Fasting (restricting intake to no more than 500 calories every other day) and the significant effect it can have on weight loss and other markers of health. Some of the most notable work on this approach has been done by research from the University of Illinois in Chicago.   And, of course documented in the popular book, The Every-Other-Day Diet: The Diet That Lets You Eat All You Want (Half the Time) and Keep the Weight Off.

What a great idea! Pretty much every individual I work with – midlife female, recreational or competitive athlete, professional dancer, or disordered eater – would like to optimize their health, lower their risk of chronic disease, most desire to lose weight, and would prefer the option of being able to “eat all you want” – even if it is only half the time.

And, of course, there’s all the latest research coming from the labs of Dr. Stephen Phinney, MD, PhD and Dr. Jeff Volek, PhD, RD about the “Art and Science of Low Carb Diets.”

Well, if you know me, you know that I LOVE science and am fascinated by research. I’m constantly digging into the latest literature in popular scientific journals or looking up supporting research on Pubmed about various topics in nutrition and beyond.

My question is always, “Why?”…Why do things work the way they do? Why are midlife women gaining weight when seemingly nothing else has changed? Why do some athletes perform better than others? Why doesn’t energy in = energy out for most of my clients?

Ultimately, I want to know: “What’s the best solution to the problem?” and “What will be the most effective nutrition intervention for my client?”  

So inherently research should be able to give us the answer – right?  Well, not entirely. Yes, we learn a lot from this research and the science can be extremely fascinating, but there are a number of problems with these diets that potentially cause more problems than what the dieter started with.

The use of evidence based medicine is important in any clinical practice – including nutrition. However, after working with 100’s of individuals who have gained and lost hundreds of pounds from these “evidence based” diets; who often know enough about nutrition to have a degree themselves; and who ultimately continue to struggle with food, eating and weight, I’ve learned that clinical judgement and practical application are critical to an appropriate and effective nutrition recommendation.

And, as obvious as that may seem, it’s very interesting how often folks (including well-meaning researchers and providers) get enthralled with the “science” and seem to miss asking an important question of “how will this recommendation work out in the long run for this individual?” and ultimately whether the application of this “science” is even practical.

Remember:  Clinical judgement is something you don’t learn in school, from an online course, or from reading Pubmed articles. It is something you learn in practice!

In fact, we are reminded in an editorial about Evidence Based Medicine: What it is and What it Isn’t, that “Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.”  In other words, it’s important that researchers and clinicians work together to develop realistic, practical and do-able approaches to health and well-being.

As an illustration of this point, let’s take a look at just 5 reasons why it might be “practically impractical” to use an intervention like Intermittent or Alternate Day Fasting.

Problem #1:  This is not normal eating. Rigid diets that rely on counting and restricting calories is just plain and simple disordered eating. At the very least, the majority of dieters will not be able to sustain this plan for the rest of their life (ultimately sustainability is important, right?). Many will likely suffer guilt and shame when they go over their 500-calorie limit; and consequently continue the cycle of dieting that, research has demonstrated, leads to even more weight gain, depression and a worsened health condition. There’s a lot more we could say about this point, but hopefully you get the gist.

Problem #2: How do you sustain your mental stamina, focus and not suffer from dizziness on a 500-calorie day?  The researchers state that your body “gets used to it” and you aren’t hungry on the fasting days. In a study published in the Journal of Nutrition looking at the  effect of alternate day fasting (ADF) on disordered eating behaviors, researchers noted that “Subjects undergoing ADF experienced mild gastrointestinal issues, occasional problems with staying asleep, and minor dizziness/weakness.” Bad breath seemed to be the most annoying symptom to which it was recommended for dieters to chew sugar-free gum in between meals. It’s also important to note that 20% of the study subjects dropped over the course of the 8-week study.

I just want to stop for a moment and remind the reader that tax payer dollars from the National Institute of Health are funding much of this research as an effort to “improve our health.”

Problem #3: How can an individual participate in stress-relieving, mood-stabilizing exercise on a regular basis, especially on a 500-calorie day? Researchers have a recommendation for that too. They suggest that the dieter get exercise or activity out of the way in the morning on the fasting days. What if you are an afternoon or evening exerciser – because of work, responsibilities, or that’s just what you prefer? Also, I’m a pretty active person who enjoys my exercise in the morning, but then I might also work in the yard for a few hours after lunch or I stay active running from appointment to appointment. It’s not an option for me to just “plop” for the rest of the day – nor do I want to or recommend as a solution!

Problem #4:  How does the dieter manage social events on the 500-calorie day? I’m guessing that if you tried to implement this plan consistently; at one time or another, you are going to have an event with food like a grad party, wedding, birthday party, work event, gala, etc on the calorie-restricted day. Are you just supposed to abstain from eating at these events? If the answer is yes, that’s unfortunate. And, if you decide to throw in an exception here or there, how’s that going to work in the long run? I know for most of my clients who are trying to make behavior change, not learning how to navigate these kind of events is many times the reason for sliding into old behaviors.

Problem #5: Eating doesn’t need to be this difficult. In a small, non-scientific survey I completed with a number of individuals of various ages, not one person thought they could (or would want to) implement this diet consistently. A common response was that it “sounded like a lot to think about” and they “weren’t sure they could keep the days that organized”.  I have plenty of clients who are just fine with the feeling of control they get from counting calories, but even these folks admit it’s distracting and a very compulsive and obsessive behavior, and frankly would rather not to have all those numbers in their head.

I’m completely aware that there is always the possibility that none of these scenarios would pose a “problem” for you. If that’s the case, and this sounds like a useful approach for managing food, eating and weight, then it may certainly be an option.

Ultimately, the decision about what nutrition intervention would be best for an individual hoping to lose weight, optimize their health and decrease their risk of chronic disease needs to be a collaborative effort between the health care provider and patient.

Being fascinated by science is a cool thing. And, providing sound, evidence-based nutrition recommendations is an important principle in any practice. But, science alone should NOT become a replacement for critical thinking and experienced clinical judgment about what is appropriate for each and every individual client or patient.

Fighting Midlife Weight Gain

Midlife weight gain is common, but is it inevitable? The complaint I often hear from women goes something like this:

“I never used to struggle with my weight. I’m active and eat well, but since I turned 40, the weight just won’t stay off like it used to.”

For the health-conscious individual, this can feel extremely frustrating. In addition to battling challenges with negative body image, concerns with overall health related to increasing waistlines become overwhelming for women in their 40’s and beyond.

Why do women experience midlife weight gain?

A common misunderstanding is that hormones are to blame for midlife weight gain. Although the menopause-related shift in hormones contributes to the problem, lifestyle and aging play a significant role. As women age, there is a gradual loss of muscle mass or lean tissue, which is more metabolically active. Behavioral factors such as stress and the tendency to move less, sleep less, and increase alcohol and food intake also change as women reach midlife.

“But, why am I gaining all this belly fat?” Numerous studies demonstrate that the change in hormones during the menopause transition is associated with an increase in body fat and more specifically an increase in abdominal or visceral fat. This type of fat is a concern as it is related to several adverse health problems, including cardiovascular disease, diabetes and some cancers, including breast cancer. Visceral fat also contributes to increased inflammation in the body potentially resulting in insulin resistance and further weight gain. Coincidentally, dieting or restrictive eating (at any age) has also been shown to contribute to an accumulation of abdominal fat upon weight re-gain. Therefore, midlife weight gain becomes “a perfect storm” of sorts with the convergence of behavioral factors, aging, and shifting hormones.

What can women do to counteract unwanted weight gain?

Prevention is the key! Minimizing fat gain and maintaining muscle by getting back to the basics of healthy eating and regular exercise are essential for attenuating midlife weight gain. So, do we need to just “eat less and exercise more”?

1. Eat Wisely. Many of the female athletes I work with don’t eat enough to begin with and their body has consequently “learned” to become very efficient with the low amount of calories eaten. Others fill up on easily-digestible, processed foods (including energy bars or highly processed powders and supplements) and wonder why they can’t lose weight with such a low intake. And others struggle with the cycle of “diet at breakfast, diet at lunch and blow it the rest of the day.” So, the message: “eat less” is often misunderstood.  Instead, focus on eating wisely. It has been shown that women who were successful with weight loss and weight management goals used food journals, ate out less, and ate at regular intervals during the day.  Also, eat more nutrient-dense foods, including fruits, vegetables, whole grains, lean meat, fish, beans, yogurt, nuts, seeds, avocados, olives and olive oil.

2. Regular exercise. For the sedentary individual, the message to “move more” may be helpful. In fact, physical activity has been shown to be the single most important factor in preventing age-related weight gain. But, for the active woman, what does this really mean? Too often, I see women running, biking, accumulating “steps” and interpret this message as “just run more, bike more, and accumulate more steps” yet still struggle with weight. While there may be benefits to doing more (for training purposes) adding in a variety of activity, most notably resistance and strength training exercise, is critical for slowing the loss of lean tissue and preventing weight gain.

Midlife weight gain is complex and not easily explained by the effect of one thing, such as hormones. This is an ideal time for women to reassess their health and weight management goals with the support of a qualified medical provider or dietitian. Women can find many helpful resources and certified practitioners on the North American Menopause Society (NAMS) website at www.menopause.org.