S03E45 WHY IS WEIGHT LOSS HARDER FOR WOMEN IN MIDLIFE?

You are a woman who never had weight issues before. Suddenly you hit your 40s and that weight creep becomes relentless even though you haven't changed anything. The struggle is real. A recent Wall Street Journal article discusses why the midlife weight management can be harder for women than men. What can be done about it?

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S03E45 WHY IS WEIGHT LOSS HARDER FOR WOMEN IN MIDLIFE?

Sam Rhee: [00:00:00] Do you know any women over the age of 40 who tell you that managing their weight is a struggle and that it's only gotten worse as time passes? And if they even look at a chocolate bar, they feel heavier? I know a lot of women who have said these things to me.

Definitely my friends, athletes that coach at the gym, and my patients in my plastic surgery practice. So let's talk about weight management for those over 40, specifically women. This podcast episode will probably make a lot of women shake their heads and sigh saying, are you kidding me? As if life wasn't hard enough?

So based on a Wall Street Journal article last week by Sumatha Reddy titled, "Weight Loss Really is Harder for Women in Midlife," the heavy sighs and the head shaking is justified. But let's also talk about fighting the good fight today and how to win the Battle of the Bulge.

(Wow, what an old cliche. Does anyone even know what that reference means anymore?)

As a woman, you may already know or be living the fact that on average weight increases for both men and [00:01:00] women after the age of 40 due to slowing of metabolism. But for women, the transition due to menopause makes it more difficult for women to manage their weight.

The Wall Street Journal article suggests women gain an average of six pounds due to hormonal changes when the menopause transition occurs, as the menstrual cycle becomes more irregular.

So why do these hormonal changes cause weight gain? The primary reason is a decrease in estrogen. And this decrease in estrogen not only causes weight gain, but it changes where the fat accumulates. So the weight gain during this time is more in the abdominal region and less in the hips and thigh regions.

Abdominal obesity is linked to increased medical problems versus fat in other parts of the body. The reasons why a decrease in estrogen causes weight gain is multifactorial. Some of it is related to an increase in insulin resistance, which means the body has to produce more insulin to regulate blood sugar levels.

There's even evidence that estrogen levels can possibly influence women's [00:02:00] motivation to exercise. In one study, patients who are on an ovarian hormone suppressing medication, had their exercise activity measured, then the patients who received estrogen back into their system increased their levels of exercise.

In studies of women who are 44 to 58 years old, who are either premenopausal, perimenopausal, or postmenopausal, the premenopausal women had lower blood pressures, lower cholesterol levels, and decreased inflammation markers compared to the perimenopausal or postmenopausal women of the same age.

Okay, based on what's out there on research studies, if we accept that some of these midlife changes for women, including potential weight gain, can be caused in part by the transition to menopause, is estrogen therapy, really the solution?

Well, maybe. Hormone therapy, usually estrogen and progesterone similar to, but lower doses than birth control pills can help. Many patients who experience other perimenopausal symptoms such as hot flashes, insomnia, [00:03:00] mood swings, brain fog, they find that hormone therapy can be helpful.

Maybe estrogen replacement does reverse some of the fat distribution issues we mentioned, but hormone therapy does carry some risk as well, especially for those at risk for breast cancer or cardiovascular disease. So consult with your physician to see if hormone therapy is right for you.

(Yeah, that sounded like a drug commercial.)

But what else can women do to help manage their weight in the face of menopausal transition? Well, I got two, actually three solutions. The first one from Big Pharma, one I offer as a plastic surgeon, and the third solution that I offer as a CrossFit coach.

The Big Pharma solution, which I talked about on a previous podcast episode: newer weight loss drugs such as Ozempic remain to be seen, but are looking very popular these days. For now. It's expensive. Long-term studies are absent, but boy is it popular. Let's call this one solution To Be Determined.

The plastic surgeon in me also knows that cosmetic surgery, such [00:04:00] as liposuction or tummy tuck, will obviously help patients look better. Often, fairly dramatically in very short order as well. But clearly cosmetic surgery does nothing for a patient's health or continued weight gain.

It's not to say that surgery should never be done, but for long-term health, I don't think anyone should honestly offer drugs or surgery as solutions by themselves. The third solution the Wall Street Journal article suggests is that patients recommend staying active, engaging in high intensity interval training or HIIT, and adding strength training to their workouts.

And the CrossFit coach in me thinks you could have just saved a lot of time and just written CrossFit. Because that's exactly what CrossFit is. And I suppose other exercise methodologies out there like Orange Theory or F 45, if I want to be non-denominational.

And if you go to any CrossFit gym, including mine, you will see many women athletes in their forties and fifties who are exactly doing this. There's no doubt in my mind that the benefits of this type of exercise can be tremendous. And in [00:05:00] addition, actually, the highest performing competitive athletes at my gym are women in their forties and fifties.

So while there are those that are just looking to fight midlife weight gain, there are also those athletes who are performing at their peak at this age as well. The only issue I have with the Wall Street Journal article is that they suggest a minimum of 150 minutes of exercise a week and recommend more like 300 to 420 minutes.

Now if you've done CrossFit, the average workout is like 15 to 20 minutes. So the recommended 300 to 420 minutes of exercise would be like 15 to 20 CrossFit classes a week, which would be absolutely insane. I don't know anyone who even does seven CrossFit workouts a week regularly. So other than the recommended exercise amount, which is total BS, the Wall Street article is actually pretty good.

Just to finish things off, they also briefly mentioned dietary changes can be helpful. This is actually way more important than the brief mention that the article makes, but we ought to save that for a future episode.

One of the most entertaining things about the article are the comments [00:06:00] made by the readers at the end. They fall into two general categories. One, guys saying, "Hey, this happens to men too, and the solution is so obvious. Exercise more and eat less. I lost 20 pounds by eating less pasta, drinking less beer, and working out. Stop eating those apple fritters."

And two, women saying, "Hello, did you undergo menopause? Why are guys even commenting in an article about menopause? Stop mansplaining and shut up. The title of the article is "Weight Loss Really is Harder for Women in Midlife."

So, at the risk that this whole thing was mansplaining, thanks for listening. If you have comments or thoughts about midlife weight gain and have actually gone through or experiencing the menopausal transition, I'd love to hear your comments or thoughts.

DM me @BotoxAndBurpeesPodcast on Instagram. And if you're a guy and have an easy and simple solution to weight gain, no need to reach out. Thanks again.