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Weight gain won't budge after menopause? Study offers diet strategies

Courtesy of Robin Herman

Robin Herman, 60, says it's harder to keep weight off after menopause. But some simple, subtle changes may help.

Robin Herman has always been slender. She eats right, exercises regularly and keeps an eye on her weight. But middle age and menopause have hit her right in the waistband, and she’s frustrated.

“What is this? I used to be able to look straight down at my feet and now there’s this rounded tummy in the way,” Herman says. While she’s still not overweight, Herman, 60, has gained 11 pounds that she just can’t seem to shake. Her problem illustrates what many women are finding in mid-life -- they are putting on pounds despite their best efforts.

“At first I cut back about a quarter of what I was eating. And then I was just eating about half of what I had been eating. Now I don’t take seconds. I don’t eat a lot of bread. I don’t eat potatoes. I don’t eat empty calories. I don’t drink sodas,” said Herman, who recently retired from the Harvard School of Public Health in Boston.

She joined Weight Watchers, a program that’s been clinically proven to work in helping people lose weight. “I kept a food diary. You could eat as many fruits and vegetables as you wanted. I put in a little more exercise,” she says.

“I got nowhere. It just wasn’t doing anything. And it was making me crazy about following every spoonful I ate.”

Herman sounds like thousands of women across the country who are slowly tipping over the point from being normal weight to overweight, or from being overweight to obese. A study published on Tuesday sheds a little light on what may work and why some approaches that help women shed a few pounds in the short term aren’t helping them keep the weight off long-term.

Bethany Barone Gibbs of the University of Pittsburgh Medical Center and colleagues analyzed data from a study of more than 500 overweight women in their 50s and 60s to see what made a difference. They had been randomly assigned to either intensive nutritional and exercise counseling, or to a more general, less weight-loss-focused program. The woman also reported what and where they ate, for four years.

As expected, more of the women who got specific diet and nutrition counseling lost weight. But Gibbs and colleagues wanted to know what worked for any of the women who managed to lose weight, regardless of which group they were in.

Early on, some of the more obvious diet strategies worked -- eating less fried food, staying away from restaurants, avoiding sweets and eating more fish. But these approaches didn’t work for the women in the long term, Gibbs reported in the Journal of the Academy of Nutrition and Dietetics.

 “What we found at four years is that the women who changed their eating behaviors to eat more fruits and vegetables, who ate less desserts, less sugar-sweetened beverages and less meats and cheeses were more likely to have greater weight loss or less weight gain long term,” says Gibbs, an assistant professor in the Department of Health and Physical Activity.

“But on the other hand, something like eating more fruits and vegetables did not predict weight change at six months but was one of the most important predictors for long-term weight change.”

Avoiding restaurants didn’t seem to make a difference long-term, either, she said. Gibbs said the key to keeping weight off long-term may be a little counter-intuitive. “Short term, people are still motivated when they start a weight loss program,” she said. “They are never going to eat another French fry, eat another piece of pie, so you see the pounds coming off.”

But hardly anyone can keep this kind of abstinent behavior up forever. The women who added fruits and vegetable to their diets, using them to replace higher-calorie meats and cheeses, lost more weight over the long-term. “That small change can give you a big, long-term result,” Gibbs said.

How could something so subtle work better than going for the big effect? In part, it’s because weight gain is often subtle and sneaky, too, says Katherine Tallmadge, a personalized nutrition counselor and speaker and immediate past president of the DC Metro Area Dietetic Association. “When people gain weight, it’s usually a pound or a pound and a half a year,” she says. “It is a very small and creeping kind of weight gain.”

The study also illustrates what many middle-aged women complain about. “I recall at age 25 if I wanted to lose five pounds I could do it in a week.  Now, it takes far longer to lose weight,” says Karen Giblin, president of menopause support organization Red Hot Mamas North America, Inc.   

This doesn’t surprise Dr . Domenica Rubino, an endocrinologist who runs the Washington Center for Weight Management and Research. “As we age, the average person has a tendency to gain weight and to gain more fat than muscle,” Rubino says. On top of this, women are undergoing hormonal changes that can disrupt sleep, stress them out and make them tired, three things also associated with weight gain. “Women are getting early morning awakening  and even though they are exhausted, they are not getting back to sleep,” she says.

Giblin can vouch for what happens next. “My willpower goes down the tube when I'm stressed and I will not do all the good things I should do be doing like eating properly and exercising,” Giblin says.

It all can add up to the muffin top effect: that shift of weight to the abdomen that makes clothes fit poorly, if at all, and that stresses out a woman every time she gets dressed.

“It’s so hard counting calories and keeping food diaries for years and years and years,” Gibbs agreed. “We have a population-sized problem here.” With two-thirds of Americans overweight or obese, she says, people need some simple solutions.  

“I've had to make exercise a lifestyle choice,” says Giblin, who co-authored "Eat to Defeat Menopause" with Dr. Mache Seibel last year. “Never skip a meal,” she advises. “And if you are prone to snacking, grab a piece of fruit or six  to eight almonds.”

Rubino says hormone replacement therapy can help, too, if it helps cut hot flashes and anxiety. “You are sleeping better and not having the hot flashes and your mood is better,” she says.

STOP Obesity Alliance Director Dr. Scott Kahan says managing stress can really help people control weight. “If things are very stressful, things are going on in your life, often stress management techniques can help,” he says.

Kahan and others admit this can be easier said than done. “I think we live in a very difficult time, a toxically busy world,” Tallmadge says. “What really upsets me is when people call themselves lazy or undisciplined when in fact they are running themselves ragged.”

But it’s not exercise.  Many women are busy getting their families ready for the day and then commuting during the very morning hours when they would have been otherwise most likely to exercise.

“It’s a real balancing act.”

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