"Middle-age spread" isn't just a humorous term. Many menopausal women associate this life phase with a widening midriff. What should you know?

Menopause can be a challenging time: many women struggle with symptoms such as hot flushes and night sweats, and the question regarding the use of hormone therapy can be a challenging one. In addition, menopause is often associated with a change in body shape.

If you’re heading for menopause, or already there, you may be wondering how to keep your weight in check. We checked in with a couple of experts and did the legwork for you.

Hormones, weight gain and abdominal fat
Women often assume that they’ll gain weight during menopause, but this, thank goodness, isn’t necessarily true: research shows that menopause may lead to a change in fat distribution, but actual  weight gain and overweight or obesity may be linked to other factors.

"We still don’t fully understand why some people are obese and others are not," says Prof Tess van der Merwe, President of the South African Society for Obesity and Metabolism and Director: Bariatric Centers of Excellence in South Africa. “We do know, however, that being overweight or obese is associated with a range of conditions including depression, hypertension, cardiovascular disease and diabetes.”

According to the Australian Institute of Health and Welfare, the highest obesity rate for women in 2007-08 was in the 55-64 year age group (33.2%). So, Australian women seem to gain weight as they reach their 50's and 60's – a phenomenon that echoes overweight and obesity trends in many other countries.

Menopause may seem like the obvious culprit, but scientists at the Biomedical Research Center in Columbia in the US say they also don’t yet have all the answers for increasing obesity in menopausal women.

One theory is that the absence of oestrogens may be an important obesity-triggering factor, as the factors that control fat distribution in humans are partially determined by sex-hormone concentrations. "The hormonal changes are associated with a change in the way fat is distributed, leading to more abdominal fat," says the International Menopause Society (IMS).

A comprehensive scientific review by the IMS on weight gain at the time of menopause, published in the Climacteric journal in October 2012, considered the evidence on why women seem to gain weight around the menopause. They found that absolute weight gain is determined by non-hormonal factors, rather than the menopause itself.

“It’s a myth that the menopause causes a woman to gain weight,” asserts IMS review leader, Prof Susan Davis of Monash University in Australia. “Our key finding was that the way fat is deposited changes at the menopause,” she continues “Studies indicate that this is due to the drop in oestrogen levels.”

So, whether or not you gain weight at midlife, you’ll experience a shift in your fat stores to the abdomen after the menopause, according to Prof Davis and other experts.

Some have to work harder
Are you already overweight or obese, or heading that way?

Prof Van der Merwe notes that, if a woman has a genetic susceptibility towards obesity, she’ll have to work harder to lose weight in midlife.

This, unfortunately, isn’t always as simple as eating less and moving more. Obesity, says Prof Van der Merwe, is riddled with myths and misconceptions – one of which is that the same strategy can be used to treat all obese people.

"This is simply not true. For example, lifestyle interventions like diet and exercise work well for people with a BMI of between 25 and 30, while pharmacotherapy is far more effective in those with a BMI of between 27 and 35," she explains.

Body Mass Index (BMI) is the most widely-used method of measuring and identifying obesity, according to the World Obesity Federation, and refers to weight in kg/height in m2. Overweight or pre-obesity is defined as a BMI of 25-29.9kg/m2, while a BMI of >30kg/m2 defines obesity.

If you struggle with your weight, it’s important to get professional help – whether you’re nearing the menopause or already post-menopausal. With concerns raised in the IMS review that increased abdominal fat in postmenopausal women increases their risk of future metabolic disease such as diabetes and heart disease, it’s clear that maintaining a healthy weight, or losing weight, should be a  priority.

How to keep your weight in check
Prof Davis advises to start early to try and control your weight before it becomes a problem. “This entails being mindful of what you eat and being more active every day.”

If you’re menopausal and you want to lose weight, you must ensure you don’t consume more than 1600 calories (6720 kilojoules) per day, stresses Prof van der Merwe. She adds that being sedentary is also a huge problem in terms of obesity. “With most people, spending 90% of their day seated, sitting has become the new smoking.”

The World Health Organization (WHO) recommends doing 60 minutes of structured physical activity most days of the week. The best way to reduce abdominal fat, decrease body-fat percentage and increase muscle mass is to combine resistance training with aerobic (cardiovascular) exercise.

Consider joining a gym and asking a personal trainer to devise a proper exercise programme for you.

If you’ve just entered menopause and have weight problems, starting to take menopause hormone therapy (MHT) may help.

Both oral and transdermal oestrogen (with or without progestin) in women without diabetes increases lean body mass, reduces abdominal fat, improves insulin resistance, decreases the LDL/HDL cholesterol ratio and decreases blood pressure, according to a meta-analysis of over 100 randomised trials in menopausal women that analysed the effect of MHT on components of metabolic syndrome.

"Contrary to popular opinion, oestrogen therapy doesn’t cause women to put on weight," remarks Prof Davis in the Climacteric article. “There’s good evidence that MHT can prevent abdominal fat increasing after menopause.”

Speak to your gynaecologist or doctor who specialises in menopause about whether MHT would be right for you.

 

References:

- International Menopause Society. "Menopause does not cause weight gain, but increases belly fat, major review finds."  Science Daily, 16 October 2012. http://www.sciencedaily.com/releases/2012/10/121016084938.htm

- Fernando Lizcano et al. “Estrogen Deficiency and the Origin of Obesity during Menopause”.  Biomedical Research Center, Colombia. BioMed Research International, Volume 2014 (2014).

- Tess van der Merwe. “Excellence in Obesity Management”. Published by Bariatric Centers of  Excellence, South Africa.




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