It’s no secret that menopause
seems to cause weight gain, particularly belly fat, or that in general it can be an unpleasant experience for many, if not most or all women. As someone of the male gender, I won’t pretend I can empathize with what it’s like… but my dear clients have sent me on a mission to research and learn about what the clinical evidence says on the relationship between your weight (and body fat) and all stages of menopause.
I will do my best toobjectively provide the clinical answers to the following questions:
1. What does weight gain have to do with menopause?
2. Does menopause directly cause weight gain?
3. Why do women seem to get “fatter” on menopause, independent ofweight gain?
4. How does a woman’s weight affect her risks, experiences, andsymptoms during menopause?
5. What should you take away from this data?
I found sources that report as much as 90% of menopausal women gain weight [1]. This type of association would immediately make anyone think that the end of a woman’s reproductive period, in some way, causes weight gain. But I like to dig deeper...
Eric T. Poehlman and his team from the Department of Medicine, at the University of Vermont, conducted an analysis of 183 healthy females aged 18 – 81. Among the ages, they tested for differences in Resting Metabolic Rate (RMR), differences in: Fat-Free Weight (FFW), Maximum Oxygen Consumption (VO2 Max), Thyroid Hormone T3, physical activity, and dietary protein intake. The results were published to the American Journal of Physiology in March of 1993.
All measurements declined with age. The decline in metabolism (RMR) was most strongly associated with the decline of FFW. It was also very well associated with a decline in total T3, but the authors make it clear that they believe the decline in RMR was mostly due to the decline in FFW, based on previous studies they have conducted, and well, because we all know how strong the connection is between muscle mass and metabolism is… I hope.
Ultimately, as women age, the decline of RMR is connected to the decline of FFW, which is caused by the decline of physical activity and overall protein intake [2].
More recently, Professor S.R. Davis and her team, together known as the Writing Group of the International Menopause Society, did an extensive search and analysis in the Medline/Pubmed database (1946 – present) for all literature relating to menopause, estrogen, weight gain, obesity, and everything in between.
I’ll be referring back to this publication to answer some of the other questions we have, but it is currently important to note that they have found no evidence that weight gain is directly caused by the transition into menopause, or menopause itself. The only “causal” connection they were able to make is menopause could lead to weight gain through the increased likelihood of depression, since people tend to eat more when they are depressed. They admit, however, that this connection is weak at best, especially because being overweight in the first place would cause low self-esteem and stress/depression, independent of menopause [3, 4].
Data from calorie-controlled studies are clear.
Published in 2003, to the Annals of Behavioral Medicine, are the results of a 5-year randomized clinical trial by Simkin-Silverman LR, et al. 535 healthy premenopausal women were randomized to either a “observation only” group, or a calorie-reduced diet and physical activity intervention group. After 54 months, while transitioning into menopause, the intervention group of women either lost weight or remained the same, and experienced a decrease in waist circumference, while the control “observation” group gained weight [5, 26].
Al-Zadjali M et al. did a search among all publications that can be found in online databases up until the end of 2009, to analyze certain controlled intervention trials in post-menopausal women, and published their findings in 2010. What kind of intervention trials? Only ones that had the participants on a calorie-reduced diet and included increased physical activity, compared to some type of control group of participants. 15 trials were found, and all 15 of them resulted in either a favorable weight management outcome, including but not limited to a decrease in fat mass, waist circumference, and blood profiles [6].
The Department of Nutrition, together with the Department of Kinesiology, from the University of Montreal, put this question to the test between 2003 and 2006, and their results were published a handful of times in the years following. 137 overweight and obese post-menopausal women were divided into a calorie restriction group, or a combined calorie restriction + strength training group. Both groups resulted in significant weight loss. The group that included strength training resulted in a greater loss of body fat, and better overall body composition [7, 8, 9].
Dr. Lewis Kuller, MD, DrPH, arrived at the University of Pittsburgh in 1972, published hundreds of articles, and has spent a huge chunk of his career studying women going through menopause. He played a leadership role in the previously referenced trial published to the Annals of Behavioral Medicine. Some of the most recent publications from him and his team are about a controlled trial conducted last decade, studying the impact of physical activity and nutrition counseling on overweight and obese post-menopausal women.
The various publications of this study give slightly different numbers, mainly due to certain external factors influencing the lifetime of the study (funding mainly), but 508 participants were randomized into either a Lifestyle Change group, or a simple Health Education group. The Lifestyle Change group used simple dieting techniques to produce an ambiguous calorie deficit, like eating out less, targeting more fruits and vegetables, less sugar sweetened beverages, etc. Follow-ups continued for years, and measurements were taken throughout the time.
Although there are serious limitations to this study, it is still easily conclusive that weight loss is 100% probable, for post-menopausal women, as long as a calorie deficit is produced [10, 11, 12].
The data is quite clear that menopause has no direct causal relationship to gaining weight. The weight gain is caused by poor eating habits and lack of physical activity.
However, women are clearly noticing that their weight gain is concentrated towards their stomach area. That is because it has been confirmed using multiple assessment techniques, including Dual X-ray Absorptiometry, that menopause causes body-fat accumulation to be favored in the stomach region [13, 14, 3].
The explanation for this is that the reduced estrogen changes how fat is metabolized for women, and hormone replacement therapy seems to minimize this effect [14, 15].
First and foremost, allow me to make it clear that in all studies referenced here that resulted in weight loss for the women in pre/peri/post-menopause, also resulted in significant improvements to blood profiles (risk factors), including but not limited to: triglycerides, fasting insulin, glucose disposal, HDL/LDL (total and ratio), blood estrogen and other hormonal levels, and other markers of inflammation.
Significant reductions in stress and increased body/self-esteem have been observed in post-menopausal overweight/obese women that have lost weight [9, 3]. Sexual dysfunction is common among overweight/obese post-menopausal women, while weight loss improves these symptoms [3].
In a 12-month controlled trial looking to examine depression, stress, anxiety, and social support, 439 overweight or obese post-menopausal women were randomly assigned to a dietary weight loss group, a moderate-to-vigorous aerobic exercise group, a combined diet + exercise group, or a control group. Great results were observed in the combined diet and exercise group, while the exercise only group did not have any significant results. It is also uniquely noted that weight loss, regardless of which group the participant was in, was associated with the improvements in psychosocial factors [16]. Two other similar studies had the same findings [17, 18].
Peri/Post-Menopausal women of normal weight have considerably less symptoms (and of course risk factors), than those of a higher weight. In fact – losing weight is strongly associated with a reduction of such symptoms, besides the psychosocial ones noted above. This is thought to be largely due to the much improved metabolic profile of women with normal weight, or women that experience weight loss [3].
Unfortunately, being overweight does not have favorable effects on the timing of menopause. Studies to date show that higher adult body-mass-index is associated with a significantly earlier transition from pre to peri-menopause. What is even more unfortunate is that the period of peri-menopause has also been observed to last significantly longer in overweight or obese women [19, 20, 21].
While it is true that menopause is ultimately associated with reduced estrogen, is also well-established that post-menopausal risk for breast cancer is significantly higher in overweight/obese women, due to higher-than-normal blood concentrations of estrogen, androgens, and other sex hormones.
In the previously referenced 12-month calorie-restricted study examining the effects of diet and exercise on psychosocial factors in overweight/obese menopausal women, the researchers also observed and published results relating to blood estrogens, and other hormonal concentrations. What they found was that the weight loss resulted in substantially lower blood estrogen and free testosterone [22, 23].
A different, but similar randomized trial, published 8 years earlier, had similar findings, however they observed that exercise resulted in better reduction for blood risk factors [24, 25]. In my opinion, although weight and body fat was measured, the design was not controlled for weight loss, and thus the results are a bit “off.” The more recent study shows how weight loss will result in a lesser risk for breast cancer, and other cancers, regardless of whether exercise is involved [22, 23].
Lastly, many other cancers, both exclusive to females and not, are much more likely in overweight post-menopausal women [23].
My research began with a simple mission: to determine if weight gain/loss was dependent on the various menopausal stages of a woman’s life. I will admit I hypothesized that it was not, because… well… calories in – calories out… always!
What I did not expect to find, however, is how strongly related menopause and weight status are, in terms of symptoms and overall risk factors. Wow… I thought I was in for a quick and easy article.
Nevertheless, for those of you that don’t want to spend 10 minutes reading what took me HOURS to research and put together… here are the highlights:
Bottom line: eat less and move more! I have already established on many occasions that even a little bit of excess body-fat around the midsection is extremely problematic.
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