I read Today's Dietician regularly. While I am not a dietician or nutritionist (nor do I pretend to be - I coach behavior change), I look to this publication for relevant information for myself and my clients. Their latest issue, "Injury Prevention & Recovery," obviously caught my eye because (HELLO) I'm in the deep, dark stage of early ACL surgery recovery. It did not disappoint. I learned all sorts of relevant information I'll be blogging about next week when I hit my one-month recovery milestone.
But I digress.
It did disappoint in its Ask the Expert section about Menopause and Nutrition. Firstly. They didn't ask an expert. They asked a nutritionist who has published many cookbooks and has often contributed to their publication but doesn't appear to have specific experience with treating menopausal clients. I'm sure she is an excellent professional and provides outstanding care -- I really don't want to sh*t on this person -- but when asked the question, "Does menopause cause weight gain?" This is what she said:
It's not body changes during perimenopause and menopause that lead to weight gain, but rather lifestyle changes that happen during this time. "...many women may be less physically active at this time of life, as their kids leave home and there's less running around to do." In addition, women may be eating out more often because they don't have to feed a family every night.
I'll just let that sink in for a moment. I won't comment why it's offensive and annoying because you already know why.
First off. It's true. TECHNICALLY menopause does not "cause" weight gain, as referenced here on the North American Menopause Society (NAMS) website. And yes, it is linked to lifestyle changes but also a slowing of metabolism that comes with aging. So. Here is my question, and if you're a specialist-type-person reading this and have the answer, I'd like to know: since menopause and aging (typically) happen concurrently, how can you say that one has nothing to do with the other and why does it f*cking matter -- either way, it's happening!!
Speaking from personal experience, I started battling weight gain (and a shift in body composition which I'll talk about here later) around 40. I am a child-free-by-choice human with a husband who has always done most of the cooking. I am and have always been a very active person doing Pilates, yoga, and cardio, and since I have lived in or commuted to New York City since 2005, I walk A LOT. Also - I've always been a "healthy" eater. When 40 rolled in, nothing had changed but my age and (in hindsight) a shift in hormones, but the number on the scale kept going up.
So, please. Tell me and thousands of other women with the same story that perimenopause or menopause has nothing to do with weight gain.
Now, to backtrack a little bit here - I do want to say that often "weight gain" gets conflated with a difference in the "distribution" of fat or a difference in body "composition." I say this because while people haven't put on pounds, they might have more visceral body fat, specifically around the belly and inner thighs. NAMS agrees that a shift in fat distribution is a thing due to a drop in estrogen. So. A client may complain that they are "getting fat" or "gaining weight" when in fact, they're experiencing a shift in body composition. However, some folks like me actually gained weight without any lifestyle change, for f*cks sake, so let's stop gaslighting people!
I'm sure these changes might be due to empty nests, but let's not forget that most women reach the HEIGHT of their careers in their 40s and are killing themselves with cardio, dieting, and everything else to keep fulfilling their obligations, so it's probably elevated cortisol! Not to mention that more and more women aren't having kids or ARE having kids later in life and might be getting pregnant during perimenopause and raising children into menopause! Feel free to unpack that mindf*ck at your leisure.
My point? There is a bigger picture here.
The body you had in your 20s is not the one you have in your 40s, which is not the one you'll have in your 60s. Each evolution of your body has different nutritional and physical requirements to keep that meat sack ticking along. In fact, from age 30, muscle mass decreases by around 3% to 8% per decade. This decrease accelerates after 60—more on the connection between a reduction in body mass (sarcopenia) and aging at Pubmed here.
What to do?
Come to an understanding that what's been working for you for YEARS no longer works for you now, and that is okay because it's NORMAL. So what does work? Whelp. Every body is different, so be prepared to experiment, but we know that eating enough protein is essential because the aging process tends to reduce the quantity and quality of our muscle mass (free protein calculator here). We also know that if you're not already doing some resistance training - whether it's Pilates or weight lifting or a combo of both, you need to get started with this YESTERDAY. What else? Sugar, gluten, dairy, and alcohol might be things you need to eliminate or dial back, among other inflammatory foods.
Furthermore, if you are a mid-life trans woman or trans man (I cannot stress this enough), working with a dietician well-versed in trans-care would be wise. This person can help you meet your changing nutritional needs while receiving gender-affirming care. We all need strong muscles and bones!
If you have the means, it's a great time to start building a team of healthcare professionals to support you, which might include an educated gynecologist or functional medicine doc that can prescribe the gold standard care of MHT (menopause hormone therapy - for cisgender women), a personal trainer, a dietician and you guessed it - a health coach like me.
In conclusion, I'm not interested in whether menopause directly affects weight gain, nor should you. Your experience is your experience, and it deserves validation. The cause is not important. What is important is what you do next. Think of it as a pivot in lifestyle. Coincidentally, our latest interview on Circling the Drain Podcast with Dr. Vonda Right is a goldmine of information on this subject. If she doesn't inspire you, something is seriously wrong with you. You can listen here if you like.
Preserve the body now so that you can prevail as you age!