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Time was when I never worried about my weight. If I ate too much Key lime pie for dessert, or scarfed down way too many slices of buttered bread, I didn't sweat it -- I simply added a mile on to my daily walk and steered clear of potato chips until the scale reverted to life as I knew it. Even after I gave birth, dropping a few extra calories a day over the course of several weeks was all it took to get back into my prepregnancy jeans. No more: The surefire weight-loss strategies of my 20s have become the not-very-effective weight-maintenance strategies of my 40s. And it's starting to dawn on me that if something doesn't change, I'll hit 50 weighing a good 10 pounds more than I weighed at 40.
I make this confession without shame because I know I'm not some middle-aged sloth who has "let herself go," to borrow a term from our mothers' begirdled generation. Sure, some of those extra pounds can be attributed to lifestyle changes in midlife, when most of us become more sedentary.
"At this age, it's a lot easier to pop into Starbucks for a scone than to pop out of bed in the morning and exercise," observes Pamela Peeke, MD, author of Fight Fat After Forty (Penguin, 2001). And these are certainly the years when a career in full swing can mean a lot of calorie-rich restaurant meals, and the stresses of dealing simultaneously with jobs, kids, and older parents can bring on binge eating or carb loading to soothe one's nerves. But these are secondary causes: The truth about midlife weight gain is that the main culprit is hormones.
Beginning typically at around age 40 -- though sometimes as early as 35 -- age-related hormonal changes predispose women to put on pounds even when they aren't increasing calories or decreasing physical activity, says Susan Lark, MD, author of 6 Secrets to Peak Health at 40+ (Lifeline, 2001). In younger women, menstrual-cycle hormones balance one another out: Estrogen facilitates the storage of body fat -- particularly in "female" areas such as breasts, thighs, and buttocks -- while progesterone helps maintain lean muscle, which promotes the burning of that extra fat once it's not needed to prepare for gestation.
In women over 40, however, that equilibrium begins to falter, says Dr. Lark. Estrogen is usually believed to drop off in midlife, but actually levels fluctuate, alternating between steep declines and sharp increases during perimenopause (the two- to eight-year period leading up to menopause). Yet even before their periods become irregular, perimenopausal women have cycles in which they do not ovulate. During these anovulatory cycles, there is a drop in progesterone. Thus, the balance between the two hormones is thrown out of kilter -- unfortunately in favor of fat storage.
Adding insult to injury, estrogen contributes to fluid retention, which means that during low-progesterone cycles it's not uncommon to carry around an extra two to five pounds of water weight, according to Dr. Lark. This goes away during normal cycles, but the number of anovulatory cycles increases with age. That means water weight sticks around longer and can be mistaken for fat.
Naturally, given the infinite wisdom of Mother Nature, there's a good biological reason for this fat-amassing propensity. Since estrogen is produced in fat cells as well as in the ovaries, the accumulation of fat during perimenopause may be nature's way of compensating for the oncoming loss of estrogen during menopause itself.
But estrogen is not solely to blame: The ovaries also produce testosterone, and fluctuations in this hormone before menopause can affect energy levels. So you're apt to exercise less, which leads to a reduction in lean muscle mass and a tendency to conserve fat. (Muscles burn calories even at rest.) In addition, a midlife decrease in the output of growth hormones slows the metabolism by about two percent a year, beginning at around 40, says Michael Goodman, MD, author of The Midlife Bible: A Woman's Survival Guide (Robert D. Reed, 2003). "Basically, your motor is idling at a lower speed," he explains. "This change decreases calorie expenditure by as many as 25 to 100 calories a day -- even if you're exercising and eating the way you always have." (If it's any consolation, men in midlife, though spared the hormonal roller coaster, are equally subject to metabolic slowdown -- and many have the spare tires to prove it.)
But another harsh truth is that you may not be eating and exercising the way you always have, even if you think you are. Besides dealing a blow to your energy, hormone fluctuations can increase stress-related eating, says Dr. Peeke. Women of all ages produce 50 percent less serotonin -- the hormone linked to feelings of well-being -- than men. Thus, at times of stress, such as during PMS, they are more likely than men to boost their serotonin levels by eating sweets, particularly chocolate. Because the duration of PMS often increases during perimenopause, perimenopausal women are more likely to crave sweets, says Dr. Peeke. And extra chocolate carries extra calories.
Since metabolism and hormone function vary so much from woman to woman, and from year to year in the same 40- to 50-ish woman, even experts can't pinpoint an individual woman's likely midlife weight gain. All, however, say that it can be significant. My own fear of a 10-pound gain between 40 and 50, they agree, is thoroughly justified. Indeed, Dr. Goodman's research confirms an average gain of about a pound a year during perimenopause.
Luckily, they also emphasize that such whopping gains are not inevitable. The trick, says Dr. Peeke, is to think of calories as you would your checkbook: Calories in must be balanced by calories out. The following tips will help you come out even at the end of the day.Keep moving, all day long.
Even if you're hitting the gym three times a week as you've always done, chances are you're not doing the other little calorie burners that used to pepper your days. One reason my daily walk doesn't cut it anymore is that it's no longer being boosted by the countless hours I spent chasing down suicidal toddlers headed straight for the street, walking the floor with a sick baby, or pushing a stroller for blocks on end. So take the stairs at work, park on the far side of the mall, walk a couple of laps around the soccer field while your kids are at practice. It all adds up. One easy way to track how many calories you burn is to strap on a pedometer first thing in the morning. A quick glance now and then throughout the day will let you know how you're doing and remind you to get moving. Even if you're only burning extra calories a few at a time, it is a lot easier than forgoing food.Lift the other kind of weight.
Midlife women lose bone density and muscle tone, both of which are crucial to weight maintenance. So in addition to whatever aerobic activity you've been committed to, you should now spend at least 20 minutes twice a week on weight or resistance training. Remember, muscles burn calories more efficiently than fat cells do, which means they're working to burn calories even when you're not working out.Unload the stress.
For most women, stress is an unavoidable side effect of a full, demanding life. Throw in the haywire hormones of perimenopause, and many of us find ourselves in a daily stress fest. Besides being bad for our health, stress can trigger the release of the hormone cortisol, which in turn can stimulate hunger. In addition to upping your aerobic and weight-training workouts and enjoying the stress relief they provide, circumvent stress eating by finding activities that calm you down before you feel the urge to binge -- a cup of chamomile tea, a half hour with a good novel, a hot bath.
One consequence of financial stability -- or maybe just of having kids finally old enough to behave in public -- is that midlifers tend to eat out more than they used to. The caloric disaster of "supersizing" fast food is well known; what's less obvious is that a sit-down meal at a nice cafe can be equally hazardous. Restaurant food tends to be loaded with fat, and serving sizes are two to four times larger than nutritionists recommend. The real problem with big portions is that we're hard-wired to clean our plates. In one recent study, women offered a 12-inch sandwich ate 31 percent more than when they were offered a six-inch sandwich. The moral: If there's food on the plate, we'll eat it, hungry or not. A solution Dr. Goodman suggests is to ask for a take-out container to be delivered with your meal. Pack up half of your entree before you even lift your fork. At home, serve portions directly from the stove onto your plate, rather than putting extra food on the table, where it can be all too easily reached for seconds.Make friends with protein.
The components of a healthy diet change subtly in midlife. "A bit more protein may help maintain muscle mass as we age," says David L. Katz, MD, author of The Way to Eat (Sourcebooks, 2002). So if your kidney function is normal, shift some of your calories to lean protein such as fish, skinless poultry, beans, and soy. (According to some research, soy may have the extra benefit of keeping insulin levels low, in turn controlling appetite and slowing the rate at which carbohydrates are converted into fat.) Note, however, that the recommended increase is slight -- only about 15 grams a day (roughly the amount of half a cup of cottage cheese). Protein should not exceed 25 percent of your daily calories, warns Dr. Katz, because chronic excesses of protein can lead to kidney and liver problems. Too much protein can also leach calcium from the body, a particular hazard for midlife women because calcium both enhances bone density and seems to promote weight loss and maintenance (irrespective of age). Researchers don't fully understand the latter effect but theorize that calcium helps muscles burn calories more efficiently. The ideal calcium source is low-fat dairy products, three servings daily. Can't tolerate dairy? Dr. Katz recommends a 500-milligram supplement twice a day.Be a grazer, not a gorger.
The hormonal changes of midlife can predispose women to insulin resistance, a tendency for blood sugar levels to spike very quickly after eating and then switch immediately into storage mode, converting food into fat. Thus, says Dr. Katz, "spacing calories out over the course of the day can help keep insulin levels low and steady." Instead of your usual three squares, eat five or six small meals a day. Avoid unhealthy impulse snacks -- candy bars, chips, buttery croissants -- by planning ahead. And remember to lay off the salt: Since midlife hormone changes already increase water retention, why compound the problem? (Besides, excess salt has also been implicated in calcium loss.) A can of low-sodium vegetable soup, a handful of unsalted peanuts, a carton of low-fat yogurt, or a piece of fruit satisfies hunger without risking extra pounds.
Originally published in Ladies' Home Journal magazine, January 2005.