Weight Gain in Perimenopause and Menopause

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What are you waiting for? Good night. It's no secret weight gain in perimenopause or menopause transition and postmenopause, it's different. It doesn't respond the way you would have predicted it should. It doesn't come on the same rate or in the same place as you think it should. My guest today is an MD, and yet she's first a woman who also entered midlife and experienced much of the same you may have. She also defaulted to many of the same tactics a woman with a heartbeat will. So this episode is just a simply basic discussion about what happens, about why it happens, and about what to do about it, and why your default mechanism may fall short. I'm Debra Atkinson. You're listening to Flipping 50, where I address your top struggles and concerns and I share what to eat, how to move, and how to change your mindset so you can have the energy and the vitality that you want, need, and deserve in this second and better half. And my guest today is Heather Awad. She is a family medicine physician and the founder and CEO of Vibrant Weight Loss Age 50+, where she helps professional women over age 50 lose weight for the last time through a virtual platform. She offers a simple system that saves time, helps them achieve their health and weight loss goals, and they discover how to say no to foods they don't want without using willpower and creating an eating protocol that they will enjoy going forward so their weight loss is permanent. Dr. Awad is also the host of the Vibrant MD podcast, where she talks about weight loss, women's health, and food. Let's dive in. Heather, thank you so much for being here.

Thanks for having me.

So obviously we are gonna have a lot of listeners and many of my listeners know we do prerecord. So as I say that, simply the title will be very attractive because we're all drawn to this and for many in some way, shape, or form, this is a challenge. But before we untackle or unpack and tackle all of that, Share a little bit about you. I mean, I don't think a little girl grows up, goes to elementary career day, and says, I want to help midlife women lose body fat. Um, where did this come into your vision that this is what I want to do?

True, true. So I'm a family doctor by training and was always one of those food as medicine doctors. So if you had a high cholesterol, I would— the first thing I would say was, what do you eat for lunch?. And we talk about, you know, how maximizing our nutrition can help with our health. So I had a number of different doctor jobs over the years, and then just personally, I hit my mid-forties and had not really had any weight issues over the years. And then all of a sudden, with not changing anything, my weight just started to go up and up and up. And, you know, I tried eating less and moving more, which at the time I did not know Does not work. And, um, but it kept going up and then I got to into what we really note as the unhealthy range. And then I got kind of scared and worried. Um, so then I tried some diets, which either made me feel terrible or just didn't work or, um, ended up being yo-yo diets. And I thought, you know, I need to figure this out because we don't learn a lot about weight loss in medical school. Um, so I did some diving in and then found out, uh, about what happens at midlife, how our bodies change that actually has us put on weight in our midsection. And so armed with that, then I was doing some life coaching and I realized that I needed to know the nutritional stuff and hormonal stuff, but then also I needed to learn how to feel my feelings instead of eating them. And I needed to have my own back more. And then all of a sudden, weight loss got really easy. And at some point, I thought this would be really fun to help other people with because I found the journey so rewarding myself, besides getting back to a healthy weight.

So good. What a great story. And so much great in there because I think that, you know, doctors are still on a pedestal, you know. I think, you know, we still think— and I, even with the influx of functional medicine and functional doctors where you actually sit down and get to have a conversation with someone, so you're much more humanized than this 15-minute white coat you see coming in and out of the room. Yeah, but it's still nice, I think, for listeners to realize that experts, you know, can fall into the same dogma, like the things that we've always all thought or been led to believe. Eat less, move more. That's going to be the answer, right? And, you know, my audience has heard me say no. I've taken one for the team. I did way more, way less. And no, just no. You know, you don't need to go there. I've done all the research for both of us. So I think it's you know, applaud you for saying that out loud because some would hide that in the closet, you know, as if, no, no, I would have known better than that. So I think it's so great to know. Let's unpack that first. Why does that backfire?

Well, especially at midlife. I mean, in general, you— there's that great saying, you can't outrun a bad diet, and that's really true, you know, that we don't burn off enough calories to, you know, eat horribly and, and have our bodies feel good and, and be at a normal weight. But beyond that, at midlife, it really doesn't work anymore because even the math doesn't work because our hormones are changing. So I often meet women who are eating very little, and I have to tell them to eat more to lose weight because their body gets stressed and gets really high cortisol levels, and it says there's an emergency. In order to live, we must hold on to everything that we have. And so then you don't allow any release of fat when you eat really, really low calorie. And we just can't— we really can't burn off enough calories to lose, you know, a significant and sustainable amount of weight when we work all day and have families and, um, and do all the things we want to do.

Yes. And I will say this. So I remember I've trained for 8 Ironman triathlons. So when I said I've really done the more, I totally have. But, you know, in training for an event like that, you spend a lot of time in exercise doing endurance rides, you know, the longest period of time you do is training on a bike. And I can remember those long afternoons when, you know, I would get off a bike trainer, usually because controlling for the weather and, and all things, it's actually sometimes better to train indoors on a trainer. And I'd get off after a 4 or a 5-hour bike session and realize how few calories I'd burned, you know. And, and it wasn't that— I mean, because I was gonna let my hunger dictate what I put back in anyway. Yeah, but that's an incredible hunger, really, after that, you know. It's— you're still eating during, but the amount of calories is not all that great. And I don't know what some of you would think if you were to guess. What would you guess? So we'll ask a rhetorical question here since it is a one-way conversation, right? You know, and I think you'd probably guess this was just a lot, but you know, sometimes a ride that long would only be, you know, 5, 6 hour ride, even 600 calories. Yeah. That's not all that many. That's like a decent dinner. That's it.

Then you're done. And somehow we've linked this, you know, you know, this system that if we work out than we deserve and that we should work out so that we burn off what we eat. And those were— I don't think they were ever really meant to go together.

Earn them or burn them. Yes. Yeah. Yep. Yeah.

So true.

And that'll be a hard one to shake because it's so ingrained, it's like in our skin. So let's talk about the physiology of the perimenopause and the menopause. I mean, what hormonal factors are really changing and at play that make women gain that weight? And exactly as you painted it, because so many women can relate, I didn't change anything and the weight just kept coming on.

Yeah, well, in perimenopause, our estrogen starts to go down, but it bounces around quite a bit. And then we have our cortisol levels, again, stress hormone that bounces around as well. And then when we get to menopause, our estrogen really goes down and then cortisol becomes a general issue, you know, with, um, sometimes we aren't sleeping as well so that our cortisol is high, which can make us, um, feel hungrier or just not be able to tell when we're hungry and when we're not, that those natural cues are difficult when our cortisol is high. But the main thing is that when the estrogen is going down, then we get a natural bump in insulin resistance. And insulin is a normal digestive hormone that works our— that helps our body clear the glucose from the food that we've eaten. But it also tells our body to store fat, which it should normally, because we need to take the stuff from breakfast and, you know, use a little bit, put a little bit in our liver, and then put some in fat. And then we're supposed to have time before the next meal where we just pull that tiny bit out of the liver again for energy that's stored there, and then pull from fat naturally for energy. So we need— so when we have high insulin, we don't want it to be high all the time. So we want to have some time where insulin gets quiet and gets low. But we're kind of fighting that system a little bit at perimenopause and menopause because what used to happen a little bit more naturally, insulin is just generally higher because of this resistance because it doesn't work as well. And then it's hanging around.

What about cultural factors that either work for us or against us?

Sure. We live in a, you know, in the United States and the Western world that is, you know, the culture that is spreading, we live in an eat-all-day culture where there's food everywhere. I remember being a little kid and watching the Wonderful World of Disney sitting on the floor with my brothers. And we weren't eating anything. You know, even when I was a teenager, we'd all sit down on Thursday night to watch TV together, and there wasn't any food involved with that. But now food is normal watching TV, and food is normal at every event we go to. I talk to people who say, you know, I have many clients who will say there's cake every day in the break room, or there are donuts every day in the break room. So we have that kind of issue where there is food around all the time and there are people expecting us to eat that food who are there as well all the time, which is difficult for women because we're socialized to be flexible and help each other and appreciative. And, and so that's a cultural thing as well where people are telling us what to eat and they're telling us to eat all the time.

Amen to that. Yeah, it is tough. What's dangerous? I think we should talk about this because I think many of us will first go to what's not aesthetic. It's the vanity piece. I mean, we don't like it, doesn't look good, doesn't feel good, and it's more of a feeling. We've taken fat to be an emotion, right? Like, I feel fat. What's the danger though in the menopause belly fat? I think we should just review that for everybody because we often leave that low, and there are some women who are thinking, well, maybe I'm— I should be more accepting of my body now and not forcing it to change, but there is some risk here, right?

Right. So at 38, if you go into, if you go and you say, I'm feeling some indigestion, you know, in my chest, they're gonna say, well, yeah, that could be indigestion. At 48, when you're at perimenopause and menopause, all of a sudden the medical community is very concerned that you might be having a heart attack because when women hit menopause or get into that midlife range, we do have a bump in heart disease. And part of that is this insulin resistance. And the sign is actually that belly fat. So we, belly fat is at midlife is actually not just in our belly. It's, it's deep. It's in our visceral center. It's around our organs. And that kind of fat increases our risk of heart disease, type 2 diabetes, fatty liver disease, and some cancers.

Wow. I do think we just all needed to hear that reminder. And I'm just gonna throw this in right here. So let— and I'll, I'll ask you to weigh in on this. What's the best way to target that belly fat in your experience personally and with those that you're working with as patients?

Well, this will sound overly simple, but it's true. I think the first thing that people should try to do is think about eating when they're hungry and not eating when they're not hungry. And that might be, you know, boredom eating, stress eating, emotional eating, eating when other people tell you to, eating because it's just there, eating because it's socially because we feel socially awkward. Taking those away and thinking about nourishing ourselves when we're actually hungry. If I get some people who say, just give me the quick and the quick, the real quick version, what should I do to lose this belly fat? And I say the first thing to do is to go toward eating 3 meals and no snacks. And you might need some snacks when you first start this because you didn't eat enough lunch, so you can't make it till dinner. But then the next day, maybe you eat more at lunch and you need to have some protein and some fiber, which is fruits or vegetables, and you need a little healthy fats with that meal. But you want to have time in between where you're not eating.

Yeah, I would say amen to that. That is kind of the first step that we take through people through too. 12 hours overnight and 3 meals, no snacks. And exactly the same, you know, unless those people maybe who are having blood sugar issues because they're cutting back, still that mentality of I'm going to cheat the system and win, you know, at each meal we keep, we keep doing that. And just to every woman listening, you're not alone. I think we all do it. There's a little— I mean, just imagine going to a restaurant where they put the calories of each item on the menu, we— it's, it's compulsive to not make a choice or to make a choice based on that. I think it's, it's hard to ignore.

Yeah. And actually, I, you know, it's funny, we beat ourselves up when we overeat, but we sometimes underfeed ourselves. And we don't need to beat ourselves up for either of those, but just examine and think, well, gosh, my lunch is maybe too small, or it was today and it's normally fine. Um, so, you know, take a look at that because sometimes you're going to do that as well.

Yeah, and I also want to call this out, so— and not necessarily to any, any listener, but if you're around these people, I think it can be hard to be around them. But there are certain individuals who will say things like, oh, I'm always hungry. And, you know, honestly, those are the women I think who are cheating the system and usually under eating, and that's why they're always hungry, you know. So you don't want to compare yourself. I mean, probably in any realm that we could talk about— not somebody's workout, it's not your workout, it's hers, you know. And likewise, but just begin to examine and get curious. Probably a better way to approach what you're doing— not judge it, but get curious about what you're doing and, and why. And realizing that you're at this moment feeling or looking the way you are partially because of habits, but then partially because of hormonal changes that might require you to change those habits to win again. Right, right. How do you find— how are you finding that people, women particularly, so let's ignore men just right now because their problems are a little different, but How do they most easily lose that middle zone midlife weight?

Really, if they make sure that they get, um, a— also a savory breakfast, because that will keep your blood sugar and insulin down all day. So a savory breakfast, but really some protein and vegetables with with each meal. And there are— and I'll tell you that in my, you know, people that work with me, half of them will do something like intermittent fasting, which we're not going to get deep into today, but the other half really just go with the 3 meals and make sure they get some protein and vegetables. And then I encourage them to get some fat with that as well. And, and that really gets all, you know, they get going on this where they're not having a lot of refined sugar, you know, maybe once a week. They're really not having much bread. And then they start to notice that a couple of weeks in that it gets really easy because your body will just use fat between meals. And then you nourish yourself with food that you like at the next meal, and then your body will use fat again. And all of a sudden they're, they're just astounded that the weight just drops.

I love that, making it easy. This is really what everybody's hoping for, right? This is great, right? So a lot of women will feel stuck with their weight, you know, starting at midlife, but it doesn't necessarily end there. What would you tell them?

I would tell them that there is hope, that that you, that a lot of us have believed that, oh shoot, maybe I'm just stuck with being heavier at this age, or I remember my grandma was heavy, so maybe I'm going to be heavy, you know, before I become a grandma and when I become a grandma. But you, that is not your destiny. That's a story that we tell ourselves. And it's not necessarily true because our biology does not have to go that way.

So what else gets in the way of women losing weight at midlife?

I think another one that comes up a lot is people pleasing. You know, I'll get people who say, you know, I, I don't want to be that person. You know, I don't want to be that person that doesn't eat at the event, or I don't want to be the person that says no to dessert. And so we have this kind of thought that we need to please everyone all the time, including by eating. And that's a big one, 'cause I'll have people who they'll say their mother-in-law puts a plate of food on their lap, or that their family is a food-as-love family and really pushes it on them, or they have food rules amongst their friend group that everyone must eat something of each dish., or they're not a nice person. Um, but we, you know, a lot of women have that problem where, um, they, you know, do a lot of eating that other people have decided for them.

What would be the first step? So let's say you've got a woman listening right now and she has struggled with belly fat and and is feeling that she's tried everything, you know, maybe dabbled in intermittent fasting and tried, tried the restriction, but also tried to simply eat normally or to eat more protein and feels like still nothing is working.

What then? I mean, I think that working with a coach is, you know, an obvious next step because I am a coach. Who helps with people like with this issue, and so do you. So I think that getting some accountability can be very helpful. Also, when you talk to, when you work with a coach, you get to have them notice the stories that you're telling yourself that maybe aren't true about weight and about how you eat, and someone who can help encourage you through past some of the limiting beliefs that you have. You know, I had one client who her mom loves her with food, and she told her that she was going to be not eating sugar and bread for a while. She's trying to lose weight, and she had moved to the 3 meals. And then her mom invited her over and named all the bread that she was cooking. And she made the decision to not eat at her mom's house for 3 months. They would just meet up at a restaurant. And then when she felt really more comfortable going places and saying no thank you to the bread and yes, I'll have the main dish, then she was ready to go and eat at her mom's house again. And this is something that I really helped her with and let her kind of go until, you know, kind of talk through all these ideas until she was ready to, um, you know, be there and be able to say no to something and still be a loving daughter. Um, because that's what we all want to be, right, is a nice person, a loving friend, a loving relative. And we can do that without eating the food that other people expect us to eat.

Such great advice any time of year, really. And I think though that sometimes it's birthdays, anniversaries, it's holidays, reunions, when you get a little bit more added sense of pressure. So I appreciate that one. I think every listener will too. And I'm gonna ask because I know you're gonna have somebody who wants just a little bit more of this just simple common sense and You know, putting it in words that, you know, this is not, not your fault, you know, it's default. You know, we're still in this place where, you know, we are going to experience the physical changes before we know that under the hood we're having the physical changes, the physiologic changes. It's just the sign. It's like, oh, hello, we are here. You just took a right turn, you didn't know it, but Hey, here's what, here's what the view is, right?

Right.

So, so we can change things up. And that, I think, is, you know, the number one thing we opened with was, you know, I was putting on weight and I didn't change a thing. And, and yet everything did change for you physiology-wise. So now it's with that information you can go forward making some conscious changes. That will work in all of the directional ways that you mentioned, you know, helping with the blood sugar levels and the stabilization. Where can everyone follow you?

Sure, I'm easy to find on LinkedIn, um, Heather Awad, MD. I am also on Instagram, um, and I have a The Vibrant MD podcast, which also we talk about weight loss, women's health, and food there.

So good, so awesome. This has been, I think, just really refreshing and maybe reconfirming for a lot of women. It's like, I'm not alone, this happens. And because it happens, there are people out there who have been there and they're the expert, as opposed to just an expert. So I think there's a huge difference between the two. So listeners, now it's up to you. If this one resonated with you, you know that if you're seeing it on Facebook or on Instagram shared, tell me about it. Tell me it resonated. I love to hear from you. And you can come over to show notes at flipping50.com/weightgaininperimenopause. What are you waiting for? Let's start Flipping 50 today!