Ah, diet, the word that seems to give mixed messages - most of which are bad.  Science calls it “diet” not because it means “restriction” in any way, it refers to anything that we ingest.  Eating nutrition filled foods is ideal, most women know this, but many of them do not make the best choices.  In addition to staying away from sugar based products, aim for a diet high in fiber and calcium, that is low in fat and cholesterol in addition to exercise.2,10,11  This will establish a healthy foundation for the body before menopause and help ward off the increasing risk of heart disease.  

The Women’s Healthy Lifestyle Project from 1992-1999 involved 535 women who were premenopausal and wanted to ward off weight gain before menopause.  This study aimed to help women lose weight and lower their cholesterol and did so by sticking to a plan of a well balanced diet of 1,300 calories per day and was low in fat at 25% of daily calories.  The weekly exercise plan was to burn 1,000 to 1,500

calories per week of moderate-intensity brisk walking.4  That is only about 10-15 miles per week of walking!   

What if I am already going through menopause? It’s never too late to begin a healthy exercise and diet plan, even if you have never participated in one.  If you have always exercised, maybe some changes should be made by participating in different physical activities.  The Study of Women’s Health Across the Nation determined that if women increase their activity during menopause, they will likely lose weight regardless of their hormonal status.8  You might have heard that once a woman reaches menopause, the rise of weight gain slows down.12-14  Although this sounds great, the reason may be that women are losing lean muscle tissue during this time.  Incorporating a resistance training program in addition to cardio exercise will deter the loss of lean muscle tissue.  

Additional physical activity can be walking the dog daily or meeting friends to walk instead of sitting for coffee or lunch.  Making these small changes can help increase the number of calories burned weekly.  Lifestyle is a factor when it comes to changes in weight gain during menopause as proven in a study of Japanese women researching changes in weight gain before and during menopause.12  The results reported lower weight gain during perimenopause and menopause.  Although this is another interesting topic for future research, it makes us think about the Japanese diet that includes rice, fish, vegetables and light sauces and a way of life that includes more physical activities compared to the diet of many Americans that is full of meat, sugary carbohydrates, heavy flavorings and an abundance of junk food choices mixed with smaller amounts of daily activity.  

*If you are in this phase of menopause (diagnosed by your physician):  Recommendations are the same as in perimenopause, cardiovascular exercise at a minimum of 30 minutes 5 days per week along with an additional 2-3 days of resistance training. The diet for weight loss should include 50%-55% carbohydrate, 15%-20% protein and less than 30% total fat intake as recommended by the U.S. Department of Health and Human Services along with research resulting in weight loss.4,7      

What if I am postmenopause?  What can I do to change or maintain my body composition?   First let’s talk about blaming hormone replacement therapy (HRT), or lack thereof, on weight gain:   Several research studies have been performed to try to prove whether or not HRT has a greater impact on weight gain.  A research study by Davies et al comparing women who chose to use HRT and those who did not resulted in similar upward linear curves that climbed at or about the same rate for weight gain.15  Davies et al discuss that the rise in weight gain could also be the result of age increase.  Another study of Japanese women also came to the same conclusion where women taking HRT and women who were not had similar weight changes.12  This introduces the possibility that hormones may not be to blame for the increase in weight gain during a woman’s life, but rather the reduction of activity and/or exercise is the cause for the increases that we see on the scale. Ultimately, we are responsible for our own weight fluctuations (excluding some medical situations).  So, women, take control of this time, find the exercise that you enjoy most and watch that your caloric intake does not exceed your caloric expenditure.  Ask your physician or a qualified fitness professional for recommendations to guide you through the process to help you prevent injury and reach your goals.   

Great news for athletes and endurance athletes in this age range with regard to menopausal weight gain and cardiovascular risk factors.  

A study comparing sedentary women, active women and female endurance athletes ages 60+ found that the endurance athletes (running 20-38 miles per week in the no HRT category and running 22-42 miles per week in the HRT category) had lower levels of body fat, most notably in the mid-section where accumulation leads to a higher cardiovascular disease risk.16  You go girls!  *If you are in the phase of postmenopause (diagnosed by your physician):   Aim for at least 30 minutes of cardiovascular exercise for at least 5 days per week.(Sound familiar?)  Also, add in your 2-3 days of resistance training if you do not already participate in this activity.  If you are already participating in a program, change it up, add the other 2 days of cardio, walk with speedy intervals (just 5 intervals of 10 sec fast walking), swim, cycle or take a class at the gym. 

If you already engage in an exercise program and eat a healthy diet and find that you are still gaining weight through this time, take a moment to write everything down and input your caloric intake and expenditure into a nutrition and exercise program.  FitDay.com is a free source excellent for keeping a food intake and exercise log in order to identify what may be causing your weight gain or preventing you from weight loss.  It may be as simple as changing your choice of exercise in order to burn that additional 300 calories per day.  If you are injured and feel that you cannot participate in exercise, see your physician to determine if you need assistance from a physical therapist to get you back on track or give you different options for exercise. If you need additional help, seek support from a nutritionist or dietician and hire a fitness professional to teach you the latest fitness regimens to promote changes in your body composition as well as help decrease your risk for cardiovascular disease and other diseases associated with weight gain (i.e. breast cancer).  

The Bottom Line No matter what age, it is important to engage in consistent physical activity at least 30 minutes, 5 days per week to decrease body fat composition and exercise the heart to reduce your risk for cardiovascular disease.  Women of all stages should engage in a resistance program at least 2 times per week to maintain or increase lean muscle mass for strength and for bone health.  With a well-rounded, nutrition filled diet not exceeding calories expended throughout the day, the chance of weight gain can be reduced throughout all stages of menopause.  

To figure out how many calories that you naturally expend throughout the day, calculate your basal metabolic rate (BMR) using the Harrison-Benedict formula for women:  BMR = 655 + (9.6 X wt in kg) + (1.8 X ht in cm) - (4.7 X age in years) This answer will give you what the number of calories you burn throughout the day with no additional activity.  Then, you can figure out how many calories you burn with additional activity and the number of calories that you ingest daily to make sure that you aren’t eating too much, need to exercise more or even if you are eating to little to maintain lean muscle mass!

References

1. U.S. Department of Health and Human Services Web site. http://www.health.gov/PAGuidelines/guidelines/summary.aspx  Accessed April 19, 2009.

2. Lange-Collett J, Schumann L. Promoting Health Among Perimenopausal Women through Diet and Exercise. J Am Acad Nurse Pract. 2002;14(4):172.

3. McVeigh C. Perimenopause: More Than Hot Flushes and Night Sweats for Some Australian Women. JOGNN: Journal of Obstetric, Gynecologic, & Neonatal Nursing. 2005;34(1):21-27.            

4. Simkin-Silverman L, Wing RR, Boraz MA, Kuller LH. Lifestyle Intervention Can Prevent Weight Gain During Menopause: Results From a 5-Year Randomized Clinical Trial. Annals of Behavioral Medicine. 2003;26(3):212-220.            

5. McAuley E, Elavsky S, Motl RW, Konopack JF, Hu L, Marquez DX. Physical activity, self-efficacy, and self-esteem: longitudinal relationships in older adults. J Gerontol B Psychol Sci Soc Sci. 2005;60B(5):P268-75.            

6. Bittner V. Menopause and cardiovascular risk cause or consequence? J Am Coll Cardiol. 2006;47(10):1984-1986.            

7. Hagey AR, Warren MP. Role of exercise and nutrition in menopause. Clin Obstet Gynecol. 2008;51(3):627-641.            

8. Sternfeld B, Wang H, Quesenberry C, J., et al. Physical activity and changes in weight and waist circumference in midlife women: findings from the Study of Women's Health Across the Nation. Am J Epidemiol. 2004;160(9):912-922.         

9. Larew K, Hunter GR, Larson-Meyer D, Newcomer BR, McCarthy JP, Weinsier RL. Muscle metabolic function, exercise performance, and weight gain. / Fonction metabolique du muscle, performance et prise de poids. Medicine & Science in Sports & Exercise. 2003;35(2):230-236.           

10. Smith KR. Exercise can help control body changes during menopause. Health Care Food Nutr Focus. 2005;22(10):10-11.           

11. Wenger NK. Diet and exercise for perimenopausal women: lifestyle interventions can decrease cardiovascular risk. J Am Coll Cardiol. 2004;44(3):586-587.       

12. Nagata C, Takatsuka N, Kawakami N, Shimizu H. Weight change in relation to natural menopause and other reproductive and behavioral factors in Japanese women. Ann Epidemiol. 2002;12(4):237-241.           

13. Sowers M, Zheng H, Tomey K, et al. Changes in body composition in women over six years at midlife: ovarian and chronological aging. J Clin Endocrinol Metab. 2007;92(3):895-901.            

14. Sturdee DW, MacLennan AH. The weight problem. Climacteric. 2007;10(2):83-84.    

15. Davies KM, Heaney RP, Recker RR, Barger-Lux MJ, Lappe JM. Hormones, weight change and menopause. Int J Obes Relat Metab Disord. 2001;25(6):874-879.