As part of our Lunch & Learn series of webinars, we were joined by Nigel Denby of Hormone Health.
Finding the pounds piling on and not sure why? Could it be the menopause and what can you do about it? We asked registered dietitian Nigel for his expert advice.
Henpicked: Is weight gain inevitable around menopause?
Nigel Denby: I wouldn’t say it’s inevitable but there is a strong trend. Around 50% of women will gain in the region of 1.5 kilos for each year of their perimenopause. The average weight gain is 10 kilos, which is around a stone and a half, easily a dress size. But it’s not the same for every woman.
For those that do struggle, it can be very distressing. But don’t worry, as there are things you can do about it.
Henpicked: Why does weight gain happen at this time?
Nigel Denby: It’s not usually one thing, more of a perfect storm. There are several reasons leading to the weight gain in the first place and making it difficult to get rid of.
The first thing is hormones. Your oestrogen levels are falling, and oestrogen has been giving you your shape, the nipped-in waist. That begins to change and you become more straight up and down. Many women notice weight gain in their trunk and back, as hormones change the way your body lays down fat.
But your metabolic rate is the thing that really impacts the likelihood of gaining fat. This is controlled largely by the amount of lean muscle tissue that your body contains, as opposed to fat tissue. The normal process of ageing for men and women starts around 35. We start losing muscle tissue, this causes the metabolic rate to slow down and we need slightly fewer calories. As women begin to lose oestrogen the rate at which that muscle tissue is lost speeds up a little. That has a significant impact on the number of daily calories you need.
You might find over the course of the perimenopause your calorie requirements reduce by at least 200 calories a day. That’s not a huge amount, a two-finger Kit Kat or a couple of pieces of toast. But the cumulative effect of that reduced requirement has quite an impact over a week, a month, a year and you can begin to see weight gain increase.
Also, your activity levels might change. If you’re struggling with symptoms you might not want to do the exercise you’ve done before, you may also find that you eat more or drink more alcohol. On the other hand, once you get on top of your symptoms you might feel a whole lot better and start going out again. That in itself could bring extra calories.
So there are hormonal, physiological and social reasons why this happens.
Henpicked: Is this a different type of weight gain?
Nigel Denby: Yes, the weight you gain in perimenopause is very different than that you’ve gained before. Many women who’ve struggled with their weight all their lives will find this becomes more persistent and the tried-and-tested methods they’ve used in their younger years are now not working for them.
But it’s equally upsetting for a woman who’s never had to think about weight, suddenly finding this is an intrinsic part of perimenopause.
Henpicked: If our usual tried-and-trusted methods won’t work, what would you suggest?
Nigel Denby: First let me say: I’ve been specialising in menopause for 25 years and I’ve never worked with anyone who can’t address this. There are things you can do.
But there are some fundamentals. You need to think of this as a new phase to be addressed in a new way. The first thing I always suggest is a really honest food and activity diary for at least three or four days. Look at the timings of when you eat. If there are large gaps in between meals that needs to be addressed. You need to be eating regularly throughout the day, but trying to keep your calories a bit lower than previously.
Of course, you need to look at what you’re eating and the quantities. And is there any emotional link, are you stressed, bored, anxious, lonely?
Then consider your activity levels. Look at your baseline functional activity, the number of steps you do each day, and try to get these up by two or three thousand. The thing that is absolutely non negotiable in controlling menopausal weight gain is strength exercise. That doesn’t mean you have to go to the gym. Think things like Pilates, band resistance, yoga, or you might start doing some simple strength exercises at home. It’s about exercising the big muscle groups, chest, back, core, buttocks and quads.
So the basic template to control menopausal weight gain is to seek a calorie deficit of about 300 a day, along with an increase in steps, plus some regular strength exercise. It works, it takes a little time, but it’s safe, it’s maintainable and it becomes personalised for you.
Henpicked: It sounds like we need to change our habits long term rather than seek quick fixes?
Nigel Denby: Absolutely. It’s behaviour change, recognising that your body is moving into a new phase. I often work with people over a 12-week period, as that’s the amount of time it takes to start instilling new habits. It’s not the time for quick fixes and fads. In amongst all of this you’ve got to look after your bones, your heart — your body needs nutrition.
Even if quick fixes have worked for you in the past, the chances are they won’t now. At this stage in life, you’re losing lean muscle tissue. Very often if you leap into a gimmicky diet you’ll lose weight rapidly but you’ll lose muscle as well as fat. Ultimately that is slowing your metabolic rate down even further. Faddy diets aren’t viable long term either, so you go back to what you were doing before, and you gain even more weight.
One of the gifts of menopause is that it’s a great time to take stock. You can break free of yo-yo dieting and embrace a lifelong lifestyle plan.
Henpicked: Any tips on how to eat throughout the day?
Nigel Denby: Breakfast, snack, lunch, snack, dinner, means you can control your appetite. You’ll go into meals feeling hungry, not ravenous, and eat until you’re satisfied, not stuffed. A couple of quick tips. When you’re looking at your plate imagine you’re dividing it into four quarters. One quarter carbohydrate, one quarter protein and half your plate with veg, salad or fruit. That will always keep the balance of your food groups right. Then look at your whole plate of food and imagine if that would fit into your cupped hands. That’s a good portion to start with.
Eat that amount slowly, mindfully, don’t race through it, and try to eat without looking at devices. Recognise when you’re satisfied – it’s a slightly delayed reaction. Stop and check with yourself if you still feel hungry. If you are, go back and have a little more, if not, that’s the end of eating. We’re only looking to save about 300 calories a day, which is quite simple if you reduce your portion size, balance the food groups more appropriately, and stop grazing on sugary, fatty foods. Plan in nutrient-dense snacks instead. They’re still tasty!
Also, perimenopausal women are one of the groups in society in which we’re seeing higher intakes of alcohol. If you like a couple of glasses of wine you can save some calories by having a few alcohol-free days or reduce the quantity you’re having.
Henpicked: Will this method help with our long-term health?
Nigel Denby: Yes. It’s a good time for women to stop and think ‘what type of 85 year old do I want to be?’ The reality is that some of the lifestyle decisions you make now will have a huge impact on your health, fitness and strength in the decades ahead. We’re all expected to live into our 80s and 90s now and that’s great. But let’s think about the quality of those years. It’s in our 40s and 50s that we lay the foundations for these decades. Changing behaviour, not dramatically, but just cleaning things up a bit, can really help. The art of finding this new lifestyle to take you into the decades ahead is not about being perfect but just about being a bit better.
Henpicked: Can HRT make a difference to weight gain?
Nigel Denby: There is a mountain of evidence which has always shown that there is no direct link between HRT and weight gain. But any menopause doctor will tell you that for some women they do gain weight at the same time as they go on HRT, which can be for multiple reasons.
Some women find progesterone might make them feel puffy or fluid retentive. That’s not fat gain but it can feel like that. If you start on HRT and you gain weight at that point, it will usually settle after a few months.
Equally, HRT isn’t giving you the same levels of oestrogen you had previously, so it won’t prevent weight gain either. The quantities are not enough to reduce the way that your body starts laying down fat. The only thing that really is reversible is the loss in muscle tissue. You lose muscle when you don’t use it or when you age. But you can gain it when you introduce regular strength exercise. And the keyword there is regular. One or two crazy weight sessions at the gym is much less effective than 10 or 15 minutes of gentle strength exercise four or five times a week.
Henpicked: Any tips on coping with cravings?
Nigel Denby: Cravings for sugar are very common. If you are on your knees with symptoms you’ve got to get those sorted out before you start trying to manage your weight. To start changing your behaviours you’ve got to be feeling good and if you’re struggling with symptoms I’d urge you to seek some help.
Once you’ve got your symptoms under control, the first thing is a food diary. If you’re going for long periods without eating then you’re likely to get the munchies. So you need to eat regularly. Choose low glycemic index carbs which will keep your blood sugar under control. Baby new potatoes, grainy breads, basmati rice, grains like cous cous, bulgar wheat, quinoa, al dente pasta, all these will help keep your blood sugar stable.
Occasionally we all have an emotional relationship with food, I’m fed up I want chocolate or a bag of crisps. To manage some of those it’s really useful to establish ‘am I hungry or is this a craving?’ A craving is a chemical reaction in the brain. But we can only maintain the craving sensation for 6-8 minutes. As soon as a craving comes along don’t fight it. Just think ‘I’m going to give this 15 minutes’. Start a timer, get a drink and make sure you’re not thirsty.
Then see if you’re still looking for that food or if the feeling has passed. If it’s just a craving it will go. If not, then have a healthy snack. There’s no point trying to resist being genuinely hungry. Great snacks that are two food groups combined include a Babybel and cherry tomatoes, a couple of oatcakes with houmous or peanut butter, or a slice of malt loaf with cream cheese. Just ordinary foods but they are good combinations that will keep you satisfied. With cravings, own them, understand what’s going on and know if you’re really hungry. Just recognise a craving for what it is.
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