Smart Solutions | A Woman's Guide to Weight Management
When women are asked what their #1 health goal is, they often cite weight loss as their primary focus. Sex hormones such as estrogen and progesterone can impact energy, the ability to exercise, appetite and cravings.1 Female sex hormones are also responsible for where a person carries weight on their body and can influence the body shape a person.1,2 As hormones transition throughout the lifespan, for instance the perimenopause transition, hormones can make weight loss feel confusing and overwhelming.3
Estrogen is the primary sex hormone related to body composition, weight management and how women feel day to day.1 As cycles become irregular, like during perimenopause, women experience less ebb and flow to their appetite and energy as they did in their younger years.During the 4 phases of the menstrual cycle women experience a reduction in food intake and increase in energy during the follicular phase (day 1-14) and a decrease in energy and an increase in food intake during the luteal phase (day 14-28).1,4 This ebb and flow creates a relative balance throughout the month. As ovulations become less frequent, like during perimenopause, or in women who do not ovulate regularly as in PCOS, energy and appetite is higher and energy levels are lower.1 This combination of low energy and higher appetite and cravings can create new challenges for women as they work towards weight management.
Estrogen is also the hormone responsible for regulating where body weight is stored on the female body, with a preference for hip and gluteal weight gain in a woman’s younger years.5 The loss of estrogen in perimenopause and menopause also loses the ‘guidance’ of where to store body fat and women may notice a change in their body shape as there is a change in where body weight is stored, with an increase in abdominal weight carrying.6
Weight gain is prevalent worldwide. In Canada, 24% of the population is considered obese.1 Fifty eight percent of women between 40-59 year of age are also considered overweight or obese.7 There are several factors that can increase the chances of weight gain – diet and lifestyle being the two dominant ones.4 However, especially for women, hormones play an important and impactful role in weight management.
The most notable changes that women notice during their perimenopause transition with respect to their body shape and weight through their fourth and fifth decade6 but, perhaps more importantly, women need to be aware of the other changes that are happening to their health that may be influencing the way that they are experiencing their metabolism.
Tracking your symptoms such as energy, mood, sleep and resiliency is equally as important as tracking your weight and body shape. The changes that occur to these aspects of health have the greatest impact on metabolism – and the cause of these symptoms is often related to changing hormones.
The lab testing that women can consider to evaluate their metabolism and hormone status at this time can help give some perspective on what to focus on in your solutions and ensure that there are not more significant changes to your metabolism such as prediabetes. Lab tests to consider could include FSH and estrogen on day 3 of your cycle to assess your perimenopause status, fasting glucose and insulin to assess your insulin resistance (HOMA-IR score) and your cholesterol panel.3These tests can guide solutions and help you monitor your progress as you work on your health.
You don’t have to look too far into the research on nutrition and weight loss to see that many weight loss attempts are not successful. Even though weight loss occurs through a negative energy balance (eating lees calories than you burn during the day), maintaining an energy balance over time is a challenging feat for most people. Studies that have examined nutrition during the perimeneopause transition to support weight management focus on satiety, protein adequacy and the impact of motivational interviewing on helping people overcome the challenges they face day to day with their weight loss.8,10
The word “satiety” means being satisfied or feeling full from meals, and plays a significant role in how easily a person can follow a nutrition plan. If a plan for nutrition creates hunger, doesn’t follow a person’s cultural preferences or feels highly restrictive, it’s less likely to be successful in the long run.11,12
The most important aspects of nutrition to focus on for weight management are satiety and balance.
As women age, their muscle mass also changes, which has a significant impact on metabolism and metabolic rate.6,13If patients lose muscle mass, their daily calorie needs decrease. 8-10This can lead to women feeling as though they are gaining weight while eating the same way they always have. Protein needs for aging women are approximately 1.5 grams of protein per kilogram of body weight.14 This amount of protein helps support fullness after meals, but more importantly contributes to maintaining muscle mass as women age.
Perhaps the most surprising factor in the long term success of a person’s weight management is amount of connection and support they receive while working on their nutrition and the strategies they use to help overcome obstacles as they pursue their goals.9 Motivational interviewing is a strategy used by health care providers to help people overcome their challenges sticking to a plan and helps people become more independent over time as they pursue their goals. Motivational interviewing can help people understand the real reason why they want to support healthy nutrition and weight loss and can help people devise solutions when they have difficulties. Most nutrition programs that support people over time have better outcomes than handouts or booklets that just tell people to eat better.10 Many women can identify health foods but have difficulty finding the time or the motivation to eat well consistently. Working with a practitioner who can help you achieve your goals is an excellent strategy for successful weight loss.16
There are no specific foods that help or hinder weight loss, nor is there one macronutrient (such as carbs) that influences weight gain. The goal is to achieve a balanced, Mediterranean-style diet that focuses on the right amount of fuel and calories based on what your body needs for the day. This can be achieved through tracking the diet and working with a practitioner that can help you find the right formula for weight loss.
There are several aspects of our day to day routine that can influence weight management.
Sleep is one part of our daily routine that impacts weight. Studies show that individuals who regularly slept less than 7 hours per night have a higher chance of having higher BMI than those who achieved more hours of sleep.17 Furthermore, less hours of sleep was associated with hormonal changes, like increased amount of the hunger hormone – ghrelin.18 It is recommended to get 8 hours of sleep, not just from a weight management perspective but for overall health and wellbeing.
Exercise is also important for weight management. Being active helps muscles utilize the foods we eat in to energy, therefore, preventing food from being stored as fat. The type of exercise also matters. Strength training helps build lean muscle and can help with weight loss and the way the body looks.18
The World Health Organization recommends 150-300 minutes of total moderate intensity physical activity per week, or at least, 75-150 mins should be vigorous activity per week.18 Adults should also do muscle-strengthening activities at moderate or greater intensity, involving major muscle groups.18Staying consistent with activity can be hard, that is why it’s important to do things you enjoy! Swimming, dancing, & hiking are all examples of activity that can be used as a form of exercise. Using a fitness tracking app can also help with motivation.
Supporting hormones that can cause a slower metabolism and weight gain is another important step when considering weight management.
Inositol’s are a form of sugar and play a role in how the body metabolizes sugar.19 Research shows that D-chiro-inositol, a form of inositol, is effective in promoting insulin, the hormone responsible for glucose absorption and utilization.20 Insulin resistance is when cells in the body don’t respond to insulin and therefore, can not utilize glucose for energy.21Prolonged insulin resistance can lead to increase blood sugar levels and contribute to weight gain, high blood pressure, & high cholesterol.22 Research shows that d-chiro-inositol helps promote healthy glucose metabolism.20
Chronic stress also plays a role in weight gain, so supporting the stress response can also be beneficial. Long term cortisol levels are higher in obese individuals and increases abdominal fat.23 Chronic stress also promotes behaviours like wanting, seeking, and eating high fat and caloric dense foods.23Ashwaghanda is a popular herb known to help increase resistance to stress.24
Leeners, B., Geary, N., Tobler, P. N. & Asarian, L. Ovarian hormones and obesity. Hum. Reprod. Update 23, 300–321 (2017).
Lizcano, F. & Guzmán, G. Estrogen Deficiency and the Origin of Obesity during Menopause. BioMed Res. Int. 2014, (2014).
Peacock, K. & Ketvertis, K. M. Menopause. in StatPearls (StatPearls Publishing, 2021).
Asarian, L. & Geary, N. Sex differences in the physiology of eating. Am. J. Physiol. Regul. Integr. Comp. Physiol. 305, R1215-1267 (2013).
Brown, L. & Clegg, D. Central Effects of Estradiol in the Regulation of Adiposity. J. Steroid Biochem. Mol. Biol. 122, 65–73 (2010).
Greendale, G. A. et al. Changes in body composition and weight during the menopause transition. JCI Insight 4,.
Jull, J., Stacey, D., Beach, S., Dumas, A., Strychar, I., Ufholz, L.-A., Prince, S., Abdulnour, J., & Prud’homme, D. (2014). Lifestyle interventions targeting body weight changes during the Menopause Transition: A Systematic Review. Journal of Obesity, 2014, 1–16. https://doi.org/10.1155/2014/824310
Armstrong, M. J. et al. Motivational interviewing to improve weight loss in overweight and/or obese patients: a systematic review and meta-analysis of randomized controlled trials. Obes. Rev. Off. J. Int. Assoc. Study Obes. 12, 709–723 (2011).
Barnes, R. D. & Ivezaj, V. A systematic review of motivational interviewing for weight loss among adults in primary care. Obes. Rev. Off. J. Int. Assoc. Study Obes. 16, 304–318 (2015).
Chopra, S. et al. Weight Management Module for Perimenopausal Women: A Practical Guide for Gynecologists. J. -Life Health 10, 165–172 (2019).
Westenhoefer, J., von Falck, B., Stellfeldt, A. & Fintelmann, S. Behavioural correlates of successful weight reduction over 3 y. Results from the Lean Habits Study. Int. J. Obes. Relat. Metab. Disord. J. Int. Assoc. Study Obes. 28, 334–335 (2004).
Wing, R. R. & Phelan, S. Long-term weight loss maintenance. Am. J. Clin. Nutr. 82, 222S-225S (2005).
Williams, L. T., Hollis, J. L., Collins, C. E. & Morgan, P. J. The 40-Something randomized controlled trial to prevent weight gain in mid-age women. BMC Public Health 13, 1007 (2013).
Beleigoli, A., Andrade, A. Q., Diniz, M. D. F. & Ribeiro, A. L. Personalized Web-Based Weight Loss Behavior Change Program With and Without Dietitian Online Coaching for Adults With Overweight and Obesity: Randomized Controlled Trial. J. Med. Internet Res. 22, e17494 (2020).
Mayo Foundation for Medical Education and Research. (2019, October 10). Weight loss diet and exercise. Mayo Clinic. Retrieved November 4, 2021, from https://www.mayoclinic.org/healthy-lifestyle/weight-loss/basics/diet-and-exercise/hlv-20049483#:~:text=Exercise%20means%20being%20more%20physically,in%20with%20food%20you%20eat.
FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, Carty C, Chaput JP, Chastin S, Chou R, Dempsey PC. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British journal of sports medicine. 2020 Dec 1;54(24):1451-62
Saleem, F., & Rizvi, S. W. (2017). New therapeutic approaches in obesity and metabolic syndrome associated with polycystic ovary syndrome. Cureus. https://doi.org/10.7759/cureus.1844
Davinelli, S., Nicolosi, D., Di Cesare, C., Scapagnini, G., & Di Marco, R. (2020). Targeting metabolic consequences of insulin resistance in polycystic ovary syndrome by D-Chiro-Inositol and emerging nutraceuticals: A focused review. Journal of Clinical Medicine, 9(4), 987. https://doi.org/10.3390/jcm9040987
Insulin resistance: Symptoms, causes, tests, treatment, and prevention. WebMD. Retrieved November 4, 2021, from https://www.webmd.com/diabetes/insulin-resistance-syndrome.
van der Valk, E. S., Savas, M., & van Rossum, E. F. (2018). Stress and obesity: Are there more susceptible individuals? Current Obesity Reports, 7(2), 193–203. https://doi.org/10.1007/s13679-018-0306-y
Chao, A. M., Jastreboff, A. M., White, M. A., Grilo, C. M., & Sinha, R. (2017). Stress, cortisol, and other appetite-related hormones: Prospective prediction of 6-month changes in food cravings and weight. Obesity, 25(4), 713–720. https://doi.org/10.1002/oby.21790
Choudhary, D., Bhattacharyya, S., & Joshi, K. (2016). Body weight management in adults under chronic stress through treatment with Ashwagandha Root Extract. Journal of Evidence-Based Complementary & Alternative Medicine, 22(1), 96–106. https://doi.org/10.1177/2156587216641830
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