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Thursday, June 7, 2007

Fighting Midlife “Weight Creep”

The Pelvis Queen’s Guide to Fighting the Effects of a “Permissive Environment”

Weight Loss Pills

There are pharmaceutical options, most of which are by prescription. For short term use phentermine can be prescribed as an appetite suppressant. It is related to amphetamine type medications so it can increase heart rate, and in some women worsen symptoms of anxiety and insomnia. For longer term use the US FDA has approved subtramine which works via serotonin signals from the gut to the brain creating a feeling of satiety.

Orlistat, formerly a prescription drug has been approved for over the counter sale in the US. When taken with a high fat meal it causes some of the fat to move rapidly through the gut so it cannot be absorbed. The side effects, if one eats a high fat diet can include oily stools and some rectal leakage. With most of the prescription drug treatments a weight loss of 5-10% of original body weight is considered a good result.

But is weight loss really as simple as taking a pill?

Women often ask on my message board if there are “natural” or alternative treatments to pharmaceutical approaches. There have been two recent reviews of the alternative medicine literature concerning weight loss. All proposed treatments were studied in combination with a placebo. These reviews found the best outcomes for ephedra, conjugated linoleic acid, pyruvate, and hypnotherapy.

In terms of diets, a meta-analysis of many diet studies (Nordman, Archives of Internal Medicine, 2006) identified that both low carbohydrate and low fat diets were equally effective for inducing weight loss for up to one year. The “A to Z Weight Loss Study” (Gardner, JAMA, 2007) showed that the Atkins diet (very low carbohydrate) produced the most weight loss. In this group the mean loss was 9.2 pounds. But the differences between the Atkins, Ornish, Zone and LEARN (traditional 60% carbohydrate + calorie restriction) would likely have diminished over a longer follow up time according to the authors.

Even small improvements in diet can stop “weight creep”. While there were no differences in the incidence of heart attacks and strokes, participants in the Women’ Health Initiative diet study did not gain weight compared to a control group (Howard, JAMA, 2006). Both groups were followed for three years. The “winning” women ate one serving more of a fruit or vegetable, ate ½ more serving of whole grains, and decreased their intake of saturated fat.

How Much Weight Loss Is Really Feasible, or Will I Ever Be a Size 4 Again?

If midlife women are enrolled in an intensive four-month program that encompasses a 400 calorie deficit and 150 calorie increase in exercise (eg waking two miles/day) what could one expect as a result? This intervention was done with 136 women where the average age was 48 years old (Teixeira, Medicine and Science in Sports & Exercise, 2006). After 4 months there was an average loss of 6% of initial body weight. By 16 months the mean loss was 5.5% of their initial body weight. Individual variation was large at every assessment. That means that some women had much better results than others. Yet it was noted that exercise was one of the strongest predictors of success.

How Much Exercise Is Needed?

The Centers for Disease Control (CDC) suggests a “minimum of 30 minutes most days to improve health.” That would be about 150 minutes/week. The Institute of Medicine in the USA specifically addresses weight issues: “Minimum of 60 minutes per day on most days per week to control weight.” That would be 300 minutes of some type of exercise per week. If one walked a mile in 20 minutes, whether at the mall, pushing a stroller, or taking with a friend, walking two miles per day would fulfill this “exercise prescription.”

If exercise is combined with decreased calories the outcome is enhanced. Among 200 subjects taking about 1500 calories per day, those that exercised 200 or more minutes per week had an average 13% loss from their baseline weight. Those that exercised less than 150 minutes per week the average loss was about 5% (Jakicic, JAMA, 2003).

But I Have a BUSY Family Life, You Say…

Ok, it is true that women have way too much to do and never much time for themselves. It is a gift to have a few minutes of alone time at night. So what can one do? A registered dietitian (C. Nonas, NAMS, 2006) got straight to the point in a recent presentation. She asserted that women have a harder time losing weight as they move into middle age – if they can just maintain they are doing well. She suggested starting early in the cycle of “weight creep.” If your body mass index (BMI) is less than 25 lose 3-5 pounds by age 40. If your BMI is more than 25 consider losing 5-10 pounds.

Given that most diets show similar results over the long haul, choose one that is workable for your preferences. Since the secret of many commercial diets is portion control or decreased calories by eliminating certain types of foods, you could try something even simpler. Ms. Nonas suggested a 1200 calorie meal plan which utilizes easily obtained meal replacements such as bars or shakes. For example: Breakfast is a shake plus a fruit, Snack is one fruit or protein serving, Lunch is a bar and a vegetable serving, Dinner is a reasonable portion of what you have fixed for others in the family.

Say you don’t have time to do 30-60 minutes of exercise on most days. It is an option to break that time up into smaller segments. Keep track of the walks across campus, walking at work, walking kids to school and back home. All those trips up and own stairs, yard work–all those minutes count. And it’s never too late to learn a new physical skill. For me it was cross-county skiing, and backpacking in my 30′s. I took up running in my early 40′s, and began weight lifting at 50. This was a departure for a person who was always last to be chosen for a team because I was so uncoordinated (I still am).

In Conclusion…

What I learned can be summarized in a few words. While becoming menopausal may impact weight and fat distribution, the effect of menopause is smaller than that of general aging and lifestyle choices. Genes do play a role but their impact is modulated by age and how we eat and exercise. …Thanks for all the good questions which pushed me to make this investigation.



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Technorati Tags: women’s health, weight, obesity, menopause, age, diet, exercise, fitness, health and wellness

Posted by: Jane Harrison-Hohner, RN, RNP at 11:49 am


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