Recently, I was diagnosed with an injury that has benched me from my regular exercise. Couple this with the impending onslaught of eggs, bunnies, and other chocolate wonders that appear this time of year and not surprisingly, my attention has turned to the possibility of weight gain.
Weight gain in peri and post menopausal women is a significant health issue. We know that women in late middle age have an increased risk of cardiovascular disease (CVD) that rivals men, and that carrying too much excess fat is a significant contributor to CVD. In our age group, carrying too much weight can also increase the risk of things like problems with metabolism, cognitive decline, arthritis, urinary incontinence, cataracts, and cancer. Good times.
Many women have been conditioned since an early age to weigh themselves regularly, but using weight as a measurement becomes more problematic over 50. Most importantly, the number on a scale doesn’t reflect the loss of what we call “fat-free mass”.
Fat-free mass includes muscle and bone, which contributes a significant amount to overall weight. Why does this matter? Put simply, these days, when I lose a pound or two, I am less likely to celebrate and am more likely to be concerned about my muscle mass and bone density; smaller muscles and thinner bones weigh less. As we get older, preserving muscle and bone mass needs to become a priority.
If you have read some of my other blog posts, you know that I talk a lot about sarcopenia, the gradually loss of muscle mass that comes with aging. With dieting, we can lose our precious muscle and bone. Over one quarter of intentional weight loss in women in our age group comes from the loss of fat-free mass. Even more alarming is the phenomenon of the cumulative loss of fat-free mass that comes with weight-cycling.
Weight cycling is the habit of gaining a little weight and then going on a short-term diet to then lose weight, usually in the form of something like, “I’ve got to get thin for my vacation!” Although in your younger self this didn’t pose much of a problem, for women of post-menopausal age, weight cycling can have some unintended consequences.
In a study looking at weight regain in post-menopausal women who had participated in a weight loss program, researchers found that after one year, many of the women had regained some or all their weight. When the researchers analyzed the type of weight gain, on average only 6% of the original fat-free mass was recovered while 26% of fat lost was regained.
Even though losing weight can reduce our overall risk of developing many diseases, we need to be careful with changes in weight post-menopause. Losing muscle has a significant impact on our ability to burn calories, our physical function, and our overall chronic disease-risk. Bone loss can put us at greater risk of developing osteoporosis and subsequent fractures.
Here are some things to consider if you are in the habit of dieting, or if you are trying to reduce your weight long-term:
1. Consider breaking up with your scale: There are better ways to measure your body mass. Although there are debates in the scientific literature about what method is best, here are two ways that you can think about moving away from the scale.
a) Buy yourself a soft tape measure (the kind you would get at a fabric store) and measure your waist. Here’s what to do to get an accurate measurement: while standing, wrap the tape measure around your middle, just above your hipbones. Measure your waist right after you exhale. You will want to take note if your waist measures over 80cms (that’s just over 31.5 inches for our American friends).
If your waist is bigger than 80cms, your risk for many diseases (especially heart attack and stroke) increases substantially. You may want to consider a program that combines diet and exercise (especially one that includes strength-training) to improve your overall body composition.
b) Calculate your Body Mass Index (BMI). Although we tend to discourage the use of BMI in younger populations, in a study of different types of methods to assess fat mass in post-menopausal women, BMI was surprisingly accurate. This may be because women in the over 50 category are less likely to do intense exercise, so their BMI is not as easily skewed by large amounts of muscle that we may see in a younger group.
Using BMI won’t be the best measure if you are doing regular moderate to vigorous physical activity or if you have a routine strength-training program. If you want to know your BMI, there are many online calculators that work well. Having a BMI of over 25 puts you in the category of “overweight”, and over 30 indicates obesity.
Your best bet is to take BMI and waist girth together, but not too often. Try taking your measurements every two weeks or once a week at most.
2. Eliminate dieting that doesn’t have an associated exercise program. You’ve heard the term “skinny fat”? This term changes to “sarcopenic obesity” in post-menopausal women. In other words, you could be considered a normal weight, but have significant muscle and bone loss along with the increased health risks associated with carrying a high amount of fat mass.
3. Make peace with imperfection. This is the age that we can let go of striving for an unrealistic body composition. That cellulite on the back of my thighs? It’s never going away, no matter how many miles I run or what I eat. It’s just my body, and it’s okay.
So, this weekend I will swim and take it easy on the chocolate bunnies. What about you? If you have a moment, check out this great article about realistic weight loss from one of my favourite health researchers.
Your sister in health,
 Beavers, K. M., Lyles, M. F., Davis, C. C., Wang, X., Beavers, D. P., & Nicklas, B. J. (2011). Is lost lean mass from intentional weight loss recovered during weight regain in postmenopausal women? American Journal of Clinical Nutrition, 94(3), 767–774.
 Kanellakis, S., & Manios, Y. (2012). Validation of Five Simple Models Estimating Body Fat in White Postmenopausal Women: Use in Clinical Practice and Research. Obesity (19307381), 20(6), 1329–1332.
 Batsis, J. A., Gill, L. E., Masutani, R. K., Adachi, M. A. M., Blunt, H. B., Bagley, P. J., … Bartels, S. J. (2017). Weight Loss Interventions in Older Adults with Obesity: A Systematic Review of Randomized Controlled Trials Since 2005. Journal of the American Geriatrics Society, 65(2), 257–268.
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