Obesity is now one of the largest contributors to poor health in most countries, with rates having risen steadily around the world over the past four to five decades.
Researchers have used the term ‘nutrition transition’ to describe major diet and
activity pattern shifts lead to increased obesity and chronic diseases.
Technology, urbanisation and expansion of global trade have helped drive the trend towards obesity. In all countries, these changes have led to reduced physical activity in work and leisure and a shift towards the 'Western diet', characterised by a high intake of fats (particularly vegetable oils), added sugars, animal-source foods and refined carbohydrates. They have also paved the way for transnational food and beverage corporations to shape global and local food systems. This includes the spread of fast food outlets and ‘ultra-processed foods’ such as packaged snacks, confectionery and sugary drinks.
This week, Professor Annice Mukherjee, a leading UK-based endocrinologist, used the term obesogenic when she shared that forty years ago, women typically put on 2 to 4 lbs through perimenopause; today, they put on an average of 28 lbs (2 stone). 40% of women over 40 in the US are classified as obese. Similar statistics exist in other countries.
Yet, women have not experienced a radical base physiological change in the last 40 years. Menopause weight gain has always occurred because our bodies slowly ease up on the production of estradiol and progesterone, which regulate our appetite and energy levels.
According to the Mayo Clinic, this shift in our hormone levels brings on a host of other physical changes that prompt menopausal weight gain, such as:
Insulin resistance
According to the National Institute of Diabetes and Digestive and Kidney Diseases, during perimenopause, muscle, liver, and fat cells slow insulin processing, sending the pancreas into overdrive so sufficient glucose gets to the cells. Ironically, this makes us hungrier and more likely to store the carbs we eat as fat.
Decreased muscle mass
As you age, your muscle mass decreases while your body fat increases. It burns more energy to move muscle around than fat. So, as your metabolism slows, fewer calories are expended.
In her work and books, Dr Lara Briden points to an evolutionary mismatch that arises from living in an environment substantially different from the one in which we evolved.
I would call out these environmental factors as playing a key role in the weight gain of perimenopausal and menopausal women.
Sugar, Sugar Everywhere
Added sugar is everywhere in the food supply. It's so ubiquitous that you might find some packaged and processed foods unappetizing without it.
Evolution has hard-wired our palates to prefer sweet-tasting foods to obtain quick energy and avoid bitter-tasting poisons. But our diet has reinforced and strengthened that preference from early childhood. In the Western world, we take in an average of more than 17 teaspoons of sugar (about 290 calories) a day from added sugars, which is far more than recommended.
Sugar is added to countless food products, including bread, condiments, dairy-based foods, nut butter, salad dressings, and sauces. It imparts sweetness, extends shelf life, and adjusts attributes like texture, body, colour, and browning capability.
We often need simple, practical advice to incorporate into our lives to get our nutrition right. I owe so much to my nutritionist, who helped me in perimenopause to lose 10 kg and keep it off. I still refer to her simple programme years later when I need a nudge.
If you want to get your nutrition back on track, my partner, holistic nutritionist Cynthia Brace, is offering a wonderful seven-week transformational coaching programme starting soon. You can learn more about it here.
The Rise of Mummy Wine Time Culture
Alcohol is portrayed as a means to help midlife women manage complicated and demanding lives, but it's likely affecting their health. Many women now entering or in perimenopause grew up in the 1990s and early 2000s when drinking hard was sensationalized.
Now, drinking alcohol is embedded in their everyday lives, a legitimate activity for themselves and an important part of their social connection.
‘Wine-mum’ culture with its strong messages that alcohol is here to help – to slow down, to reward yourself, to take a break from the never-ending roles and responsibilities, and to engage in much-needed self-care.
Menopausal women are conscious of the health impacts of alcohol, particularly disrupted sleep, lower mood and lack of motivation the following day and how alcohol impacts weight gain front of mind. Many women engage in health-compensating behaviours, such as exercise and diet, to justify their drinking alcohol.
Society is saturated with alcohol products – and alcohol marketing that amplifies its role in enhancing and enabling everyday activities – and drinking is the norm.
This underlying need has attracted the attention of profit-driven alcohol corporations and the hospitality sector, which identifies women as a lucrative market. In the last decade or so, there has been an increased emphasis on designing and marketing women-specific products and feminised drinking venues.
I highly recommend checking out Sarah Rutbatch’s newly released book Beyond Booze. On the podcast, Sarah shared valuable insights on her journey of beating booze and how she helps others break free from grey area drinking.
Chronic Stress
In APA’s October 2023 Stress in America survey, which included a nationally representative sample of more than 3,000 adults, women reported a higher average level of stress than men (5.3 versus 4.8 out of 10) and were more likely to rate their stress levels between an 8 and a 10 than men (27% versus 21%).
Women cite family responsibilities and relationships as key stressors in their lives. They report the overwhelming sense of being burdened by home life responsibilities while often trying to maintain a standard of excellence at work. Additionally, many report feeling that their male partners are not shouldering an equal share of these responsibilities, which exacerbates their frustration, stress levels, and overall well-being, significantly impacting their mental health.
Excellent books like Hysterical and Why We Can’t Sleep provide strong evidence that women are simply running on empty. But what does that have to do with weight gain in menopause?
In times of stress, the adrenal glands secrete hormones, like cortisol, that can block weight loss in perimenopause. High cortisol levels can also push the body into starvation mode and cause it to store extra calories for energy. High cortisol levels can also affect the other hormones. Specifically, there is a complicated relationship between cortisol and estrogen. When high cortisol levels lower estrogen levels, symptoms of a hormonal balance can occur. In other cases, circulating estrogen can also increase cortisol levels in the blood, which can cause further weight gain.
Daily mindfulness can lower stress not just in the moment but in the long term. It doesn’t have to be time-consuming or complicated. It’s something you can slip into your day when you’re feeling frazzled, during a coffee break, or anytime you have a moment to sit and breathe.
I suggest finding a quiet place, setting a timer for 5 minutes, and focusing on your breath. Remember, there is no right way. Just sit and breathe for five minutes.
If it feels better, try gentle movements and do them with intention and attention. I teach simple Qigong moves that allow you to do that. You can do it first thing in the morning. Take a few moments mid-afternoon between meetings and assignments to gently move, tune into your body, breathe and release any tension.
No Time for Exercise
A survey in the UK in 2022 showed that more than 50% of women had done no vigorous exercise (running, swimming, cardio) over 12 months. A sedentary lifestyle in menopausal women is associated with more severe menopausal symptoms and obesity, as well as having long-term implications for bone health, heart health and dementia.
Exercise is proven to boost mood mentally. It can also support sleep quality and duration, something some women struggle with during menopause. Exercise helps build muscle and burn calories more efficiently to shed excess weight.
Strength training can help to improve your metabolism at this time of life. By building muscle mass, you can increase your resting metabolic rate. A higher metabolic rate is good because you use more energy even at rest. So, building more muscle can help you to manage your weight during the menopause and beyond.
Common barriers for women considering initiation of exercise are lack of time, feeling uncomfortable in the gym and not having someone to exercise with. Finding a knowledgeable and supportive trainer and environment is critical. I know many women have found that male or young trainers lack the knowledge around menopause and sometimes push women too hard, resulting in them feeling exhausted after exercising or sustaining an injury which puts them off. I have interviewed and worked alongside some excellent women-centric trainers and I highly recommend checking out Dr Maria Luque and my interview with Kelly Howard for programmes and advice on getting moving.
Rise in Sleep Disruption
Over the last 30 years or so, everyone has seen a shift towards poor sleep. Women, in particular, are often poor sleepers due to changing hormone levels during their monthly cycles or menopause. Changes in estrogen and progesterone affect many systems that can interrupt our sleep.
Thermoregulation: During menopause, estrogen withdrawal causes the brain to become more reactive to temperature shifts. This causes it to initiate cooling processes, like sweating, at lower core body temperatures—leading to hot flashes and night sweats.
Mood: Changing estrogen levels may interfere with neurotransmitters involved in mood regulation. This could explain why mood swings, depression, and anxiety are more prevalent during the menopausal transition—along with the sleep difficulties associated with these conditions.
Metabolism: Menopause affects the way the body converts food into energy. Low estrogen levels can contribute to weight gain, which can contribute to the development of snoring or sleep apnea.
Circadian Rhythm: Following menopause, many people experience a weakening of their circadian rhythms, the biological processes that operate according to a 24-hour clock. This includes the sleep-wake cycle
These problems become greater in the modern world because infrastructure and our lifestyle choices have ‘thrown a wrench’ in our biological clockwork. Our day length is longer due to artificial lighting, staying up staring at screens and being primarily sedentary. Many live in environments of constant temperature and noise, which are not conducive to good sleep.
We are eating longer, i.e., our feeding window has now extended to more hours in the day. We evolved to eat more carbs when there's bright light and sunshine and more fat and moderate protein during winter. But today, we are less likely to eat seasonally due to the all-around availability of food, thanks to our modern food supply chains, leading to a mismatch inside our system.
If we ignore natural rhythms, we are more at the mercy of hormone imbalances, the effects of stress and seasonal changes. Some key things we can do to get better sleep beyond the typical bed routines and get better sleep and have more energy include:
Daily timing shifts [light-timing, meal-timing, movement-timing] are designed to reset your circadian rhythm. For example, go to sleep simultaneously every day, take a 20-minute walk in the morning in natural light, and turn off our screens at night.
Routines like going to bed, waking up at the same time and winding down at night an hour before bed.
Dietary choices include simple intermittent fasting of 12 hours a day, eating seasonally and cutting back on added sugars.
Relaxation-Response activation to calm the body and mind, e.g. meditation, journaling, breathwork, progressive muscle relaxation
Many of these factors draw attention to the fact that menopause is a biopsychosocial change that needs to be tackled from multiple angles. And that the factors are highly intercorrelated. For example, cutting back on sugar helps sleep, exercises reduce stress and support better sleep. Cutting back on alcohol helps to reduce calorific load, supports better sleep, and reduces anxiety and feelings of mild depression.
Medication for obesity and hormonal therapy for menopausal symptoms only go so far. They may even be papering over serious psychosocial issues that need to be addressed by individuals, organisations, and the government.
With the right knowledge, individuals can partly address some of the factors. We can take proactive steps to change daily habits and mindsets. Small steps to big change have been my mantra for many years because behavioural change can be stressful. Improving our nutrition, upping our daily exercise, and embedding better sleep routines are vital. Finding ways to bring short stress-reducing practices, cutting down on time spent on social media, and more opportunities to rest into the heart of daily life supports women to meet and manage their stressors.
However, a significant part of managing the chronic stress component lies also with men. They should reflect on their expectations of women around them in the workplace – and in the home. Men reading this should reflect: do you treat women differently than your male colleagues? Do you expect them to carry often invisible and unpaid tasks? If so, address your internal biases and become an ally.
Workplaces have an important role to play. Menopause at work policies actively support women going through menopause, whether they choose to share that or not. Workplaces proactively provide information and education to all employees on menopause and provide supportive programmes in areas like nutrition, stress management, and exercise. I would also ask businesses to review policies and behaviours around alcohol consumption. Does every team event, get-together, or after-work meeting need to involve alcohol?
The roles of government and proactive action are critical. The alcohol and food industries work against consumers, and their lobbyists are routinely attempting to stop better food labelling, sugar taxes as well and restricting alcohol purchases.
A scheme similar to Sweden's alcohol rules, where alcohol can only be bought in government-controlled stores at specific times and has led to a 30% reduction in alcohol consumption, was floated by the Scottish parliament but blocked in the UK parliament by politicians who receive funding from the alcohol industry.
If we want to see an improvement in women's health in menopause and beyond, we must look at the whole picture. Multiple changes can be adopted to help decrease the impact of obesity and its wider impact.
As always, I appreciate my community and welcome so many new subscribers, and I love to hear your thoughts and feedback. As well as topics you would like me to write on.
Clarissa x
Don’t forget my new book Beyond Hormones is now available through Amazon and provides practical and. actionable fact based support for Thriving Through Menopause.
Thank you for this thorough, informative and passionate piece! You really are a great advocate and I learned a lot!