Drop Those Pounds!

There comes a moment, some time in your 40s, when you climb on the scale and have an epiphany: What you used to refer to as your "high" weight (when only your "fat" jeans fit) has become your average weight. You also seem to be carrying a lot more around your middle. And none of your old tricks for quick weight loss--doing three days of Atkins, going to the gym a couple of times a week, cutting back on alcohol or sweets--are working for you the way they once did. To reverse this, you go on a diet for a few weeks and lose a little weight, but it's coming off ... much ... more ... slowly than in the past. And when you resume your old habits, it's back on in a flash.

"Most women tend to blame themselves when this happens," says Cathy Nonas, the director of the diabetes and obesity program at North General Hospital in New York, and author of "Managing Obesity." "We women tend to think, "I must not be doing this right.' We're somehow blinded to the fact that all women 45 to 60 years old are dealing with the same thing. We only see the 23-year-old next door who seems to be having no problem at all."

In fact, Nonas says data from the huge federal study called the Women's Health Initiative (WHI) indicates that ages 45 to 60 may be the toughest years in terms of weight maintenance that women face during their lifetimes. While older people generally have a harder time losing weight than younger people, the WHI study found that fiftysomethings had "a much tougher time maintaining their weight" than women in their 60s and 70s, she said.

Hormonal fluctuations associated with menopause may play a role in this, although exactly how remains unclear, since about equal numbers of women gain weight as lose weight while taking supplemental estrogen. What we do know, however, is that "there's a very subtle slowing down of the metabolism between 45 and 60," said Nonas. "On a daily basis, it's not that big of a deal, but over the course of a couple of years, it adds up." Plus there's the fact that most 45-to-60-year-olds tend to have fairly sedentary lives, she said, so they are not getting as much exercise as they once did. "And even if your weight doesn't change, your body fat distribution is changing," she added. "Suddenly your waist is getting bigger and none of your pants fit right, and you can't figure out what's going on. This period is very frustrating for women."

Rather than get discouraged at midlife, Nonas urges women to use this knowledge to turn the situation around and come up with a battle plan that will be effective. "Women need to know that it's not impossible to lose weight during these years, but it is going to be difficult to do, and it's not going to work if you approach it in a vague or half-hearted way."

In practical terms, what does that mean? First, she says, doctors need to start talking to women about the coming metabolic changes much earlier, when women are still in their 30s or early 40s. "We need to get on women about this when it's still a little problem, before it gets to be a big problem," she said. "They need to know what's coming, and be encouraged to think of it as an opportunity to get healthier."