Her Body: Battling Midlife Weight Gain

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."

Secondly, she says, you're probably going to have to increase your physical activity. Generally, doctors advise getting 200 minutes of exercise a week to maintain weight, she said. "But for anyone going through the menopause transition, you have to do at least 300 minutes a week of exercise," she said. That translates into walking at least 10 to 15 miles a week, she said. As someone who doesn't enjoy exercise herself, Nonas said she's sympathetic with those who aren't thrilled to hear that message. "But you have to stop thinking of exercise as a punishment," she said. To get off to a good start, she suggests working with a trainer or taking an aerobics class several times a week. "You need someone who's going to keep you going, and something that's measurable," Nonas said. "Not a walking partner who's going to say, "It's too cold to walk today'."

Getting more exercise is not enough, however. "If you want to maintain your weight, or lose weight, you will also have to go on a more restrictive diet, and you have to make it measurable," she said. Any diet that's vague--such as promising yourself to eat more vegetables and less sugar and starches--rarely works. Instead, start a food diary. By writing down everything you eat, Nonas said, you will determine your eating patterns, and when the temptation to overeat is highest. What's typical, she says, is that women eat a small breakfast, go out for lunch, and then come home after a long day and start cooking. "We tend to nibble while we're cooking, then we put out the meal and eat it, then we clean up, and starting nibbling again, and then we finally go sit down and relax. For the rest of the night, we go in and out of the kitchen until bedtime. Sometimes we're good and just get an apple or a rice cake, but other nights, we snack on things that are more dangerous." And ultimately, it all adds up, she said. To counteract that pattern, she suggests letting someone else clean up and making the kitchen a no-go zone after dinner. Putting up a masking-tape barrier at eye level as you exit the kitchen helps reinforce that pledge. And don't eat anything in front of the TV.

Another effective aid: meal-replacement plans, which include programs like Weight Watchers, Slim Fast and the Subway diet. Nonas said she's become a reluctant fan because of research that shows they reduce portion size, are easy to use and are inexpensive. "These programs are very repeatable, very rote," she said. "And if you eat anything else, you'll know it. There's no confusion." If one plan doesn't work for you, try something else, or make an appointment with a dietician "to help find the right mix of tools," Nonas said, and to get a steady supply of encouragement.

The ultimate goal is to change your lifestyle so that you're taking in fewer calories and expending more energy to keep the weight off permanently. "You're now in a new phase of your life," she said. "You need to get over it, and figure out what you're going to do about it." What's best is to aim "to make every meal, every snack, healthy. It should all help you achieve a complete nutritional picture." But even if you just go on a series of diets, and keep gaining and losing the same five or 10 pounds, you deserve a pat on the back, since research shows that the alternative is often steady weight gain. "We need to redefine maintenance and redefine success," she said. "If you're just maintaining your weight, you're doing a hell of a job."

And finally, she suggests being smart about food during the coming holiday season, when temptations abound. Here's a handful of tips for getting through the season without the gift of extra pounds:

Don't wait until New Year's to make weight-loss resolutions. Put a plan in place before the holidays. If your co-workers bring in goodies to the office, keep gum in your mouth during the day. Not only does gum burn up some calories, but it forces you to pause before popping a cookie in your mouth--which should give you time to focus on what you're eating and resist the urge. At cocktail parties, keep your beverage glass in your dominant hand. (For example, if you're right handed, keep your drink in your right hand.) That will force you to pause before picking up finger food--and again, time to resist when necessary. Decide before you go to a party if you're going to eat dinner afterward, and adjust your food intake accordingly. If you eat until you're full, you're probably eating too much. Increase the amount of vegetables you're eating, but avoid potatoes, corn and peas, all of which are high in starch. Be aware of the calories you drink; eggnogs, alcoholic drinks and fancy coffee drinks all add to your calorie load. Don't give gifts of food and discourage others from giving them to you. The more treats in the house, the harder it is to avoid them.