Why I Don't Write About Weight
A Personal Manifesto by Selene Yeager
What nearly 30 years of health and fitness writing has taught me.
When I launched Hit Play Not Pause and started writing for the Feisty Menopause team two years ago, my goal was to help active, performance-minded women understand what was happening during the menopause transition so they could work with their changing physiology to feel and perform their best during this time of life.
Over 113 episodes, only two (including the one out this week with obesity medicine scientist Fatima Cody Stanford, MD, MPH, MPA) cover weight in menopause, and neither is through the lens of weight loss as the ultimate goal. It’s honestly something I hadn’t thought much about until recently as I’ve been watching diet culture follow the masses and the money and increasingly setting its sights squarely on our demographic.
This is not new for us. When our bodies changed in puberty, the teen magazines started selling us diets to stay thin and battle our burgeoning bodies. If we had babies, there was no shortage of outlets promising to help us “get our bodies back” as soon as possible. And now, as our ovaries are shutting down production and we’re reversing hormonal course, our shapes are shifting again, giving us padding in places perhaps we hadn’t had before. And there are plenty of diets directed our way.
You just won’t find them here. Why? Because I spent much of my professional life writing about diets: South Beach, Atkins, Low Carb, Low Fat, Smart Carb, Keto, Weight Watchers, Intermittent Fasting, Fit Not Fat at 40+. Decades of endless diets. Did they work? If they did, they wouldn’t still be multiplying. Over the decades, I’ve met hundreds of women who put their lives on hold while they tried to lose weight. Who felt like failures every damn day because they couldn’t “take it off and keep it off” as the headlines always promised.
They’d been sold a bill of goods that weight management is all about “calories in calories out,” exercise, and willpower. I won’t say that what you eat or your physical activity levels don’t impact how much fat your body does or does not store. Of course it does. But there’s also a whole lot that scientists are still trying to figure out. Nobody knows all the answers, and weight itself, as well as what a “healthy” weight actually is, is a whole lot more complicated than what we’re often told.
We’ve Been Sold a Bunch of Bullshit
Before we get to the science of weight, specifically fat storage, let’s take a moment and shine a big bright light on the ugly bill of goods women have been sold when it comes to their bodies. Remember supermodels like Twiggy in the 60s and Kate Moss and heroin chic in the 90s? (Which is trying to make a comeback and can just go f*** right off.) In her heyday, Moss reportedly had a BMI of about 15, according to the Atlantic, and is said to have weighed just 98 pounds at her skinniest. She also appeared on more than 300 magazine covers.
Remember Bridget Jones of the Bridget Jones’s Diary? You know what she weighed as she lamented how fat and unlovable she was? At the start of the movie, the 5’5” Renee Zellweger who played the character was 130 pounds, according to the Washington Post. The movie starts with Bridget distraught at weighing 136 lbs. Let that sink in. Singers and fashion models died from anorexia during these decades. The ideal body image many of us have burned into our psyche is not healthy.
A lot of the reason I don't focus on weight loss is because it feeds into the idea that fat is bad, period. We’ve been conditioned to think of fat as a personal failure. If we gain weight or are fat (which can be pretty subjective), we must be lazy, eating the “wrong things,” or not trying. When someone says they are eating healthfully, exercising lots, and don’t lose weight, we don’t believe them. The cultural message also assumes they must be unhealthy. That’s all something Dr. Stanford is on a mission to change, which I’m sure will be welcome news to many in our community who line up for running events and triathlons, bike hundreds of miles, do CrossFit, and live active, healthy lives in bigger bodies.
Weight is a Product of Your Brain
So, why do we gain weight? And to be clear when we talk about “weight” we’re talking about energy storage—aka fat. Ultimately, because our brain directs us to.
“The central nervous system regulates weight,” says Stanford. That’s right, fat storage starts in the brain. It’s the master control center that determines appetite, cravings, behavior, and importantly, fat storage.
Stanford explains that there are two pathways of the brain that regulate weight. One is the proopiomelanocortin (POMC), which is the pathway that tells us to eat less and store less. The other is the agouti-related peptide pathway (AgRP), which tells you to eat more and store more.
This whole system and your weight are influenced by countless factors—internally and externally—including our genes, environment, behavior, development, medications, gut microbiota, and more.
In people who have the disease of obesity (which, to be clear, is not synonymous with “being fat”; you can be fat and not have the disease of obesity…more on that in a bit), Stanford explains the root cause is often the AgRP pathway triggering them to store and hold more fat tissue than they need or is healthy for them.
She shared this slide during her presentation at NAMS to illustrate just how complex, individual, and multifactorial all these contributing factors to energy storage really are.
Things like physical activity, a nourishing diet, quality sleep, and stress management all can help alter fat storage and burning. But it’s important to recognize that for some people these changes won’t always be enough to alter those pathways, and that is not something you control.
Your body will also fiercely defend weight, which is why weight loss is notoriously difficult to maintain. Stanford explains that extreme restriction can trigger the brain to favor the storage pathway. There’s also metabolic adaptation to contend with, which is the process by which your brain will dial down your baseline metabolic rate (the energy you use just to function) in response to weight loss, which is why people end up weight cycling (aka yo-yo dieting). Your body is changing your metabolic rate to maintain energy balance—that’s what it wants.
As an example, Stanford points to the Biggest Loser contestants, who were put on extreme diet and exercise regimens. Their baseline metabolic rates dropped dramatically, making weight maintenance nearly impossible. As reported in Harvard Health, one man lost 239 pounds, finished at 191 pounds, regained 100 pounds, and 6-years later still had a metabolic rate of just 800 calories.
Menopause and Midlife Matter
Menopause and the general aging process also play a role. Estrogen helps regulate many biological processes, including cholesterol, bone health, and many facets of our metabolism. When it goes into decline, your cholesterol levels can suddenly increase. You can become more insulin resistant. You can start losing bone. So, your body says, “Woah. We need to prop ourselves up here” and it starts producing more fat, which in turn produces some estrogen, as Diana Reid, MPH, RDN, of The Global Dietitian explained on episode 44 of Hit Play Not Pause.
Research also shows that the menopause transition is a “vulnerable period for the loss of muscle mass” and you can lose as much as 10 percent of the muscle mass in your arms and legs from early perimenopause to late perimenopause. That alone can be a major factor in body composition change because muscle tissue gives you the strength and energy to be more active, helps pull glucose out of your bloodstream without insulin, and drives metabolism.
The stress hormone cortisol can rise and sleep is often disrupted during menopause. Both of those can also contribute to increases in fat storage.
Menopause intersects with midlife, which has impacts all its own. Research published in Nature revealed that lipid turnover—the rate at which fat in your fat cells is removed and stored—naturally declines with age, so you accumulate more fat even if you don’t eat more or exercise less.
We can see this in images of older adult women (and men) from around the world, including people working in fields and performing arduous physical labor day in and day out. You will still see they have a belly. They have proportionately more fat and less muscle than their younger counterparts. Some scientists suggest there is an evolutionary reason for this: that as humans aged and could not hunt and gather as well as they could in their youth, they stored more fat, which helped them survive times of famine, and those survival genes stuck.
Research shows that older people who are classified as normal and overweight via the BMI scale have similar life expectancies as well as active life expectancies (ALE), which is having no difficulty performing tasks of daily living.
When Weight Interferes with Health
Stanford says she never gives her patients goal weights or a specific target BMI (which was based on white Belgian men and had nothing to do with health or medicine). Instead, she looks at the person’s bloodwork, blood pressure, and overall health. Because though the disease of obesity is a risk factor for diseases like diabetes, heart disease, osteoarthritis, cancer, and in severe cases early mortality, it’s not a given that a person with a higher amount of fat will automatically have those health problems, especially if they are otherwise fit. On the flip side, you can be lean and still have high blood pressure, elevated lipid levels, and a host of other health issues.
As a pronounced example, Stanford points to one of her patients who came to her weighing 550 pounds, despite a very active lifestyle. He had myriad health concerns, including sleep apnea, impaired glucose tolerance, high insulin, and cholesterol issues. With weight loss surgery and medications, she helped him lose 250 pounds. Though he is still 300 pounds, he’s been able to maintain that weight for many years, and those obesity-related health issues are all in remission.
When she sees people who are having weight-related health issues who have not been able to move their weight in a healthy direction, she prescribes a pharmacotherapy agent that acts on the central nervous system to help shift them into the pathway that is linked to fat loss. She notes that when you look at the trials for these pharmaceuticals, peri and postmenopausal women generally make up 80 percent of the participants.
A Healthy Body Toolkit
If you need help with weight-related health issues, find a doctor who will actually listen to and work with you (we know that can be a challenge, but persistence pays off). Also, be sure to cover the healthy basics:
Make Muscle. We can’t say it enough. Strength train and make muscle. Muscle drives your metabolism and a 2022 study of more than 1200 women and men 40 years old and older reported that muscle mass predicted longevity better than fat mass or BMI. Strength training and muscle mass also reduce your risk for heart disease and diabetes, and improve your brain health. Be sure to support your strength training with adequate protein—aiming for 30 to 40 grams at each meal.
Pass on the diets. Eating well matters. Nourishing yourself with whole foods improves your health. Restrictive diets do not. When we practice restrictive dieting, cutting calories quickly the way diets generally do, we end up losing muscle first and then bone--neither of which we can afford to lose at this time of our lives. Our body often then holds onto fat as a protective mechanism. Dieting can also lead to low energy availability (LEA) for your sport or activity. That has negative hormonal effects, especially if you’re cutting carbohydrates, which you need to fuel exercise.
Women especially can get into trouble going super low carbohydrate, says Reid, because it disrupts hormone processes that are related to your thyroid and neurotransmitters like serotonin (which requires carbohydrates to produce). A low carb diet can leave you depressed, anxious, and/or angry--not something you need when hormonal disruption is already messing with your moods.
Prioritize fiber. Along with increasing protein, prioritize fiber-rich carbohydrates to help with insulin resistance and blood sugar (and thereby fat storage). Focus on beans, legumes, pulses, lentils, fruits, vegetables, and whole grains so you stack up on fiber all day (menopausal women should aim for 30 grams a day; twice what most get). Fiber takes longer to digest, so you avoid repeated blood glucose spikes. It helps manage cholesterol levels, which go up as estrogen goes down. And it’s excellent for your gut microbiome.
Avoid “grazing.” Rather than eating a few full meals, some people “graze” or snack on mini-meals throughout the day. That can be detrimental during this time of life, says Reid. Loss of estrogen can lead to insulin resistance, so you end up with elevated blood sugar. The more times a day you eat, the more times a day your body is going to produce insulin to try to take that energy and put it into your cells. Over time that can be problematic for your pancreas and blood sugar and increase your risk for diabetes. The better strategy is having three satisfying meals a day. If you have a workout during the day, snack around that as you need to fuel yourself, but otherwise, space out your food intake so you’re eating every four to five hours.
Get curious. Rather than being judgemental and angry to the point that you want to punish your body into looking and behaving as it did five or 10 years ago, get really curious with it, says Reid. With the understanding that bodies change over our lifespan, you can examine some of the factors that might not be working for you at this time. How is your sleep? How is your stress? Should you look into mindfulness and meditation? Are you overdoing cardio and under-doing strength training? Maybe you need to look at your evening glasses of wine. This isn’t about being judgemental with yourself. It’s about taking an honest assessment of what you can adjust right now that can make you feel better in this phase of life.
Otherwise, live this one active life through your body with as much appreciation as you can. It’s only here with you on this planet for a short while. And you are so much more than numbers on a scale or a size tag in a pair of jeans.
Learn More
Feisty Resources
Weighty Matters with Diana Reid, MPH, RDN (Episode 44)
https://podcasts.apple.com/us/podcast/hit-play-not-pause/id1533088916?i=1000532354522
Protein for Women & The Power of Calling People In
https://www.feistymenopause.com/blog/protein-the-power-of-calling-people-in
Why Active Women Really Need to Eat Enough During Menopause
https://www.feistymenopause.com/blog/why-active-women-really-need-to-eat-enough-during-menopause
Another Reason to Eat More Carbs: Fiber
https://www.feistymenopause.com/blog/another-reason-to-eat-more-carbs-fiber
Guts & Glory with Stasi Kasianchuk, RDN (Episode 27)
https://podcasts.apple.com/us/podcast/hit-play-not-pause/id1533088916?i=1000517072788
I hot linked all the studies…we can list them here or not….
Obesity, POMC, and POMC-processing Enzymes: Surprising Results From Animal Models
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8489426/
Emerging Signaling Pathway in Arcuate Feeding-Related Neurons: Role of the Acbd7
https://www.frontiersin.org/articles/10.3389/fnins.2017.00328/full
A Review on the Role of Food-Derived Bioactive Molecules and the Microbiota–Gut–Brain Axis in Satiety Regulation
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7919798/
Exercise, metabolism, and weight: New research from The Biggest Loser
Adipose lipid turnover and long-term changes in body weight
https://www.nature.com/articles/s41591-019-0565-5
The young hunter hypothesis: age-related weight gain – a tribute to the thrifty theories
https://www.sciencedirect.com/science/article/abs/pii/S0306987700911125?via%3Dihub
Association between self-reported body mass index and active life expectancy in a large community-dwelling sample of older U.S. adults
https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-022-03021-7
Effects of age and gender on body composition indices as predictors of mortality in middle-aged and old people
https://www.nature.com/articles/s41598-022-12048-0
