Diet and Women

Medical Author: Carolyn Janet Crandall, MD, MS, FACP
Medical Editors: Melissa Conrad Stöppler, MD and William C. Shiel Jr., MD, FACP, FACR

Ms. W. J., a 55 year-old woman, comes to her doctor saying, "Doctor, I have never been this heavy in my life, even after I had my kids. I am trying to diet, but it's not working. I'm so frustrated. Is it due to my hormone pills? It seems like it's worse since my mother passed on last year." This type of encounter occurs every day across the U.S. Over half of all Americans are overweight, meaning they are at a weight that is associated with increased health risks. Even though Ms. W. J. has worked hard at trying to lose weight, she needs to know some of the possible reasons why she hasn't been successful. Her situation brings up four major issues, including menopause, hormones, personal loss, and diet failure.

Menopause and hormones

Women have more body fat throughout their lives as compared to men. After menopause, women generally gain weight. Research is still conflicting as to whether this is due solely to menopause or solely to age (because men also typically gain weight as they become older), or perhaps a combination of age and menopause.

When women are taking hormone therapy, they are just as likely to gain weight as women taking a sugar pill (placebo). This means that the hormones are not causing the weight gain but rather that menopause itself, in conjunction with age, is likely to be responsible. It is not Ms. W. J.'s imagination that she is heavier than she has ever been during this menopause period. This is very common.

What about personal losses?

Ms. W. J. has suffered a major loss with the death of her mother. Weight gain commonly occurs after emotionally traumatic events. A woman with significant stress in her life should not pick that time to try to lose weight but should focus on eating a balanced, nutritious diet to maintain her strength and fitness. Successful weight loss requires a large amount of energy that she may not have after a traumatic event or loss. This can be too much for her to expect of herself and may lead to additional disappointment. The same goes for a woman with untreated depression. She needs to be sure to discuss any symptoms of depression and begin treating them before she makes serious efforts at weight loss. That way, she can avoid failure in losing the weight and achieve an overall healthier state.

Ms. W. J. needs to confirm that she doesn't have depression that began after the death of her mother, which may require special treatment. Many women don't realize that weight gain can actually be a symptom of a clinical depression.

A woman with any single warning sign of depression, such as easy tearfulness, anger that seems out of proportion, difficulty concentrating, or feelings of social isolation and guilt should tell her doctor immediately.

Dieting has not helped her. Why?

When women diet to lose weight, especially after menopause, they will not be able to continue losing weight unless they also exercise. This is because exercise prevents the decrease in metabolism that occurs when women diet without exercising. Exercise also prevents loss of muscle. If you diet without exercising, you lose muscle along with the fat, which is not healthy.

Exercise for weight loss does not have to involve working out in the gym. Actually, the "right" exercise is simply the one you will actually do. Walking daily, for example, is typically sufficient to prevent the plateau in weight loss that occurs with dieting alone. If lower body aches and pains prevent walking or impact aerobics, a woman can try upper-body exercise, for example with a rowing machine. Sometimes, swimming or exercise bicycles are tolerated when weight-bearing exercise is too painful.

Most people don't know how to properly start an exercise program. It is critical to know the proper sequence of steps in starting to exercise to ensure success in the program and to prevent injury. The first task is to exercise consistently, preferably daily, even if it's only five minutes of walking per day. After achieving consistency in the exercise, the next step is increasing the duration of the exercise, trying to increase it very gradually to 30 minutes daily. This gradual increase is especially necessary for people who haven't been walking much. Lastly, the intensity should be gradually increased. Thus, the proper order is consistency, duration, and then intensity. This sequencing is important in preventing the person from tiring from the exercise and giving up if they try to start too aggressively all at once. People are healthier and more satisfied if they pursue exercise in the recommended order.