A personal reflection
Oh boy. OK, Dr Jen, I love you, you are often a voice of sanity in the wilderness but this is a top to bottom 'no' from me, and I'm feeling sick as I write it because I hate contradicting even people I hate but when it's someone I like...ouch. I am so so sorry but this is all coming from a place of antifat, thin, white, rich privilege and nowhere is that acknowledged, and I know that is so, so triggering for people because it is so horrible to think we might be insufficiently kind or compassionate, especially when we are 'just' looking out for people's health, but this is not kind, not at all. Talking about 'doing the things that worked' is so horrible for people for whom it does NOT work, and talking approvingly about tracking calories and exercise is beyond triggering for people with all sorts of eating disorders and it is particularly problematic when you are talking from a position of authority as a medical professional. You may talk about how it's not about losing weight but the first metric you cite in all these instances is the amount of weight gained or lost. I confront this constantly with people who profess to love me and then talk about my imminent death because I am not trying hard enough to do the things 'that work'. And I'm actually really healthy! How the hell must it feel for people who aren't doing the exercise, aren't eating 'correctly' and are consequently the authors of their own downfalls? And the thing is, you could take the weight conversation out and still have a really valuable post - for people who can do it, exercise can be incredibly valuable and helpful in changing the metrics NOT to do with weight. Eating protein and fibre can be very helpful, without reference to restriction. I know you will not agree with me and feel fully justified in placing this piece here unquestioned, and I'll probably get a ton of pushback on this but this really needs to be called out wherever it appears, even if it is on the publication of a tremendously helpful, kind, empathetic practitioner. Perhaps especially then. And again, I know you might feel comfortable in stating these positions because you operate in an evidence-based paradigm and the 'science' is 'on your side' (sorry, I'm not setting up strawmen here, this is the response I get whenever I try to challenge my friends on these positions). I've gone on way too long so I won't get into it too much here but I'm afraid the science is way more fraught than is generally assumed, and I'm particularly alarmed by the 'a waist circumference of 35 inches or more for women is associated with an increased risk of cardiovascular disease and is also one of the five criteria for metabolic syndrome, and having three or more is associated with an increased risk of cardiovascular disease, diabetes, and stroke', where the word 'associated' is doing a HELL of a lot of work. I'm not a medical professional myself and you could probably destroy me in debate but the work of people like Regan Chastain, Sonya Renee Taylor, Jessican Wilson, Asher Larmie, Lucy Aphramor, Aubrey Gordon, and and and... demonstrates that this kind of presentation of health as equated with thinness (and I'm sorry, also whiteness and wealth - we'll just sail past the bit about having a trainer, an option obviously available to everyone, everywhere, at no cost. Sorry, that was really snide but it's a little grating) is really unhelpful and actively dangerous to fat bodies. I don't expect to change any minds here but it's important to call this stuff out when you encounter it. Diet and exercise are not the universal panaceas they are so uncritically presented as, and 'fat people are worthy of respect, safety, and dignity' (https://pipewrenchmag.com/dismantling-medical-fatphobia). This piece perpetuates antifat harm, however kindly, however well-meaning. Ohhh, it hurts to write this, I feel sick.
I appreciated your recognition that “weight loss isn’t the real goal here, it’s my health.” As someone with a history of disordered eating and exercise, who has worked very hard to place my emphasis on health and not weight loss (and certainly not using the flawed indicator of BMI), I’d value more content that takes into account those of us in perimenopause and menopause with these histories. For many of us, daily tracking is contraindicated and a sure fire way to trigger unhealthy behaviors.
I deeply appreciate the fact-based information you always supply. I too have found that menopause has not caused weight gain, but that fat has accumulated around my waist while I've sadly lost muscle mass. I've always enjoyed being physically active but after the recent illness and loss of my husband and son, I've abandonned most of my routines, and feel unwell. I know that once I get my mojo back and take to the bike and walkways again, it will help with endorphins and mood. Your article has given me a mental boost.
Thanks for the candor and reason here. It has caused me to reflect on my own counseling of women around menopause, as so many come in complaining of weight gain. Intuitively they feel like a switch has been thrown, not only in terms of quantity of weight gained more easily, but distribution around the middle instead of the hips (less healthy apple). I’ve been validating their narratives - it’s just such a common occurrence that it almost has to be part hormonal, no?
The drop in estrogen catches women up to men in terms of cardiovascular risk within 10 y after menopause I think. This post is great because it reminds me not to reinforce fatalism with weight gain, and to go back to the basics… with regimentation and daily diligence and data. Yet can’t we agree that something makes this a near universal challenge for women at this age?
Or is it just that being in your mid 40’s to mid 50’s often sucks badly, with stress coming from every direction?!?
Um. I, in middle age have a waist circumfrence of 27", up from 24" for my 20s and 30s. Im also 4'11" and weigh around 100 lbs, which is 10 lbs more than 20 years ago.
My friend is 6'1" and weighs about 180lbs. Shes built like the female version of a linebacker. She has a waist circumfrence of about 37". She also lifts weights competitively, exercises and is generally in way better physical shape than I am. But according to this "she is at higher risk".
No. Theres such a thing as different body shapes. For me a waist of 35" would be obese. But for a naturally very tall and stocky woman 35" waist might be completely normal.
BMI doesnt work for very small or very muscular people. And saying broad statements like "size x waist is bad" completely negates the wide variety in healthy female body sizes. For someone whos constantly talking about how women need to stop hating on their bodies just because they are female, you done goofed here.
I appreciate you Dr. Jen for your no nonsense style of disseminating information to women! Thank you for stating the obvious with regard to menopause and weight gain. You have inspired me to tackle this problem in my life. Here goes with great love and compassion for what lies ahead.
I fell for all the Winona buzz words. I signed up and was on their “bioidentical” hormones for 4 months. But because menopause was in my algorithm I found you. I called my PCP asked her about hormone therapy and she referred me to a fabulous doctor. She put me on weekly estrogen patch and progesterone tablets every 3 months for 2 weeks. I’ve added more strength training into my routine along with my usual long distance running. My weight has never been a problem it’s where it’s settled, gut, that I’m trying to accept. Thank you for all your practical information. Love your books
For anyone who is interested in the recipes from NYT Cooking that Dr. Gunter shared, here are non-paywalled “gift” links. (Anyone who has an NYT Cooking subscription can share 10 non-paywalled recipes a month.)
Hyperlinking may not work in Substack comments but if you copy and paste the link into your browser it should work.
Slow Cooker Chipotle Honey Chicken Tacos
Turmeric and Black Pepper Chicken
Loved this articles! Being a personal fitness coach I deal with this topic every day and there’s no way, people want to believe that weight gain is all about menopause
I made the honey chipotle tacos and the chicken and lentil soup. Both were extremely good and easy...we'll be making them again. Thanks for sharing!
Any idea what amount the muscle loss associated with menopause is? Once you're post can you get some of it back? I lift heavy 4 times a week and this is what's most concerning to me. I work hard for my muscle and don't want to lose it! I'm also fully aware of muscle decline with age, just want to know how menopause contributes.
The NYT doesn't allow access to its recipes w/o a subscription.
Thank you for this Dr Jen, sometimes you just need to do what you need to do without looking for new excuses (that would be me). One question though, I have noticed progressive food aversions and significant fluctuations in appetite. I read elsewhere these can be related to estrogen (E1, E2). Any thoughts on this? Thank you!
Hi Dr. Jen, I'm working on my protein intake and still trying to find my sweet spot. I like your goal of 100-120g per day. Might you sometime share a "day in the life" post of what you eat to achieve this goal? Thanks!
This post is enough to cancel my just-started subscription.
I am SUFFERING not being able to lose weight after a HORRIFIC two years of balding, f-ing ugly and painful breast cancer treatment. I cannot lose weight. I now have disordered eating (and in therapy). I am menopausal. I am f-ing up my daughter as she watches me starve, over-exercise, and spend way too much money on trainers and pilates and nutritionists and engage rigidly in expensive, healthy food (and freaking out if I stray).
I am overweight. It increases my cancer risk. Cutting off a leg or my head is the only way I could get the weight down. I'd love to run again- but cancer and menopause have tag-teamed on my joints, I have two partially torn Achilles.
This post was total BULLSHIT- like an old man doctor wrote it.
Can you write your commentary on the skinny shot (lipotropic injections). My mom’s friends going through menopause are getting it recommended by their doctors.