40 Comments

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.

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Thank you!!!!! I love that Dr Gunter is such a voice of reason when it comes to science. That’s why it’s particularly shocking to hear things like the 35 cm waist from her. That’s correlative, not causative, and pretty obvious that it’s shaky science. Women of all heights should have the same size waist?? Even if you had causative data, it should be based on some ratio of hip bones distance and shoulder bone distance or something. Not to mention that I’d love to see a study that shows a way through diet and exercise to keep weight gain off for more than 5 years and doesn’t cause eating disorder behavior! Her personal trajectory of starting to gain the weight back is exactly what data shows happens after weight loss. So unusual for this newsletter to veer away from rigorous science

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Also gonna put this book rec here: Fearing the Black Body: The Racial Origins of Fat Phobia

By Sabrina Strings https://bookshop.org/p/books/fearing-the-black-body-the-racial-origins-of-fat-phobia-sabrina-strings/16637571

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Oh yeah, that book is AMAZING.

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*gain back at the 2 year mark

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For a pro aging, weight neutral, body liberation perspective, I’d also recommend Deb Benfield, RD, @agingbodyliberation https://instagram.com/agingbodyliberation?igshid=NTc4MTIwNjQ2YQ==

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Oh thank you, I'll check it out!

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Debra Benfield is great. She has good stuff.

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As a HAES-informed dietitian (I was actually on the committee that coined the term "health at every size" back in the late 90's), I have to agree with Jeanette. I love Dr. Jen and share many of her articles with other health practitioners. She is a breath of fresh air in a world of so much pseudoscience. But this article did come across as anti-fat and privileged which surprised me. However, I do respect and honor Dr Jen's personal experience with her body and her weight and if that's what works for her then so be it. Re waist circumference (WC), there's a better measure called wait-to-hip ratio (WHR) and the research shows higher WHR's are associated with higher risk of heart disease and diabetes (yes I know association is not causation, I'm simply stating the facts). But even more important than either WC or WHR is cardiorespiratory fitness (CRF). CRF is a better predictor of early mortality than BMI, WHR, weight, waist circumference, and even blood pressure. Better to be fat and fit than skinny and unfit, basically. But even though I sing the praises of CRF to all of my clients, most of them still want weight loss. I discourage calorie counting and or any form of dieting so if they really want to lose weight and are aware of the high risk for regaining what they lose, I help them create a small calorie deficit that produces a very slow weight loss over time and that seems to work well. But I'd much rather help them become more fit, strong, and enjoying a flexible nutritious way of eating than pursuing weight loss any day.

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I was starting a mental spiral while reading the post and this comment re-centered me. **thank you**

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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.

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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.

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Double loss (husband and son) is a terrible thing to go through, and quailifies as 'complex grief.' If you haven't sought counseling for this, I suggest that you do. My heartfelt sympathy on your loss.

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Thank-you.

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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?!?

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Yes, that is what is called the sandwich piece. You're typically parenting your kids and you're dealing with aging parents, in addition to the pressures of financial pressures of saving for college, retirement, etc. Not to mention that people are more stressed than ever with work and such. Most of my clients are stressed beyond belief and the whole body changing thing just exacerbates a lot of the stress and decreasing self-confidence.

The other thing I'll say is that I had a similar experience to Jen. In the 1st 4 months of COVID, my diet and alcohol consumption went to hell. I went to a naturopath and was given a bunch of supplements that didn't do anything except rob my bank account.

I locked in and cut out a lot of red meat and alcohol, and the amount of inches started shrinking on my body (yes, this also led to weight loss and BMI is terrible). Stopped taking the supplements. Inches still continued to drop off. It showed me that if I just had some more discipline, I could do this. BUT.... this is my experience. I am not denigrating anyone else's path or choices.

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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.

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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.

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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

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Im not sure why some were triggered by this. While I believe you should feel comfortable in your skin, ignoring evidence because it offends you is dangerous. She is not wrong - there are significant implications of waist circumference >35 inches and morbidity. Comparing rare body types who may be completely healthy at that waist circumference isn't really helpful because that is not what the evidence is based on... For the average woman with a waist circumference >35 inches you are more likely to get diabetes, hyperlipidemia, hypertension and cardiovascular disease. It has been studied A LOT. Not just a little paper with a small sample. Studies have included thousands of people from multiple countries around the world, and have shown the same evidence. Meta-analyses of these studies have shown waist circumference >35 inches is associated with the above. Getting mad at someone for stating evidence based medicine because you don't like the end result doesn't change anything.

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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

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That's a really great idea! Thank you. I never thought about doing that! If I link to anymore of their recipes I will definitely do that. Thanks again!

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🙂👍

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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!

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Awesome!

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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.

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We lose about 0.7% of muscle mass a year starting in our thirties. This accelerates a little during the menopause transition and then levels back down to the age related loss. Weight training/resistance training can absolutely slow this and you can absolutely build muscle. But even elite athletes will lose some due to the age-related changes. Basically, working your muscles is the best protection. And of course it is good for the heart, the brain, and the bones.

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I lift as well. I focus on protein consumption, which my coach is hammering me on to ensure that I am consuming enough. Just started to track it more formally to see if I am on the right path.

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I am lifting and tracking protein as well. I didn't realize how little protein I actually ate until I started tracking. I am aiming for 120 g a day.

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120 grams a day! Tracking macros has 100% improved my relationship with food.

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The NYT doesn't allow access to its recipes w/o a subscription.

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Yes, I know. But for those who do have access, they are great recipes. But I also shared ones you can access!

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I will post “gift” (non-paywall links) to the NYT recipes in my comment. 🙂

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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!

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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!

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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.

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