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Menopause
Women’s Health
How to maintain a healthy weight during menopause

How to maintain a healthy weight during menopause

Think of the perimenopause/menopause as a time of opportunity to reflect on your health including diet, notice any unhelpful habits that have crept in, and try and plan for the future. The most successful way to do this is by evolution, not revolution! You don’t need to go to an expensive clinic, or buy loads of expensive supplements; simple but permanent behaviour changes give results.

Your metabolic rate will decrease by around 10% around the menopause, and this leads to an average weight gain of 1.5kg a year. Unless you are planning to significantly increase your physical activity, you are likely to need to reduce your overall calorie intake by 200-300 calories a day after the menopause just to stay the same weight.

Your healthy eating plan needs to be sustainable, so don’t think of it as a diet. Just plan on making specific changes, perhaps one or two at a time. Then continue this pattern for at least three months to establish the change, and hopefully it will then continue long term. If you have a ‘bad day’, don’t give up - we are only human! Just go back to your plan the next day.

If you are already quite overweight before the perimenopause, you may want to get help either from a weight loss group, online support, or referral to an NHS weight management service. This could help you shift some of the excess weight before menopause officially hits. However, healthy weight maintenance is the key. So developing long term healthy habits that are automatic and don’t require too much thought is essential.

Is there a specific diet that is best for women during the menopause?

There is no specific diet. The best diet will include an abundance of healthy foods, will suit your lifestyle in particular, and can be maintained in the long term. The Association of UK Dietitian's information sheet may be useful.

There are a few points, however, that we need to keep in mind when changing how we eat:

  1. Bone loss increases during the menopause - It is important to consume enough calcium and Vitamin D to maintain your bone strength and integrity. Women need daily calcium equivalent to roughly a pint of cow’s milk. If you use plant based milks, check they are enriched with calcium, or add calcium from another source. The Royal Osteoporosis Society has useful information which can be found here.
  2. Eating a diet that is - Plant based or contains at least 5 portions of fruit and vegetables of different colours a day will provide fibre, help gut health and reduce the risk of some cancers. The more vegetables the better. Aim for half a plate of salad or vegetables for two meals a day.
  3. Try to use healthy polyunsaturated and monounsaturated fats - such as olive oil or avocado oil, rather than saturated fats. But remember, you need healthy fats for a healthy metabolism and good skin. Nuts, plants and fish are all great and accessible sources. You can find more information from the Association of UK Dietitian here.
  4. You need to eat good quality protein daily - This is to keep your muscles and body healthy. Aim to make protein the star of your meal for at least 2 meals a day. Use varied sources of protein, such as lean meat, chicken, oily fish, eggs and plant proteins. These include pulses, quinoa, seeds and nuts. Take note of your protein sources. Two to 3 portions of red meat is enough to provide the iron you need, but excessive amounts can put you at an increased risk for bowel cancer.
  5. Vegetarian and vegan diets - Can definitely be healthy but it is important to educate yourself on them. Take advice to make sure you are getting enough nutrients. Use supplements if needed to fill any dietary gaps (iron, and calcium may be lower in these diets).
  6. Avoid ultra-processed foods - There is increasing evidence that they are very bad for both weight and health!
  7. Alcohol is best in moderation - It contains empty calories and increases the risk of breast cancer. It may also worsen hot flashes and interfere with sleep.

Are there any tips to help weight loss?

  • Prioritise your health and do some meal planning.
  • Keep a supply of healthy snacks with you if you tend to graze.
  • Write a shopping list, and never shop when hungry.
  • Avoid unnecessary temptation -- pay at the petrol pump rather than going to the till which is surrounded by chocolate and crisps.
  • Only have one portion of carbohydrate with your main meal- potatoes or 1 slice of bread or one portion of rice/pasta rather than pizza, chips and garlic bread!
  • Reduce your wine to one glass a night (and have some alcohol free days)
  • Get a good nights sleep. Poor sleep is associated with increased production of the hunger hormone Ghrelin, and overeating the next day.

Quick changes to help deal with hunger

Here are a few things that have been found to be useful in reducing hunger and appetite:

  • Drinking a glass of water before each meal.
  • Bulking out your plate with high fibre vegetables (fills up the stomach and also fibre promotes healthy gut bacteria).
  • Eating protein foods such as eggs, fish, lean meat, nuts, and vegetable proteins (increases the production of gut hormones that suppress hunger).
  • Try soup at the start of a meal, which can be quite filling.
  • Eating slow release carbohydrates to avoid blood sugar spikes, which can trigger more sugar cravings if blood sugar swings widely. These are known as low glycemic index foods (low GI).
  • Eat whole fruits rather than drinking fruit juice or smoothie. This increases fibre, slows eating and reduces the GI index.
  • Avoid highly processed foods which often contain hidden sugars, excess salt and unhealthy fats.
  • Chew low sugar gum (satisfies need to chew).
  • High fat foods may be more satisfying, but take care with portion size. The body needs omega 3s and omega 6 fats. These can be found in seeds, nuts, oily fish, grains and vegetable oils such as sunflower oil.
  • Tasty foods may be more satisfying; adding herbs and spices increases flavour without increasing calories. It may also help to have a variety of textures on the plate.
  • Eat regular meals throughout the day. 3 filling meals can avert you from constantly feeling the need to snack.
  • Physical activity increases your metabolic health, and reduces stress hormone cortisol.

Think about your food environment

What foods do you keep at home?

If you have free access to healthy foods such as fruits, nuts, and vegetables you are more likely to eat them. But if you have cupboards of crisps, biscuits and chocolate, or your emergency freezer food is pizza and garlic bread, you are making life hard. There is NO NEED to keep stocks of treats for the children or grandchildren in the house - you will be tempted to eat them!

What about work?

Do you buy a sandwich or lunch deal and a coffee every day? Taking in a packed lunch gives you more control, hopefully a healthier option and saves money! It really does not take long, and in the past you would happily have made packed lunches for your partner or children, so why not bother to look after yourself?

Develop a habit of mindful eating.

Don’t eat on the run. sit and savour your food - eat slowly and you will be satisfied with less food, and possibly avoid indigestion! Avoid snacking in the evening when watching the TV. It is easy to unconsciously overeat.

What about snacking?

There is some evidence that having a healthy snack about 2 hours between meals can prevent hunger and overeating. However, the evidence is weak, and other people find the more they snack, the more they eat. Most people know which group they fall into.

A healthy snack should usually contain less than 200 calories. Avoid more than 2 snacks a day if you are eating three meals a day.

There is also evidence that eating within a time restricted window may help weight loss. But the quality of the food is important. You want to eat filling and healthy meals when you do eat, but ensure not to overindulge. Build your meals around your fats and your proteins - these are both very filling foods.

Other reasons for eating

People eat out of habit, or in response to emotions or stress. In women hormonal changes may be associated with changes in hunger or cravings. These issues need to be identified and treated with behavioural or psychological techniques. See Alva article on managing emotional eating and cravings.

What is the role of physical activity?

Physical activity is very important for health, irrespective of your weight. Weight bearing exercise helps keep your bones and muscles strong, and reduces the risk of osteoporosis. You should aim to do both aerobic activity which increases your heart rate, and resistance exercises to promote muscle health and strength.

Regular aerobic exercise can also reduce the frequency and severity of hot flushes, and also helps your mood. Exercising outdoors is especially beneficial for mental health.

Walking is great exercise. Using a step counter and aiming to meet the recommended target of at least 10,000 steps a day is a great goal. There are some great NHS-approved apps to help you increase physical activity such as Active10 or Couch to 5k.

To lose weight you need to combine physical activity with some calories restriction. It is hard to lose weight by exercise alone, and very high levels of physical activity may not be sustainable long term. But any activity you enjoy will help. Yoga and Pilates are just as useful for balance, flexibility and often have a calming effect.

If you have been affected by Obesity stigma you might be interested in getting support from the charity Obesity UK. This offers support and campaigns to reduce stigma and improve access to treatment for people who are overweight.

References
  1. Managing the Menopause. Panay N, Briggs P, Kovacs G T. Cambridge University Press. ISBN 978-1-108-79875-4.

  2. Nutrition for the primary care provider. World review of nutrition and dietetics Vol 111. Volume editor DM Bier. Karger.

  3. Dr Carly Hughes FRCGP October 2020