It’s awkward to talk about weight. Nearly every woman I know is hyperaware, and perhaps hyper self-conscious, of her current and wished-for state. Approaching and following menopause, we women tend to gain weight even if we maintain our diet and exercise regimens; three to thirty pounds gained is the typical range, usually at a rate of one to five pounds a year.
I’m not about “fat-shaming,” or about embracing one body type over all others. I really hope for the day when all of our various body shapes and sizes are prized; I reject the cultural messages that tell us that self-esteem can [only] come from being a certain dress size. At the same time, I’m doing a disservice to women if I don’t talk about some health realities that correlate with weight.
If you follow the news, you can’t have escaped the news that obesity continues to increase in the U.S. The most recent ten-year comparison reported by the CDC National Center for Health Statistics says the proporion of obese adults increased by nearly a third by 2016. Notably, that report showed a greater rate of increase among adults than among children, although “childhood obesity epidemic” has stayed in the headlines. I mention that because the weights we are now are a modern phenomenon: When we talk about accepting our bodies as they are now, we’re not necessarily talking about bodies as they were designed to be.
Also recently in the news are studies that link obesity and dementia and that show that losing weight after age 50 can reduce breast cancer risk. (We already knew that excess weight is the leading controllable risk factor for breast cancer; uncontrollable factors are things like your age and genetic make-up.) Obesity is linked to increased risk for many cancers, including colorectal, uterine, kidney, head and neck, esophageal, pancreatic, gallbladder, thyroid, and endometrium (for which obesity is the number-one risk factor; in 30 years, I’ve had only two or three non-obese patients diagnosed with endometrial cancer.)
We’ve known that obesity increases risk for cardiovascular disease and type 2 diabetes. We can also see that excess weight makes for more stress on joints as we age, and we know it’s a trigger for hot flashes.
We all live within a culture, with systems that make food available. Much of that food is processed, or even “ultra” or “hyper” processed. In many ways, our context works against, not for us as we work to maintain healthy bodies. Depending on our circumstances, it can be difficult to find, afford, and prepare the healthy food we want to eat. The simplest reminder of our focus comes from Michael Pollan, who summarizes his Seven Rules for Eating in seven words: “Eat food, not too much, mostly plants.”
And move. Burning calories is as important as choosing how many and which kind to consume.
One more thing? If it’s challenging to change your diet, remember that the goal is not perfection, but progress. And if it’s easy for you, advocate for others, who may have greater obstacles to overcome.
Dr. Barb DePree, M.D., has been a gynecologist and women’s health provider for almost 30 years and a menopause care specialist for the past ten.