Link: https://www.youtube.com/watch?v=9s9UNax-QQ0

 Dr. Lynn: Hello, I’m Dr. Becky Lynn. I am here with Katie Heaney, RD. I’m a gynecologist, and a menopause and sexual health specialist.

 Katie: I am Katie Heaney. I’m a registered dietitian working with Dr. Lynn. I specialize in weight management, obesity interventions, nutrition for the whole family, and some sports nutrition.

 Dr. Lynn: Well, fantastic! One of the reasons I wanted to bring Katie here today is because I see so many menopausal women who tell me that when they go through menopause, their metabolism slows down, and they’re gaining weight. They tell me that they watch what they eat, they make healthy choices, they exercise, and they just can’t lose weight.

 Katie: This can be really frustrating because menopause is a big transition in life. I see many menopausal women struggling with those last 15 pounds! As women journey through the lifecycle, their bodies naturally shift in response to hormonal changes that usher them out of the fertile phase of life.  Menopause is frequently accompanied by weight gain, muscle loss, and lack of energy, making it challenging to achieve a healthy weight.  Many women who have gone through menopause or are going through menopause come to us to help them with weight loss and muscle gain. 

 When people see me and want to make healthy changes and lose weight, I start by getting as much information as I can about their current eating habits. I discuss what healthy weight loss looks like and realistic timelines.  There is so much that goes into healthy eating and weight loss.  It isn’t just about calories in and calories out. I do a deep dive into what they’re eating, when they are eating it, do they exercise, and if they are getting enough sleep. Sleep is so important. It is one of the first things we talk about. We are more likely to make unhealthy choices when we are sleep deprived.

 Dr. Lynn: During the years before your periods stop (the perimenopause) and then for a few years after they stop, many women have night sweats and they can’t sleep at all or have awakenings in the middle of the night. This is not good for those carbohydrate cravings!

Stress

 Katie: Stress plays a role too. Having a lot of stress in your life affects how hungry you feel.

 Dr. Lynn:  Stress hormones like cortisol increase, which leads to insulin increase which makes you deposit fat and crave carbohydrates.   So, how would you define healthy weight loss?

Defining Healthy Weight Loss

 Katie: It depends on where we start. Generally, we say half a pound to a pound a week of weight loss. It is a bit controversial with dieticians – like counting calories or not. I like to discuss mindful intuitive eating. We try to figure out how to be mindful of caloric intake. I also calculate women’s resting metabolic rate and their activity level in order to calculate how much or how little they need to take in to lose weight.  Research show that the average weight gain during menopause is a little more than 1 pound per year.  With reduced calorie needs as women age, weight gain is expected if they don’t eat healthfully and increase physical activity.  Lifestyle factors are extremely important to consider when talking about weight gain. 

Measuring Resting Metabolic Rate

 Dr. Lynn: How do you measure the resting metabolic rate?

 Katie: I use an equation called the Mifflin-St Jeor equation. It is based on an algorithm that uses your age, gender, activity level, and height and weight (of course). It is an estimate, but you can also use a special kind of breathing machine. You breathe into it and based off of your oxygen level and carbon dioxide level, it measures how much energy you use at rest just to run your body.  This is your basal metabolic rate.  It is very useful information.

 Dr. Lynn: It gives you the calories you burn each day?

 Katie: Resting metabolic rate is the total number of calories burned when your body is at rest. From there we use the activity level to calculate how many calories you need for healthy weight loss, because the breathing machine only gives us the calories you would need at rest. Also, I have clients that will take multiple measurements over time, because as you lose weight, there is less of you to feed, so your resting metabolic rate decreases. The way you can increase or maintain your resting metabolic weight is to build muscle as you lose weight. I am not a personal trainer or a physical therapist, but I encourage 2-3 days a week of weight training and building muscle because that can really help boost your metabolic rate. Your metabolic rate tends to go down as we age and as women go through menopause.

 Dr. Lynn: So it is funny that you say that because (and I am not a dietitian), but I always think that when you’re trying to lose weight, you need to do aerobic exercise, get your heart rate up and burn calories. And so, I have said in the past, if you have limited time, concentrate on the aerobic exercise. I have changed my tune on exercise over the years. Now I see the value in strength training, especially for menopausal women because menopausal women lose muscle mass when they lose the hormones their ovaries used to make.

 Katie: Resistance training is great for muscle building!

Resistance Training and Aerobic Calorie Burning

 Dr. Lynn: What would be the optimal mix of resistance training and aerobic calorie burning?

 Katie: That is a really good question. I don’t think it’s either or; it is hopefully both. I would start with looking at what you are willing to do. Many times I have clients say, “yeah I’m just not going to lift weights, but I would like to get my heart rate up and start exercising more.” I focus on where the client wants to start.  If I say to someone, “do all of this,” it can get overwhelming, and they may not start at all.

 I just had a client the other day say “I’ll do ten minutes a week and that is all I will do”.  I have another client who is already doing three days a week of Krav Maga, high intensity interval training, and she said, “I’ll go up to four days a week!” So, it just depends on the person, but ideally the recommendation for adults, is 30 minutes a day, or 210 minutes per week. It can be 30 minutes a day or it can be three 1-hour long sessions a week. I try to choose something that works for each person.  If it were up to me, I would say the 30 minutes a day, because then maybe we can incorporate two days a week of strength training for 20 minutes.

Logging Your Data

 Dr. Lynn: Okay, so you talk about sleep habits, you talk about exercise, but then do you have them write down what they eat?

 Katie: Every client is different. Generally, when they come in, I want to know what they’re eating. Some of them come in with a notebook, and many, many, many clients come in using  My Fitness Pal. I think you’re familiar with it?

 Dr. Lynn: Yes!  My Fitness Pal synchs up with our electronic medical record.   

 Katie: Some people come in and they have it all recorded, so we can go through that. Typically, I get a verbal intake of what you are eating on a typical weekday, and I usually get a couple samples of meals and schedules. For the weekend, schedules change. So, I also get a weekend day. From there, we talk about eating habits. For example, “do you skip meals? Do you eat when you’re stressed, bored, angry…” Emotional eating is common.

 Dr. Lynn [humorously]: That’s me!

Emotional Eating

 Katie:  We have to eat all the time and we are always thinking about food. So, there is a lot of eating that goes with emotions. I also ask about binge eating habits or eating disorders, and I usually refer to a specialized therapist for those.

 Dr. Lynn: Yes 

Katie: I am not a therapist. I sometimes introduce cognitive behavioral therapy(CBT) in sessions as a behavior change technique, but I usually refer to a trained counselor or therapist for more detailed training on CBT.   

Katie: I also talk about hunger with my clients. For instance, I go through the hunger scale. I usually compare fuel for my body to gas for a car, so when the gas is empty, the car stops. When you’re really, really hungry, your body doesn’t work as well as it should. Your brain doesn’t work as well as it could.” I always say 10 is like Thanksgiving Day, when you eat so much, and you can barely move. Ideally, we want to stay between a 4 and a 6, so you don’t allow your body to get too hungry and you stop when you’re at a 6 versus eating until you’re stuffed. Achieving a healthy weight is about eating enough, but not too much. I talk a lot about what people are eating, but I also talk about how much.

Portion Control

Dr. Lynn: Portion control basically. We all know that we have large portions. If you go to a restaurant, there are sometimes a thousand calories in one meal, if not more. I feel like we are used to large portions, so a smaller portion seems too small. If you read labels and look at serving sizes, a serving might be much smaller than the amount you would normally eat.

 Katie: It can be shocking to show what a healthy portion of rice is… it’s half a cup!

 Dr. Lynn: Right, it looks like three bites!

 Katie: Yes! After we calculate your calorie needs, I create a meal plan together with your idea of what that looks like. That way it fits with your lifestyle and habits. I also talk about having all the food groups in a meal, having a healthy amount of carbohydrate, fat, and protein. I focus quite a bit on protein. I try to create meal suggestions that incorporate all the different food groups, like starch (especially whole grains), vegetable, fruit, fat, and a meat or protein.

Katie: Protein is really important in achieving a healthy weight and having energy. If you’re incorporating exercise you have to have enough protein to maintain your muscles, but not too much. I focus a lot on portion size and a tool I have been using lately, which is pretty basic but helps you visualize, is divide your plate into fours.

 Dr. Lynn: I think I’ve seen that before.

 Katie: It is through choosemyplate.gov, which is an updated food pyramid.

 Dr. Lynn: mm-hmm!

Katie: I recommend that women practice mindful eating, control portions, and focus on nutrient-dense foods such as fruits and vegetables.

Fruits and Vegetables

Dr. Lynn: Right. I have a question about that. I tend to eat a lot of fruit, but not as many vegetables. So, if you say 8-10 servings of fruits and vegetables a day and nine of those ten are fruits, am I still missing something? Should I try to balance it out a little bit?

Katie: 2-3 of those servings should be vegetable. You don’t have to go up to 7 vegetable servings tomorrow but try to find some recipes. I see many clients who just don’t like vegetables because the only way they’ve eaten them is boiled or steamed.  I talk a lot about roasted vegetables. They are so much better! If you roast brussel sprouts, asparagus, cauliflower, or broccoli, they don’t quite taste like French fries, but they have a nice crispy texture. Or some people like vegetable soup. Vegetable soup can be store bought or made. If bought, then it isn’t labor-intensive and you still get your vegetable servings.

 Dr. Lynn: We all probably need to eat more vegetables…. Me especially.

 Katie: Amen! I agree!

 Dr. Lynn:  Thank you so much Katie for helping our patients the way you do.  I am lucky to be working with you!

Dr. Becky Kaufman Lynn is a gynecologist and the founder of the Evora Women’s Health. She is a North American Menopause Society Certified Physician who has been treating menopausal women for over 20 years. Her practice is located in Chesterfield just outside of St. Louis, Missouri. Dr. Lynn offers a comprehensive midlife health program including helping women lose those pesky last 15 pounds! Go to evorawomen.com for more information about her practice or to schedule an appointment or send us an email at info@evorawomen.com

Katie Heaney is a registered dietician working with Dr. Lynn at the Evora Center for Menopause and Sexual Health. She holds an undergraduate in Nutrition and Dietetics. She completed her dietetic internship at Yale-New Haven Hospital and then obtained a Certificate of Training in Obesity Interventions for Adults. She is a member of the Academy of Nutrition and Dietetics and the national and local chapter of the Academy of Nutrition and Dietetics. Click here to schedule an appointment with Katie.