Complete Information on A Case Study on Premenopausal Weight Gain

An active, 45 year old woman decides to try meeting with a Registered Dietitian to help her lose weight. She is 5 feet 4 inches tall and weighs 165 pounds, the most she has ever weighed in her entire life. The woman’s name is Mary.

Mary reports that she has been dieting her entire adult life to maintain a weight of 120 pounds, the weight that she should weigh according to the insurance industry charts. She watches her diet very carefully, eating mostly low fat foods and consuming around 1200 calories per day. Maiy has never had to exercise to keep her weight down-dieting has always worked except for when she would go through phases of binge eating followed by weight gain. She says she was always too tired to exercise. She admits to yo yoing up and down 20 pounds with her weight over the years, and states that after having her second child at age 35 dieting stopped working. During the past 5 years, Mary has gradually gained 20 pounds even though she has watched her diet very carefully and most of the time does not eat many “bad foods.” Maiy is very frustrated with her weight, and she wants to know if starting a high protein, low carbohydrate diet is the way to go.

The Registered Dietitian recommends the following to Mary:

1. during the premenopausal period (ages 35-55 for most women), the female fat cell actually grows larger in response to declining production of estrogen. This results in an increase in body fat, particularly in the abdominal area. There is a good reason for this to occur. After menopause is when women are at the highest risk for osteoporosis. The body works to combat this by preferentially storing estrogen in fat cells in the abdominal area, where the estrogen is easily accessible to help keep calcium in the bones. An increase in body fat during this time is normal and healthy for the body. It is unrealistic for most peri or postmenopausal women to have less than 30% body fat.

2. Many women who have chronically dieted experience a large weight gain during this time. Chronic dieting is usually a sign that tne person is keeping her weight artificially low, or at less than her set-point body weight (the weight your body is genetically programmed to weigh). The more dieting a woman does, the more fat the body stores to protect itself. Weight charts are really not a good indicator of set-point weight, as set-point weight is very individual and is believed to be genetically determined. A woman’s set-point weight is the weight where she can eat all foods moderately in response to her body’s hunger and fullness signals, along with regular, moderate exercise.

3. Exercise is the key to weight management at any age, especially in mid-life. Many women have substituted chronic dieting in place of exercise, resulting in a loss of muscle and bone and an increase in body fat. After obtaining approval from your physician, begin a program of walking, biking, swimming, dancing or some other activity for 20 minutes 3 days per week. The key is to pick an activity that is fun for you, and preferably something you can do with a partner. Women who exercise with a friend or spouse are more likely to maintain their program on a long-term basis. After a week or so at 20 minutes, increase your time spent exercising to 30 minutes, and then gradually over time increase to 45 minutes to one hour. The reality is that in order to lose the weight and reach your set-point body weight, you will need to do about 5 hours of aerobic exercise per week. Most perimenopausal women maintain a healthy weight by doing an activity they enjoy for 3-5 hours per week.

4. There are no “good” or “bad” foods. All foods have nutritional value, and depriving yourself can lead to binging. Work on eating in response to your body’s hunger and fullness signals, instead of external triggers like stress, boredom, or a structured diet plan. If you eat when you are hungry and stop when you are full, your body will move towards its set-point weight. High protein, low carbohydrate diets are unbalanced nutritionally and tend to cause fatigue, cravings for sugar and bread, and depression in susceptible people. You need a diet high in complex carbohydrates to provide energy and allow for fat burning during exercise.

5. All premenopausal women need to accept that their bodies will not look the same as when they were 20 years old. Work on appreciating and accepting your natural body type. Healthy, moderate eating and exercise will help you to be happier and more productive during the peri and postmenopausal years.

Almost a decade ago doctors and coaches began to notice a trend in female athletes to enhance their athletic performance by achieving very low body weights. They also noticed that these women athletes were engaging in potentially harmful methods of weight control and that many suffered from amenorrhea and bone loss. In 1992, the American College of Sports Medicine named the collection of symptoms seen in this population as “The Female Athlete Triad”. The triad is especially prevalent in sports that emphasize the aesthetic of leanness such as gymnastics, figure skating, diving and dance. It is also seen in sports such as swimming and running, where leanness is thought to help gain the competitive edge. While the triad is most common in women participating in these sports, it can affect any athlete.

Determining the prevalence rate of the triad is difficult. Most of the data is equivocal. There are a number of methodological weaknesses in most of the studies due to either self-developed questionnaires, lack of control groups, and/or comparison difficulties due to the different measures used. These studies use different definitions for amenorrhea and disordered eating which further skews results. Evidence suggests that the syndrome is quite common. While the prevalence rate of disordered eating among non-athletes is thought to be between 3 and 8 percent, disordered eating and amenorrhea are thought to affect anywhere for 15 to 62 percent of female athletes.

The female athlete triad is a serious syndrome consisting of three separate but interrelated components: disordered eating, amenorrhea, and osteoporosis. Disordered eating affects theses athletes by causing decreased energy intake, decreased nutrient intake, decreased resting metabolic rate, low body fat stores, gastrointestinal problems (constipation, diarrhea, reflux, bloating, and post prandial distress) hypothermia, menstrual disturbances or delayed puberty, and increased risk of anorexia, bulimia, osteoporosis, morbidity and mortality. The triad increases the incidence of osteopenia, bone injury, stress fractures, and scoliosis. There is also a marked increase in psychological stress with increased difficulty handling the stress of competition, which can lead to decreased physical performance. What many coaches and athletes don’t seem to understand is that this quest for sharp reductions in body fat in the hopes of gaining the competitive edge has both long and short- term consequences for woman’s health.

Disordered Eating

In an effort to lose more body fat, an athlete may begin to consume less energy than is necessary for his/her activity level. She can fall into a pattern of restrictive eating that lead to believing that once normal portions of food are now too much. Or she becomes phobic of many foods that were once enjoyed and avoid them believing that the food will cause weight gain. Vegetarianism is commonly adopted to further curtail and assert control over calorie and fat intake, as the rules of vegetarianism further enhance restrictive eating practices. Over time the list of acceptable foods become shorter and variety may be diminished to only two or three foods. If continued for too long these individuals can develop a full-blown eating disorder.

Athletes have been known to use many compensatory mechanisms for achieving a desired weight such as abusing diuretics, laxatives and engaging in self-induced vomiting.

While these activities were once overlooked as required behavior to achieve the competitive advantage, today we know the consequences of these eating disordered behaviors upon one’s physical and emotional health. These once acceptable weight loss tactics should be addressed with professionals once they are discovered.

It may be that a sport, especially those in which the disorder is most prevalent, attracts those with eating disorders. Sport competition attracts those who are highly focused, motivated and perfectionist. These are the primary personality traits of disordered eaters and may have many of them using their sport to legitimize their eating disorder. It is difficult to see that there is a problem when the patient is excelling at her sport. In these cases the illness just looks like the quirky or superstitious behavior of an elite athlete. Often eating disorders can go on for years without affecting performance. It is not until many years later that the nutrient and energy imbalance, which produces subtle changes in physiology and psychology, begin to take their toll.