Spooked by Menopausal Weight Gain? Here’s What You Need to Know From Dr. Richa Mittal

If you’ve gone through menopause already, chances are you know: This time of life can come with weight gain and a lot of other unwanted metabolic changes. In a recent webinar, we welcomed Dr. Richa Mittal, an internist, medical weight loss doctor, lifestyle medicine doctor, and founder of Radiant Health Weight Loss and Wellness, a membership-based practice that uses a science-based personalized approach for medical weight management and metabolic disease prevention programs. Dr. Mittal did a virtual sit-down with Alloy community manager Rachel Hughes, which you can watch on our YouTube channel. 

Read the interview below, which has been edited for clarity and length:

Dr. Richa Mittal:

Thank you so much for having me. I'm excited to be here and to talk about one of my favorite topics.

Rachel Hughes:

Excellent. So let's get started with a definition, if you will. What are we talking about when we talk about metabolic health? All of us know we need to worry about it, but we don’t know what it means. So could you help us understand our goals and intentions on that?

Dr. Richa Mittal:

Yeah, I think that's a great place to start because like you said, this term is thrown around a lot of places, and what does it really mean? The way I think about metabolic wellness is it's kind of a foundational element in all aspects of our health. When we optimize our metabolic health we can prevent cardiovascular disease, diabetes, fatty liver, strokes, certain cancers, and more. It’s about preventing those things from happening.

Rachel Hughes:

So metabolic wellness, and I appreciate that you're using that term versus metabolic health, is sort of the bridge to either chronic disease or greater health. 

Dr. Richa Mittal:

We kind of want to focus on what are the things that we can do to help prevent these really bad chronic things from happening, and metabolic wellness is the foundation of that.

Rachel Hughes:

And does it really change in menopause or is this something largely misunderstood? Because I can tell you, and I know we're going to talk about weight and expanding waistlines, my waist is definitely bigger now than it was 10 years ago, certainly 20 years ago. But my cravings have also changed, and I know that hormonal shifts can sort of tee us up for all of that. But I also know that sometimes we may make a thing of something that isn't. So, is it metabolic wellness? Is our metabolic standing really changing in menopause?

Dr Richa Mittal:

It is and it's multifactorial. So there is definitely an impact of not only the fluctuation of hormones during perimenopause and then eventually that decline that women experience after going into full-blown menopause. There’s also the impact of aging in general.

Rachel Hughes:

Could you tell us a little bit more about that?

Dr. Richa Mittal:

Absolutely. So with declining levels of estrogen and with fluctuations of estrogen, we know that there are certain changes that occur in women's bodies. I'm experiencing them myself. And one of those is the expanding waistline. About one and a half pounds a year is what I've seen is the average. I've experienced more than that personally. I think that there is some weight gain, but there's also a weight redistribution that occurs during this time of life that leads to what's called more central obesity, or the waist circumference going up. But that is a risk factor for developing high blood pressure, insulin resistance, and cholesterol abnormalities that impact our metabolic wellbeing.

There's also a loss of muscle mass with advancing age called sarcopenia, and that plays a role in our metabolic rate as well as our insulin sensitivity with fluctuations and hormones. There's impact on our sleep quality, and depression and anxiety can resurface during this time of life, and that plays a role in our metabolic wellbeing. Of course, there are other factors, but those are some of the ones that come to mind. And you mentioned cravings, right? So sleep disruption, stress, weight gain itself, and insulin resistance can all contribute to cravings and also maybe coping mechanisms that may not serve us, but make us feel better in the short term.

Rachel Hughes:

So as I'm listening to you, I'm thinking that metabolic health is sort of like a whole system of health.

Dr. Richa Mittal:

Yes.

Rachel Hughes:

Okay. So when you talked a bit about expanding waistlines and aging hormones, what is redistribution of weight, the effect of estrogen on all of this, and sort of being teed up for metabolic syndrome? Is that the right terminology?

Dr. Richa Mittal:

Yes. Let's take a moment to define metabolic syndrome because that's what we're trying to avoid. Metabolic syndrome is basically a collection of medical issues that if you have three of five of them, you qualify as having metabolic syndrome, which one in three adults in the United States does. So it’s a very common syndrome, but it's silent and oftentimes people recognize all the different components but don't realize, oh my gosh, I have this syndrome and it's setting me up for an increased risk of cardiovascular disease, diabetes, high blood pressure, stroke, heart attack, fatty liver. 

Metabolic syndrome is made up of five things: high blood pressure, low HDL levels (good cholesterol), high triglycerides, insulin resistance, and increased waist circumference. This doesn’t refer to weight gain in general. Weight around our hips or in our thighs is not the same as weight in our midsection, in terms of it being dangerous. That's because there's an increase in a type of fat called visceral fat, which is different than subcutaneous fat. If you have three of five of these things, you have metabolic syndrome.  

I want to empower people. And I think part of that is understanding what’s happening and knowing what we’re at risk for and what to look out for. Know your blood pressure, know your labs, ask your doctor about your cholesterol, and have a conversation about normal values or values that are just on the border. 

When you go to the doctor, your doctor checks your height and weight and gives you a BMI. But your BMI is really not saying anything about your body composition. You could have all muscle and have an elevated BMI. And, risks are not the same across different backgrounds. So there needs to be thoughtfulness.

Rachel Hughes:

Thank you for that. I want to talk about what we can start to do, what we should be thinking about. There’s more to this than what is in the kitchen. Is that fair to say?

Dr. Richa Mittal:

Absolutely. We can start in the kitchen, but also recognize that all the other stuff actually impacts what we do in the kitchen. We have to embrace that we are going to change with age, but we have a choice in terms of if we want to look at aging as a gift because it's a privilege. Not everyone ages. It's hard to think about that. I've had to personally shift my mindset to what can I do for myself? How can I age in a way that allows me to live my life to its fullest potential?

Let’s start with diet. If you follow a lot of social media influencers or celebrities and trends, it can become very overwhelming. And we risk getting away from the basics. Can we empower ourselves to focus on a foundation of eating nutrient-dense food? Can we add more vegetables and fruit to our plates? If we’re going to choose grains, can we do whole grains that have more fiber? If you choose to eat meat, let’s focus on more lean protein and fish and poultry, and minimize red meat.

Then, we need to think about what we need to minimize. But we can’t be too restrictive. We need to honor our social wellbeing and likes and dislikes, and do what’s sustainable. 

Rachel Hughes:

That's so helpful. Please, go on. Where else should we be looking?

Dr. Richa Mittal:

So in terms of perimenopause and menopause changes, one of the places that I think it's very important to focus on and as we age is loss of muscle, and that is called sarcopenia. You can add lean protein into your diet, but that alone isn’t going to make you stronger. Weightlifting and resistance training is a huge part of healthy aging. When we build muscle, we improve our metabolism, and we burn more calories at rest. And you improve your bone density, decrease your risk for diabetes, and there are mental health benefits, too. There are lots of benefits to moving. 

Rachel Hughes:

Terrific. Thank you. Can you talk more about Menopausal Hormone Treatment and how that fits in?

Dr. Richa Mittal:

So, when you look at the data around menopause and perimenopause, there is  weight gain associated with this phase of life. When you look at whether MHT actually causes weight loss on its own, that’s variable and it’s not a reason to take it. But there is a huge component that does impact weight, which is treatment of vasomotor symptoms. Sleep disruption (which can come from things like hot flashes) has a huge affect on your metabolic health. When you don't get restorative sleep, you actually have an increase in hunger hormones that regulate hunger. You can have increases in even your insulin resistance, your blood pressure. So this is no joke. Not having sleep is a huge factor of impacting metabolic health and weight gain. That hormone replacement can help. It can benefit women to get better sleep. It also can help improve mood, and when our mood is better, we’re able to make better decisions in terms of food, movement, and sleep, so there’s definitely a relationship there. 

There are also things like stress and our coping mechanisms which we need to talk about. Namely, alcohol. It’s really not a great substance for our bodies. It's a huge part of social life, and I think that at this stage of life, it's a good time to really think about how alcohol is serving you. Become a little introspective. Alcohol increases our risk for high cholesterol, deposition of fat within the liver, increased visceral fat. That wreaks havoc on your liver, and fatty liver is silent.  

For way more from Rachel and Dr. Mittal, including questions from our audience, watch the whole webinar on our YouTube! 

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