Glad you flagged the O word, Susan. Semaglutide drugs have taken over the public consciousness as a magic bullet. But they are really meant for serious (and larger) weight loss issues, for body mass in the obesity range. To discuss the Ozempic phenomenon, and whether it works for the over-50 demographic – especially for patients who are not clinically obese – I spoke to UBC professor Dr. Lesley Lutes, the director of the Centre for Obesity and Well-Being Research Excellence, at the Okanagan campus in Kelowna. 

First of all, menopausal weight gain is not in your imagination and it is very tough to counter. “It is not just [a matter of] your willpower,” she told us. “The average weight gain for women is .8 to 1.5 pounds a year, starting in mid-life,” says Lutes, and the transition to menopause is associated with an average gain of six pounds. Plus, in menopausal women, the decline in estrogen may change the distribution of body fat, decrease insulin sensitivity and increase cholesterol levels.

Lutes runs a weight loss program called B Well; it provides individual coaching support within a network of primary health practices in British Columbia. She advocates a slower and steadier way to lose weight and keep it off. “Small changes are what makes the difference,” says Lutes. This is evidence-based and includes nutritional counselling, cognitive behavioural therapy, goal-setting and long-term maintenance support on all of these fronts, from therapy to nutrition guidance. 

The work is customized by their interdisciplinary teams, but Lutes cites great advice from Cleveland Clinic in the U.S. for dealing with menopausal weight gain, which tends to unfortunately gather around the stomach. This includes eating whole, natural foods and cooking them at home; building your meals around healthy calories focused on lean protein and veggies. Avoid sugar, swap wine or soda for sparkling water. Cut down on starchy carbs (bread, pasta, baked goods), and shift your bigger meals to earlier in the day to give your body a chance to process. Finally, keeping a food journal is a good way to stop mindless snacking, which is a real culprit for weight gain, especially when indulging in the evenings.

As for Ozempic et al., “As soon as you go off medication, it all comes back. There are no quick fixes,” she says. It’s just an injectable diet. “Same as Atkins and Keto and all the other fad diets. I wish there was a quick fix. I wish I were out of a job.” In her program, sensible eating is at the heart of things; the first 350 patients lost 4 per cent of their body weight, according to published studies. “These are sustainable losses,” she says. 

The key is ongoing, multi-faceted treatments in the community. Here is what she means by that: Weight-loss theory is simple – fewer calories, more movement – we know that, but we just don’t do it. What Lutes has identified, and quantified, is the power of individualized therapy. “Some people respond to online participation, some people to group therapy, others to individual therapy. There is no one size fits all.” That’s why generalized recommendations for public health don’t work. “Just helping support people in daily life – it’s a simple approach – one change at a time.”

We’ve been hearing good things about another slow and steady weight loss program, popular with the fashion set: The Human Being Diet. Created by Petronella Ravenshear, a  nutritionist and functional medicine practitioner, this science-backed three-month plan focuses on foods as close to nature as possible. “If you can pick it or dig it up, eat it,” is Ravenshear’s motto. The first 16 days are designed to get your body out of bad habits and get it back into fat burning versus fat storing mode. This is logical stuff, easy to follow and contains no fads.

So if your hormones are out of whack, and your estrogen is waning, and that helps contribute to menopausal weight gain, wouldn’t it stand to reason that taking hormone replacement therapy (HRT; another acronym you might see is MHT, for menopausal hormone therapy) reverse that process? Well, as with all things to do with the body, it is not that simple. Weight gain is multifactorial, thus weight loss is multifactorial.  

According to a Mayo Clinic article, Dr. Ekta Kapoor, a consultant with the Women’s Health Clinic at Mayo’s Rochester campus,“Women on MHT tend to have redistribution of the central fat to peripheral sites.” Translation: the weight that tends to settle into your middle—the weight that increases cardiovascular risk—can move outwards. “However, MHT is not recommended for prevention or management of weight gain.” Kapoor goes on to recommend the same multidisciplinary approach to weight loss that Lutes does. 

More importantly, though, hormone replacement therapy, where appropriate and as recommended by your doctor, can make you feel so much better thanks to the relief of menopause symptoms, physical and psychological. This rebalancing can then allow you to find the energy, and motivation, to eat better and exercise more. 

The best approach, Susan, sounds like a personalized combination of all the above advice: eating in moderation, choosing fresh, healthy unprocessed food, exercising regularly (both cardio and resistance training), and working through any possible issues with disordered eating with support. Also consider HRT with your doctor. It’s a lot, yup, but it’s probably worth it for the boost in energy and confidence. And the feeling like you are fighting back against middle-aged scale creep. 

Always asking questions,

—Leanne Delap