Midlife Weight Gain: What's Healthy, What's Not?

We’re not talking vanity-those extra pounds are downright dangerous.

By Joan Raymond
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Photograph: iStock

Linda Gourley has two sets of clothes. Her skinny ones, which she wore up until about five years ago, are packed away in boxes to make room for what she calls “the nightmare of fat stuff” that now takes up all available space in her closets. Almost no one would call the five-foot-six-inch, 168-pound Cleveland resident obese. But with a body mass index (a calculation of height and weight) of 27.1, Gourley is planted firmly in the cohort of the overweight. “You used to be able to bounce a dime off my belly,” says the 52-year-old. “Now it’s my belly that bounces. I really hate this.”

Depending on which research you read, the average woman packs on as little as five pounds or as much as 15 during the perimenopausal and menopausal years. Either way, the upshot is that by the ages of 40 to 59, two thirds of American women are overweight (BMI of 25 to 29.9) or obese (BMI of 30 or more), split evenly between the two categories. Studies show that it’s not just the obese who potentially suffer from weight-related health problems. Even the overweight are at increased risk for conditions such as heart disease, diabetes and breast cancer. (Find your number.)


The risks for women of being simply overweight became evident in the mid-1990s during analyses of the long-running Harvard Nurses’ Health Study conducted by JoAnn Manson, MD, chief of the division of preventive medicine at Boston’s Brigham and Women’s Hospital, and others. The 16-year study of 115,000 healthy, non-smoking women found that those who fell into the over-weight category were about 60 per-cent more likely to die prematurely than lean women. Midlife weight gains of slightly more than 20 pounds not only upped the risk for heart problems but also for cancer of the breast, uterine lining and colon.

More recently, an analysis of 57 studies (in North America and Europe) published in the online version of The Lancet last spring reiterated that being overweight is a distinct risk, but is clearly not as dangerous as being obese. The analysis reported that for every five-point increase in BMI above the healthy range (that’s 18.5 to 24.9), the chance of early death increases by about 30 percent. And so people who fall into the overweight column may have their lives shortened by one year; obese folks with a BMI of 30 or more stand to lose three years of life; and the extremely obese, with a BMI over 40, might be shortchanged about a decade—exactly the same as if they had been lifelong smokers.

“A BMI that places you in the overweight category is a less significant health risk than a higher BMI,” says Charles Burant, MD, professor of internal medicine and director of the Michigan Metabolomics and Obesity Center at the University of Michigan, in Ann Arbor. But, adds Wulf Utian, MD, PhD, executive director of the North American Menopause Society, “The data is clear that, for most women, leaner is better. For some women, mid-life weight gain is a real issue, and we need to get out the message that you don’t have to be severely obese to have health problems related to weight.”

The good news “If you lose those 10 to 15 extra pounds, it can have a really positive effect on disease risk and health,” Manson says. Adds Burant, “You can’t do much about your family medical history and your genes, but you can try to control your weight and give yourself better odds.” You can also take several other steps to improve your health. (See “What If I Can’t Lose Weight?”)

Culprit No. 1 


Why is extra fat dangerous? Scientists now say that fat, technically called adipose tissue, is more than a passive fuel dump. Rather, it is robust tissue that releases hormones and other internal chemicals. And too much fat triggers an immune response, a highly organized effort by the body to rid itself of a foreign invader. Here’s the simplified reasoning: Unlike healthy-weight people, those who are overweight or obese have fat cells that are supersize and more likely to burst, leaving behind a glob of fat in your bloodstream. The body treats this fat glob as an invader and sends out an army of macrophages, inflammatory proteins whose job it is to destroy the invader. A chronic state of inflammation causes the body’s natural protective mechanisms to go a little haywire, potentially leading to problems such as insulin resistance (in which insulin no longer adequately clears the glucose out of your bloodstream), diabetes and heart disease (inflammation seems to contribute to the thickening of artery walls), explains Donald Hensrud, MD, associate professor of preventive medicine and nutrition at the Mayo Clinic in Rochester, Minnesota.

The particular issue for women is that much of the weight gained in mid-life lands in your belly, and this visceral fat, rather than the fat in your thighs and hips, is most strongly correlated to the inflammatory process and potential disease. That’s why, according to research, a waist size of 35 inches or more puts you at an increased risk for some medical conditions, such as type 2 diabetes, high cholesterol, high blood pressure and cardiovascular problems.

One culprit behind women’s widening middles may be the declining estrogen levels in midlife. In a series of animal experiments, Deborah Clegg, PhD, assistant professor of internal medicine at the Touchstone Diabetes Center at the University of Texas, Southwestern, and her colleagues showed that specific estrogen receptors in our brain influence how much we eat, how we use this food as fuel and where our extra fat winds up residing. In one study, female mice whose receptors had been reduced or silenced ate more food than they had before. Their metabolic rates also plummeted, so they did not burn the calories as quickly as usual. The end result: Those
mice packed on the weight.

Even worse than losing their figures, the mice also developed impaired glucose tolerance, an indication of prediabetes. “The hormone estrogen,” Clegg says, “protects us from metabolic problems like diabetes.”

The good news While prediabetes is serious, a fairly small weight loss—about five to seven percent of body weight—along with 30 minutes of moderate exercise, such as walking, most days of the week, can help bring blood glucose levels under control and reduce the risk of diabetes down the road. And a 20 percent drop in your weight can reduce your risk of heart disease.

Culprit No. 2 


The more weight you carry, the more wear and tear there is on your joints, which can lead to their premature breakdown, says Lisa Cannada, MD, spokesperson for the American Academy of Orthopaedic Surgeons and associate professor of orthopedic surgery at Saint Louis University Hospital. Think basic physics. According to the Johns Hopkins Arthritis Center, if you weigh just 10 extra pounds, the force you place on your knees increases by as much as 30 to 60 pounds with each step you take.

Numerous studies have shown a link between being overweight or obese and the development of the aches and pains of the most common form of arthritis, osteoarthritis. Osteoarthritis can affect the hands, shoulders, lower back and neck, but it’s the hips and knees that take the brunt of the additional weight.“The heavier you are, the higher your risk of developing osteoarthritis in the knee,” says David Felson, MD, professor of medicine and epidemiology and principal investigator of the Multidisciplinary Clinical Research Center at Boston University. This means that women in the overweight category have an increased chance of developing knee osteoarthritis than those with a normal BMI. But overweight women still have less of a risk than obese women.

The good news A loss of just 11 pounds cuts your risk of developing knee osteoarthritis by 50 percent. “You don’t have to lose a huge amount of weight to reap benefits,” Felson says.

Culprit No. 3 


Obese women are the most prone to GERD, or gastroesophageal reflux disease, in which stomach acids back up into the esophagus, known as acid regurgitation, and cause heartburn. But now scientists have linked it to the over-weight too. A study of more than 10,000 women reported in The New England Journal of Medicine found that relatively small weight gains increased the risk: Among women with a baseline BMI of 25 or less, GERD in-creased 1.13 times if their BMI increased by just 0.5 to 1.5 units. For women who increased their BMI by 3.5 units, say from 24 to 27.5, their likelihood of having more frequent GERD symptoms grew nearly three times.

“There is a linear relationship between GERD and body mass index, and the more weight you gain, even if it is a moderate amount, the more problems you have,” says lead study author Brian Jacobson, MD, assistant professor of medicine at the Boston University School of Medicine.

The good news “It doesn’t take a lot of weight loss to reduce symptoms,” Jacobson says. Women who reduced their BMI value by 3.5 units, say from 27.1 to 23.6, experienced a 40 percent reduction in symptoms. While no one knows exactly how weight affects acid reflux symptoms, one theory is that extra fat around the middle increases stomach pressure, causing fluids to back up into the esophagus.

Culprit No. 4 


Belly fat appears to be a risk factor for dementia. Scientists from Kaiser Permanente’s Division of Research recruited more than 6,500 men and women in northern California and measured their abdominal fat when they were ages 40 to 45. Then, 35 years later, researchers looked at the occurrence of dementia in the group. “What we saw was that a bigger belly was bad news,” says research scientist Rachel Whitmer, PhD, lead author of the Kaiser report.

The study, published in the journal Neurology last year, determined that dementia risk was 2.3 times greater for men and women who were overweight with a belly bulge than for those with a normal weight and waist size. People of normal weight but with excess belly fat had a 1.89 times higher risk of getting dementia than those of normal weight and no excess belly fat. “Excess weight is an issue, but where you carry it may be a bigger issue,” Whitmer says.

Although it’s not completely understood why belly fat may attack the brain, some animal studies have linked extra leptin, an appetite-control hormone made by belly fat cells, to diminished cognitive function. The hormone
may also be a player in the process of forming plaque in areas of the brain that control memory and thinking, Whitmer says. No study so far, however, has tested whether losing weight now reduces your risk of dementia later.

Culprit No. 5


A major study on breast cancer and weight found that women who gained 22 pounds after age 18 increased their risk of breast cancer by 18 percent. Researchers speculate that the connection may happen because after menopause, most of a woman’s estrogen comes from fat tissue. Therefore, having more fat increases the amount of estrogen in the body, which raises the risk of breast cancer. “It’s clear that there’s a correlation between weight gain and breast cancer development, and between weight gain and poorer outcomes after cancer treatments,” says medical oncologist Jennifer Griggs, MD, associate professor of medicine at the Uni-versity of Michigan, Ann Arbor. But will losing weight lower your risk of developing breast cancer? While no one knows for sure, it certainly can’t hurt, Griggs says.


Yes, the odds are stacked against you whether you want to lose weight or just maintain your current size. By midlife, your metabolism is slowing down, and your lean muscle mass (which burns more calories than fat tissue) is on the decline.

Your first step is to offset the age-related metabolic decline by reducing calories. Generally a decrease of about 200 calories a day as you enter menopause should help you maintain weight as you get older, Utian says. You might also consider switching your source of calories. A Women’s Health Initiative study found that women
who ate a low-fat, high-carb diet, rich in fruits, vegetables and whole grains, after menopause were less likely to gain weight than women who ate more fat, according to lead author BarbaraV. Howard, PhD, a senior scientist at MedStar Research Institute, in Washington, D.C. (For more tips, see “Six Ways to Beat Belly Fat.”)

“If a little weight gain can hurt health, a little weight loss can really help,” says Yvonne Braver, MD, a women’s health specialist at the Cleveland Clinic. “Drop just a few pounds, and your blood pressure and cholesterol might fall into normal ranges, giving you a much healthier future.”

For how to upgrade your diet and exercise plan, see "Lose Your Thirty-Something Weight Gain."

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First Published Thu, 2009-09-03 14:00

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