When B.J. Brill names her life stressors, the list is not short. A demanding job. Long hours and not enough sleep. A mother-in-law with a fractured pelvis. A brother-in-law with cancer. An uncertain economy.
Most of us can relate to Brill’s concerns – as well as her method of dealing with them. “I was a big binger on candy and fast food,” says the 44-year-old application analyst and former staff nurse at Wheaton Franciscan. “That was my coping mechanism; that was my comfort.” Eating, in short, is how she dealt with stress.
But in 2007, Brill decided enough was enough and joined the hospital’s weight management program. Since then, she’s changed her eating habits, started a regular exercise routine and come to a deeper understanding of the role stress played in her choices. In the process, she’s shed more than 120 pounds.
Weight gain is common in adults starting around age 40 and beyond. But given the broader problem of obesity in America, “midlife” weight gain can be decades in the making. “Quite frequently, for the clients I see in my office, there are years of [behaviors] leading up to midlife weight gain,” says Lisa Grudzielanek, a registered dietician with Wheaton Weight Management Services. “It’s years of not planning meals, of dashing and dining, of not being physically active, of uncontrolled stress.”
Roughly two-thirds of Wisconsin adults are either overweight or obese, a number on par with national averages, according to the Wisconsin Department of Health Services. A 2008 report by Trust for America’s Health and the Robert Wood Johnson Foundation put Wisconsin’s obesity rate at 25.5 percent, a number that lands the state mid-pack nationally but represents a significant jump over previous decades. In 1991, for example, no state had an obesity rate above 20 percent. In 1980, the national average of obese adults was 15 percent.
There’s no doubt that carrying too much weight – whether it’s a midlife development or a lifelong struggle – is bad for your health. The good news is that shedding even a relatively small percentage of your body weight can lead to dramatic health benefits. And although getting older can result in extra pounds, there are steps you can take to maintain a healthy weight at any age.
Both men and women tend to gain weight in their middle years, the result of a variety of factors. As we age, our lean muscle mass and hormone levels decline, slowing down our metabolic rate. “You hear women say all the time, ‘Well, I’m not eating any differently.’ But your body doesn’t need that many calories anymore,” explains Debra Ketterhagen, a certified nurse midwife with the Women’s Center at ProHealth Care’s Waukesha Memorial Hospital.
In fact, a person’s caloric needs decrease by approximately 10 percent every 10 years, notes Dr. Ahmed H. Kissebah, an endocrinologist and professor of medicine at the Medical College of Wisconsin and medical director for TOPS (Take Off Pounds Sensibly) Metabolic and Obesity Center. As a result, continuing to eat the same number of calories as you age without a dramatic change in your activity levels will inevitably lead to weight gain.
People in their 40s, 50s and beyond may also find it more difficult to lose weight as a result of reduced muscle mass, since muscles are a major means by which the body burns calories, adds Kissebah. The loss of muscle that accompanies weight loss can also make weight loss more difficult to maintain.
Although issues such as declining muscle mass undoubtedly play a role in weight gain as we age, they are by no means the end of the story. Stress, alcohol or other empty calorie consumption, irregular meals, poor sleep, poor diet, lack of physical activity and past pregnancy can all be primary factors in midlife weight gain, notes Kissebah. Such behaviors and experiences are common among middle-aged people, many of whom are balancing the demands of work and family. “As we get a little bit older, we tend to exercise less. Many people don’t have time to prepare meals, and they grab food on the run that’s more likely to cause weight gain than fresh foods are,” says Dr. James Davis of Wheaton Franciscan Medical Group’s Sussex Family Practice Physicians.
Lack of planning – whether for exercise or for shopping for healthful foods – is extremely common among patients who struggle with their weight, Grudzielanek says. “It takes work to plan meals for the week, but it’s a small chunk of time that gives you a whole host of benefits on the other end.”
Although some of the same factors can contribute to weight gain, the results may appear differently on men and women. Men tend to gain weight primarily in the waistline (the stereotypical “beer belly”), a physical manifestation that has been linked to higher risks for diabetes, hypertension, heart disease and other serious health problems. Women commonly gain weight in the lower body, especially in the buttocks or thighs, but approximately 25 percent of women put on weight in the abdominal region, notes Kissebah. This is often a result of the hormonal changes of menopause, says Davis; when estrogen levels drop, the body can put on weight in a way that reflects a higher level of “male” hormones. As is the case for men, concentrated abdominal fat in women (often called the “apple shape”) is associated with significant health risks, adds Ketterhagen.
Although aging is unavoidable, there are steps you can take to maintain a healthy weight throughout your life. Awareness of the biological and behavioral changes that accompany middle age, adjusting caloric intake and developing a plan for exercise can all make a difference, notes Kissebah. Paying attention to family history and seeking support from friends or family can also help. “Prevention is certainly far superior to treatment [of obesity],” he adds.
But if you’re already heavier than you should be, taking pounds off now is far preferable to the health problems that await you. Losing 10 percent of your body weight, for example, can have striking effects, including preventing or even reversing diabetes, lowering blood pressure and cholesterol, and improving cardiovascular health, not to mention boosting self-
esteem and quality of life, notes Kissebah.
One of the keys to success in weight loss is setting manageable goals. “What generally happens in America is people are gung-ho on diets and exercise programs, and they stay on them for a couple weeks and it’s hard and they quit,” Davis says. He recommends patients concentrate on 10 percent increments for that very reason. Although tools such as body mass index may be useful to some patients (see cdc.gov/healthyweight/assessing/bmi for an easy calculator), others may find them overwhelming. Kissebah suggests patients plan to lose five pounds and then maintain that weight for a period before beginning a second round of losing another five pounds. Whatever approach you take, he emphasizes, “The goal weight should be the weight you can achieve and, more importantly, maintain.”
That means if you’re still fantasizing about your high school or wedding weight, it’s time to get real. “When you’re 50 years old, you can’t expect to weigh what you did when you were 18,” says Grudzielanek. As an alternative, she suggests patients focus on their lowest weight in the last 10 years as an initial goal. Likewise, people looking for a quick fix to a weight problem need to adjust their expectations. “You have to be realistic about it. You didn’t become overweight overnight,” Brill says. Losing one to two pounds a week is the general recommendation for healthy weight loss; more than that, and the reduction is not likely to last. “Patients want it off yesterday, and I can appreciate that,” says Grudzielanek. “But there are 52 weeks in a year, and if you lose a pound a week, that’s over 50 pounds in a year. Who do you know who lost 50 pounds last year?”
Taking a look at the deeper causes for poor lifestyle choices can be another important step in the weight loss process. “A lot of the clients who come into my office, they know the nutritionist spiel, they’ve been to Weight Watchers, they’ve done South Beach, but they haven’t really looked at the root causes,” says Grudzielanek. “The whole mind-body part is huge. How are you coping with stress? How are you coping with a busy schedule?” Wheaton and other weight management programs take a comprehensive approach to the issue, engaging patients with a psychologist as well as a physician and dietician.
Finally, banishing the word “diet” from your vocabulary (and your attitude) may be crucial to maintaining your goals. “I’m not on a diet – this is a lifestyle change,” says Brill, who credits her husband as her biggest supporter. “This is what I’m going to do for the rest of my life.”
Caroline Goyette is Milwaukee Magazine’s monthly health columnist.
A roudup of the latest health wisdom
Eating cream and butter helps epileptic kids. A diet that’s heavy on whipping cream, butter and vegetable oils, with fat comprising 80-90 percent of calories, helps prevent seizures in many children with epilepsy. But in order to achieve both sufficient nutrition and improved seizure control, parents should not implement the diet without stringent medical support, states a study by the Medical College of Wisconsin and Children’s Hospital of Wisconsin.
Caffeine reduces pain from exercise. Men who took a caffeine pill equal to about three cups of coffee before exercising had less pain than those who didn’t, according to University of Illinois researchers. Their study appeared in the International Journal of Sport Nutrition and Exercise Metabolism. Study participants – 25 fit, college-aged men – took a placebo on some days and caffeine on others prior to exercise. Researchers were surprised to find that both men who habitually consume caffeine as well as those who don’t experienced less pain if they took caffeine before exercising.
Breast-feeding comforts babies during vaccination. Infants under the age of 6 months experienced less pain and cried less if they were breast-feeding while being vaccinated compared to a control group of infants who were not breast-feeding. That’s according to a Turkish study of 158 infants reported in The Journal of Pediatrics.
Chronic pain sufferers should check Vitamin D levels. Mayo Clinic researchers recommend that people with chronic pain, such as fibromyalgia sufferers, be checked for low vitamin D levels. Their study, published in the journal Pain Medicine, suggests that low levels of vitamin D could sustain or even create chronic pain. Chronic pain patients with inadequate vitamin D levels required nearly twice as much narcotic pain medication than those with normal levels. The right foods, dietary supplements or sun exposure can increase vitamin D levels.
Thinning bones may cause vertigo.
Osteoporosis and lower bone mineral density were linked to benign positional vertigo (BPV) in a study by Korean researchers in the journal Neurology. As a result, both men and women with vertigo may want to be checked for osteoporosis. BPV is commonly known as vertigo and is characterized by a sudden feeling of spinning when the head is moved or held in a specific position. It’s caused by a type of debris that is dislodged within the ear, affecting the body’s balance system.
– Scott R. Weinberger