Insights into why midlife women gain weight

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Weight gain is a common complaint of midlife women, with more than two-thirds of midlife US women being over the ideal weight threshold. Aging-related metabolic changes promote weight gain in both sexes, but women face additional challenges because of menopause. A presentation at The North American Menopause Society (NAMS) Annual Meeting in Atlanta, October 12-15, will discuss the effect of age and menopause and strategies for managing weight.

It is a simple fact of life-;the human body's metabolic rate drops with age because of a loss of muscle mass and reduced activity in the brown adipose tissue. Sleep disturbances and mood disorders, possibly related to the menopause transition, can additionally interfere with the adoption of healthy lifestyles, further promoting weight gain. The loss of ovarian hormones after menopause leads to altered body composition, with reduction in lean body mass and an increase in visceral fat mass. In addition, menopause-related alterations in the gut microbiome can promote midlife weight gain.

All this added weight can worsen hot flashes while increasing a woman's risk of cardiometabolic conditions such as type 2 diabetes, hypertension, dyslipidemia, and coronary artery disease. Obesity also increases the risk of cancer in women, including breast and endometrial cancer.

Despite the rise in fad diets and over-the-counter supplements claiming to burn fat, the most important intervention for weight loss and maintenance remains calorie restriction. Although physical activity is less effective than dietary interventions for weight loss initially, it plays a crucial role in weight maintenance after the initial diet-induced weight loss and has multiple other health benefits. Medications for weight loss are available, but there are concerns relating to costs, interaction with other medications, adverse events, and possible long-term toxicity. Bariatric surgery may be a highly effective option in extreme cases, but ultimately, sustained behavior modification is necessary to maintain results over the long term.

Although hormone therapy should not be used for weight management in midlife women, when used for the management of bothersome menopause symptoms, it can improve body composition by redistributing the visceral fat to the lower body fat depots.

Dr. Ekta Kapoor from the Mayo Clinic's Center for Women's Health will discuss midlife weight gain at the NAMS Annual Meeting, highlighting the latest thinking about why midlife women gain weight and how they can fight back.

"In the absence of active efforts at healthier eating and regular physical activity, weight gain is an inevitable occurrence in midlife women. It is imperative that women enter menopause with this knowledge and the familiarity with practical tips to prevent and manage weight gain," says Dr. Kapoor.

Without a doubt, women face an uphill battle against weight gain as they age and transition through menopause, but that does not mean there aren't ways to help them combat the issue. This presentation promises to provide some valuable insights that healthcare professionals can leverage when providing weight management advice to their menopause patients."

Dr. Faubion, NAMS Medical Director

全文翻译（仅供参考）

体重增加是中年女性的常见抱怨，超过三分之二的美国中年女性超过了理想的体重阈值。与衰老相关的代谢变化促进了男女体重增加，但女性面临着额外的挑战，因为更年期。在北美更年期协会的报告（NAMS）10月12日至15日在亚特兰大举行的年会将讨论年龄和更年期的影响以及管理体重的策略。

这是一个简单的生活事实-;人体的新陈代谢率随着年龄的增长而下降，这是由于肌肉质量的损失和褐色脂肪组织的活性降低。

睡眠障碍和情绪障碍，可能与更年期过渡有关，还可以干扰健康生活方式的采用，进一步促进体重增加。绝经后卵巢激素的损失导致身体组成的改变，这可能导致瘦体重的减少和内脏脂肪量的增加。

此外，与绝经有关的肠道微生物组的改变可能促进中年体重的增加。

所有这些增加的体重会加重潮热，同时增加女性患心脏代谢疾病的风险，如2型糖尿病、高血压、血脂异常和冠状动脉疾病。肥胖也会增加女性患癌症的风险，包括乳腺癌和子宫内膜癌。

尽管声称能燃烧脂肪的时尚饮食和非处方补充剂越来越多，但减肥和维持体重最重要的干预措施仍然是限制卡路里摄入。虽然体育活动在减肥初期不如饮食干预有效，但在最初的饮食诱导减肥后，体育活动在维持体重方面发挥着至关重要的作用，并有多种其他健康益处。

减肥药物是可用的，但也存在与费用、与其他药物的相互作用、不良反应和可能的长期毒性有关的问题。减肥手术在极端情况下可能是一种非常有效的选择，但最终，持续的行为矫正是长期维持结果所必需的。

虽然激素疗法不应用于中年妇女的体重管理，但当用于管理令人烦恼的更年期症状时，它可以通过将内脏脂肪重新分配到下半身脂肪库来改善身体组成。

梅奥诊所妇女健康中心的Ekta Kapoor博士将在NAMS年会上讨论中年体重增加问题，强调有关中年女性为什么体重增加以及如何反击的最新想法。

卡普尔博士说：“如果不积极努力健康饮食和规律的体育活动，中年妇女体重增加是不可避免的。妇女进入更年期时必须了解这些知识，并熟悉预防和管理体重增加的实用技巧。”

毫无疑问，随着年龄的增长和更年期的过渡，女性面临着一场艰难的体重增加斗争，但这并不意味着没有办法帮助她们解决这个问题。

本文承诺提供一些有价值的见解，医疗保健专业人士可以在为更年期患者提供体重管理建议时加以利用。”

Faubion博士，NAMS医学总监

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