In life, there are clear transitional periods where nutritional needs shift. The rapid growth of infancy and early childhood is one. For women, pregnancy and menopause are others. But dip into the research literature on menopause, and you would think that this very normal, natural life transition constitutes an emergency. Really, it’s one more example of how women’s bodies are treated as problems to be managed.
Yes, the hormone shifts of menopause — as women’s reproductive years conclude — increase women’s risk of developing certain chronic health conditions, such as heart disease and osteoporosis. And, yes, menopause is often accompanied by symptoms that affect quality of life, at least temporarily. But all the panic about menopause and the changes it brings can have a decidedly unhealthy side effect.
Menopause and eating disorders
“Perimenopause is a critical time for the development of an eating disorder because of societal pressure not to gain weight or to get old,” said Erica Leon, a certified eating disorders registered dietitian based in Westchester, New York. Indeed, research suggests the hormonal changes of perimenopause may open a “window of vulnerability” to developing eating disorders. Couple that with the perfectionistic mindset of many women today, and that’s a potent mix. Instead of pausing to ask, “How can I care for myself today?,” or, “How can I have a better relationship with my changing body?,” women often see trying to control their bodies as the answer to their distress.
“Life is really challenging at that time. That’s one reason that diets are so appealing,” Leon said, pointing out that women tend to “shape-shift” around menopause — weight shifts to the midsection because of the loss of estrogen, and muscle tone may decrease due to lower physical activity levels. While less than half of Americans participate in the recommended levels of physical activity, that number is even lower among women ages 40 to 60.
Leon points to research suggesting that 70% of women are dissatisfied with their bodies. “It’s not just about weight gain,” she said. “We as women don’t really talk about changes in our urogenital system, including constipation, painful sex, pelvic floor issues. That affects body image significantly.”
Leon said she sees women of all body sizes who had an eating disorder when they were younger start to gain weight around their middles in the menopausal years and worry that this will trigger the development of a new eating disorder. Unfortunately, midlife eating disorders are far from uncommon. A 2012 study estimated that 13% of American woman age 50 and older have eating disorder symptoms, higher than the rate of breast cancer. A 2017 study found that about 3.5% of women over 40 have a diagnosable eating disorder, yet most are not receiving treatment. Another study found that while rates of anorexia plateau around age 26, rates of bulimia plateau at around age 47, and rates of binge eating disorder don’t plateau until the 70s.
“If every single woman over the age of 50 has gained weight around the middle, this means it’s supposed to happen,” Leon said. It’s true that women have a higher risk of developing heart disease after menopause, but supporting heart health doesn’t automatically translate to “lose weight.” Instead of trying to control the body, Leon’s advice is to control the real controllable factors. “We can control our movement, sleep, stress and food choices, but not our weight,” she said.
When it comes to those food choices, think gentle control. Or, as Leon suggests, think about adding rather than taking away. Things to add include fish (for the heart-healthy omega-3 fats), fiber from fruits, vegetables and whole grains — this can support gut health, which is important — healthy fats, and more plant-based meals.
“A gentle approach is needed because many women get so caught up in diet culture, including restriction and restrictive diets, and we know that diets don’t work.” She points out that weight cycling — repeatedly losing and regaining weight — is not helpful for managing symptoms of menopause. The shame and frustration of weight struggles can also cause us to abandon self-care habits and behaviors, which is what we need to stay healthy for the long run.
Then there’s this: “When you’re on a restrictive diet, you’re not making enough estrogen,” Leon said. “We know we need estrogen for everything, for bone health, for heart health, for brain health.”
Movement, stress and preventive care
Menopause aside, Leon said that midlife is simply a good time to take stock of what’s going well and what’s not going well. Are you getting routine health care? Are you due for a cholesterol check and a bone density scan? Is there other preventative care you’ve been putting off, perhaps due to the pandemic? How are you doing with reducing stress and fitting in forms of movement that feel good and are sustainable? In other words, they fit into your life.
As I wrote about a few weeks ago, physical activity may not help keep you mentally sharp as you age, but it does have many other benefits for health. These include promoting healthy blood pressure, blood sugar and cholesterol levels, all of which may help you prevent heart disease and Type 2 diabetes. Being physically active can also lessen osteoarthritis pain, reduce breast cancer risk and lower stress hormone levels.
Speaking of stress, Leon said that’s important to pay attention to during menopause. “When we are experiencing mood swings, anxiety, depression, sleep disturbances and hot flashes, we need to work on stress management. Stress makes all the symptoms worse,” she said, adding that she learned a lot after she already went through menopause herself. “It sounds really simple, but I wish I had started meditating earlier when I really needed it.”