Dr. Sarah Stombaugh:
This is Dr. Sarah Stombaugh and you are listening to the Conquer Your Weight Podcast.

Announcer:
Welcome to the Conquer Your Weight Podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here’s your host, obesity medicine physician and life coach, Dr. Sarah Stombaugh.

Dr. Sarah Stombaugh:
If you have ever had the thought, oh my gosh, I am doing everything the same and I’m eating the same, I’m moving the same, literally nothing has changed. And now all of a sudden I am gaining weight where that was never the case before. And I feel like every time I step on this scale or I go to the doctor’s office, the weight number is just a little bit higher. I’m seeing weight gain around my midsection that’s driving me insane, but I’m not doing anything different. What gives? Why is this the case? If you have ever asked that question, today’s episode is just for you because this is honestly probably the most common question that I get for patients coming into my clinic. They have been really frustrated with their weight, feeling like they are not doing anything, generally eating pretty healthy and living well and despite that they are gaining weight. And there are a lot of reasons while that can be the case, especially as we’re getting older. So today we are going to dive into that. I am Dr. Sarah Stombaugh, board certified obesity medicine physician. And I want you to understand, I feel like you can work with your body rather than feeling like you have to fight your body or just like nothing that you’re doing is working. So let’s talk about the four most common reasons that we start to see weight change and weight loss becoming harder as we get older.

Number one is that we see a decline in our muscle mass. Now this is something that starts happening honestly even as soon as our 30s and we see these declines in muscle mass that happen every decade in our life. When this progresses significantly, it’s called sarcopenia. I feel like there’s been a lot of conversation about the decline of muscle mass and the risks that that can have, but this makes a really significant difference in our metabolism. So when we think about body composition, our body is composed of so many different things from our skin and our organs to our muscles and our bones and our fat tissue and all of those things together make up our body composition. But what happens when we think about our muscle mass is as that is declining, that can have really significant impacts on our day-to-day energy needs, AKA how many calories you burn and how many calories you get to eat. Our muscle mass is very metabolically active. Muscle is, besides things like our brain or heart that are going to be stable in our bodies, muscle is something that is incredibly metabolically active. And the good news is that we can grow our muscle mass with very intentional effort because it’s naturally declining. So we’re going to have to work a little bit harder than we did when we were teens or when we were in our 20s or even in our early 30s.

As we get older, that muscle mass is going to naturally start declining even if you are doing everything the exact same. And the effect we see of that is that with less muscle, the body is less metabolically active and so therefore it takes fewer calories in order to maintain our body weight. So people will notice this exact phenomenon where they’re eating the same, they’re moving the same, and yet the scale is ticking upwards. So muscle mass is a major contributor to this. Now when we think about how do we address that, you hear a lot these days of like protein, protein, protein. And while that is absolutely true, it has to be protein in combination with regular exercise, particularly resistance training. So when we are trying to build our muscles, we don’t just need to fuel them with protein. We also want to be sending the signal to our muscles of like, “Hey, you are important. I need to use you.”

And resistance training is the way that we are doing that. And so making sure that we are having ideally three or four days per week where we are lifting as heavy as possible. What does that mean? Start where you’re at and work up over time. If you feel like, oh my gosh, I have no idea what I’m doing, work with a personal trainer, work with someone who does know what they’re doing so you can feel comfortable around a gym, feel comfortable with where your body’s at, and then how that you can grow that over time. So in order to build our muscle, we need both protein, but most importantly, that resistance training, because that is what signals to our body to grow muscle. So building muscle is going to be incredibly important because your body’s just not going to do it as simply as it did when you were younger.

The other thing that everybody faces as they get older is significant shifts in their hormones. Now, commonly, women will experience this most significantly and it’s been wonderful. I feel like we’ve had so many great conversations in the last year or two about perimenopause and menopause and how that affects weight. We know that during these years during perimenopause, estrogen’s doing this crazy thing, but ultimately it’s doing crazy to the point where it declines. And then in post, we have our final menstrual period or postmenopausal and estrogen levels are incredibly low and the effect of estrogen being incredibly low has many different effects on our body. A lot of times we think about estrogen in the context of getting pregnant or having periods. And while obviously those are two different things that estrogen does in our body, estrogen actually has more than 2,000 different receptors in our body and can be very important for everything from brain health to heart health to bone health and metabolic health.

So one thing that we see during the perimenopausal and certainly when we’re postmenopausal, the decline levels of estrogen can drive increased insulin resistance. Insulin resistance is a condition where our body is basically stuck storing fat. And so people will notice especially that not only are they gaining weight, but they feel like they gain weight centrally. So they’ll notice that their pants are tighter, their clothes are tighter, maybe they’re gaining weight just specifically in their midsection, even if their arms and legs don’t appear that different. And this is very commonly the effect of insulin resistance. Now we can combat this directly by thinking about, okay, do we need any sort of hormone replacement therapy and is that appropriate? That’s something you should have a conversation with your own physician to determine what are your risks, what are your potential benefits? Because we do know that replacing estrogen can really improve insulin sensitivity, making our metabolic health better, making a heart disease risk lower, lower risk of type two diabetes, and can have a really significant effect in that way.

Now it doesn’t cause weight loss in and of itself, but can be a really important part of a comprehensive plan where we’re working to support weight. So we want to be thinking about, is there something underlying here in which hormone therapy could be that? And then also what are the tools that we have for combating insulin resistance? So one is building muscle. So we know that muscle is really important in combating insulin resistance. So moving our bodies regularly and then especially resistance training will make a really big difference here. We also know that things like getting adequate sleep and this is not just the hours that you spend in bed, but this is while you are asleep, are you getting good quality sleep? So if you are snoring, if you are restless, if your partner is yelling at you in the middle of the night for kicking them or for snoring or gasping for air, that is concerning and you should absolutely reach out to your primary care physician, schedule an appointment and say, “Hey, I think I might have a sleep problem.” We know that people are likely when they have very low iron levels, for example, to have restless legs and restless sleep.

And so are there other things that we can solve with a CPAP machine for sleep apnea, with repleting someone’s iron, for example, sometimes there are very simple solutions that help them to get better quality sleep, but good quality sleep is one of the keys for combating insulin resistance. We also know that managing stress can be really important. When our body is stressed out, our body is not willing to release weight in the same way as when we’re feeling calm, when we’re feeling safe. So emphasizing all of these different things, our exercise, the foods that we’re choosing, our sleep, our stress can make a really big difference in supporting some of those hormonal changes. Now, men will also experience hormonal changes, particularly declining levels of testosterone. And with that, a lot of people will notice that they’re not putting on muscle quite as easily. Their bodies may be more predisposed to putting on fat.

And there can be this really bad cycle that happens for men that as they’re gaining fat mass and they have obesity, can actually derive testosterone levels down even further and it can be really hard to break out of that cycle. And so if it’s something you feel like you’re dealing with, especially as you get into your later years of life, it’s worth having a conversation with your physician if testosterone replacement therapy makes sense. And interestingly, we also consider testosterone replacement therapy in women. A lot of times we think about estrogen, we think about progesterone as being important in women. And while we have significant amounts of those hormones, what we also have is testosterone that decline significantly during the perimenopausal years and through postmenopause. So it may make sense to consider that as part of your hormone regimen as well. So we’ve talked about muscle, we’ve talked about the hormonal changes.

Let’s talk about prior diets. Now you’ve probably heard me talk about before about basal metabolic rate and the effect that it can have when we’ve yo-yo dieted. We know that when our body has gone through extreme diets in the past, particularly when there was just an emphasis on calories in versus calories out and trying to restrict calories as much as possible, our body responds by lowering its metabolic rate. Now that’s actually a very protective thing because your body is working to help you conserve energy. If you’re getting less calories coming in, your body’s like, “Okay, I think maybe that we’re going through our famine right now. Let’s make sure to slow down our energy levels, slow down the amount of energy that we’re using per day so that we can survive on this fewer amount of calories that is being fed to us.” So when that happens, a lot of times we feel it.

We feel tired, we feel cold, we feel physically just exhausted and that can be the effect of this decreasing level of our metabolic rate. Now, this doesn’t always have to be a permanent thing, but when there’s been weight cycling in the past and you’ve had weight loss and weight gain and weight loss and weight gain, it can overall lower your basal metabolic rate. Now, the good news is there’s things that we can do to combat that, particularly making sure that the food choices that we’re making are foods that are really adequately fueling the body. So foods that are really protein rich and fiber rich, giving our body good, sustained energy can really make a difference. The other thing we can do is build muscle mass. So I feel like you’re hearing a little bit of theme here that muscle can absolutely help. Now the last thing that really comes up is that life can get really crazy at 40 and beyond.

A lot of times this is a stage where careers may be really peaking. If you have a career with children, a lot of times you’re in a generation where you’re stuck between children, you’re stuck between aging parents. There could be a lot of other things that are demanding of your time and a lot of people feel, especially women, that they are not able to care for themselves in the way that they want to. And it’s common that I talk to patients every single day who are not exercising the way that they want to. They’re not able to take time to prepare meals in the way that they want to. They feel like they’re always putting themselves last on the table and this can be really detrimental to our health because for one, it’s stressful, but for two, we’ve got a lot of times food choices that don’t align with our goals. We’re looking to convenience foods, maybe even fast foods or takeout type of options. We are not able to move our bodies in the way that we want to. And so we’ve got all these changes adding up together where our body is naturally seeing declining levels of estrogen, seeing declining levels of our muscle mass and yet life is crazy and we’re not able to do the things to work towards it. This is one of the most important things that we talk about in my practice, honestly, is the psychological relationship we have with our body with caring for ourselves, with exercise, with healthy eating choices and how do we do that even when life is crazy. It’s really amazing to realize what are the things in our life that are serving us and what are the things in our life that are better not? And so are there areas that we need to draw boundaries?

Are there areas that we need to cut out or people that we need to cut out of our life or things that we need to say no to so that we can make time in our life for the things that really matter. I also find a lot of times people feel like they’re wasting time in 2026. We are in this era where we are just being inundated every day by news cycles, by social media and it’s so easy to get wrapped up in that. And it can be 10 minutes, 30 minutes, 60 minutes, 120 minutes. It’s very common that I talk to people who have hours of their day or their mind is spent elsewhere and they’re like, “Man, I wish I could have spent that time elsewhere. I have other things that I need to be doing with that time.” And so even just getting really honest with yourself about where are the challenges that you’re having right now and don’t set up just switch all of them at once.

Sometimes you’re like, “I’m just doing a whole life overall. Everything’s going to look different.” And while that sounds wonderful, it’s really unsustainable to do that. One thing I will often share with my patients is, how do you get 1% better every single day? So what is one choice that I could make today that would drive me in the direction of my goals? That and starting to shift things over time becomes really powerful because you start to shift what your day-to-day habits look like as well.

If you were looking for someone who is kind, compassionate and can support you in your weight wash journey, I would love to be that person. I see patients in person in Charlottesville, Virginia and by telemedicine throughout the states of Illinois, Tennessee and Virginia. If you are not in one of those states and you are looking for help. I do have an online program as well called The GLP Guide, which can be a phenomenal resource for people who are starting GLP medications to help them get the comprehensive support that they need to feel successful on those medications. If you ever have topic suggestions, I love answering the questions that you all have. Leave a comment with any topic suggestions, send us an email info@sarastombaughmd.com. I would be so happy to address the questions that you have about supporting your health and your weight wash journey. Thanks for joining me for today’s episode. See you all next time.