For Mary van den Berg-Wolf, 63, an internist in Bala Cynwyd, a ski accident – and the resulting knee injury — proved a wake-up call.
Knowing that every extra pound she carried translated into six pounds of additional pressure on that aching knee, she was determined to lose some of the 20 or so pounds she had gained between the ages of 45 and 50.
"My experience with weight loss was always trying to lose a couple of pounds, trying to be healthy, eating a low-fat, high-carb diet and thinking of it as calories in, calories out," said van den Berg-Wolf. She often found herself cutting back on lunch and then devouring a box of low-fat cookies later in the evening.
And not losing weight.
Her experience, as many women can attest, is common. Shedding pounds after menopause is usually harder. But it's not impossible, said Janine Kyrillos, director of the Jefferson Comprehensive Weight Management Program at Bala.
"People are resigned to gaining weight as they get older, and they assume that's what's going on," said Kyrillos. "But there are lots of subtle things happening, including lack of sleep and increased stress levels."
"If people pay more attention to what's going on in their lives, it doesn't have to be a fait accompli that they're going to gain weight," she said.
Metabolic changes during menopause, which make women more sensitive to carbohydrates, including sugars, can also promote fat storage, said Kyrillos.
"During menopause, you become more sensitive to carbs, so you become more insulin resistant. Paying attention to the quality of food is important – so you should try to stay away from carbs, processed foods, and sugars after menopause," she said.
Along with the metabolic changes of menopause, aging can also mean a loss of muscle mass, said Colleen Tewksbury, a registered dietitian and bariatric program manager at Penn Medicine. Since muscle burns the most calories, a reduction in muscle means a lower resting metabolic rate, which translates to weight gain unless you eat less.
"When people age, they tend to get less physical activity, as well," said Tewksbury, who recommends weight-bearing exercise and eating enough protein daily to build muscle.
For van den Berg-Wolf, losing weight meant changing her eating habits to rev up her metabolism. With the help of Kyrillos, she reduced the amount she ate and focused on a diet higher in fat and lower in sugar. She drank more water, gave up alcohol, and took a tiny amount of a prescription appetite suppressant for about a year, to help her adjust to eating less.
And, she slowly lost 12 pounds, which brought her to the "tippy top of the normal range" for her 5-foot-7 frame.
"I don't eat things like pasta and bread every night, but I certainly do eat them when I want to," said van den Berg-Wolf.
"People can lose weight," Kyrillos said. "People get discouraged and say you can't teach a dog new tricks, but you can work on sleep and stress, or try something different like I have patients who thought they tried everything but have been able to take new approaches that have been helpful."
If you're struggling with taking off those postmenopausal pounds, here are some tips:
But what if none of these measures helps?
Rhonda Cohen, 63, knows what that's like. She spent much of her life on numerous diets that rarely worked, but when she reached 50, the scale refused to budge. It was galling, particularly because she had never exercised so much in her life.
At first she lost weight, but then stalled.
"For a while I didn't really weigh myself, I just thought I was getting in shape," said the administrator from King of Prussia. "At 50, my metabolism stopped, despite doing all this exercise. I was getting better at keeping up with the others in the program. But I didn't lose a pound."
Doctors who checked her metabolism and ran blood work to uncover why she couldn't lose weight simply told her some people can't lose weight.
Eventually, at 61, Cohen opted for bariatric surgery. Put on a super restrictive diet of about 1,000 calories a day presurgery, she finally was able to drop a little weight.
"We don't put an age limit on bariatric surgery," said Tewksbury. "We look at patients as individuals. If we have a 70 year old with a BMI of 40 who is metabolically healthy but at risk of disease we will consider surgery. Lots of factors are at play to see if it's surgically safe to do the operation, including good psychosocial support.
"It's all about whether benefits are going to outweigh the risks," she said.
Following Cohen's bariatric sleeve surgery, she dropped 100 pounds. She feels much better, although she says she still considers herself overweight. But as an athlete who continues to go out for six-hour bike rides with friends on weekends, she realizes that she can't live on 1,000 calories a day.
"I need to eat 250 to 450 calories an hour to keep my strength up during a bike ride," says Cohen, who once took four blood pressure medications and now takes none. "My choice is to be healthier rather than skinnier."