TODAY’S DOSE OF HONESTY

Hit a weight loss plateau?
Here’s why—and how to fix it.

Here’s the truth: ANY diet can be successful in the short term. Significant weight loss is absolutely possible. The challenge is sustaining that loss over the long-term: In an often-cited meta-analysis of 29 long-term weight loss studies, more than half of the lost weight was regained within 2 years, and by 5 years more than 80% of lost weight was regained.

If this is happening to you—despite great success initially and despite not changing anything recently—you are not alone. And, actually, it may well be “all in your head.” Let me explain. 

In the brain, there are sensors whose job it is to maintain and restore equilibrium of the organism—the organism being YOU. When you lose weight, even if it’s healthier for you, these brain sensors perceive this as a threat to stability and aggressively seek to restore your body to its heaviest weight. They do this by slowing your metabolic rate, decreasing levels of your “feeling of fullness” hormone (leptin) while increasing levels of your hunger hormone (ghrelin). I learned this 10 years ago, when I was getting my master's degree in nutrition and becoming board-certified in obesity medicine. And I was FLOORED. I immediately thought of the millions of people who must be perpetually frustrated, discouraged, and feeling hopeless when this happens, thinking it’s their fault when it’s really the result of biology and physiology. So, it actually IS in your head (read: in your brain).

Consider this example (based on evidence in the obesity medicine literature): Two people each weigh 200 pounds. One is at an ideal body weight or normal BMI (body mass index). The other person is overweight/obese and has just lost 15 pounds to reach 200. Pound for pound, the overweight/obese person is burning approximately 25% fewer calories at rest and feels hungrier and less full than the other person. Cue the plateau—and the potential weight regain.

Then there are other things that affect our psyches and behaviors in an obesogenic (weight gain-inducing) way. We may anticipate failure or slippage; we may ease up on our food and fitness focus; we may not be prioritizing sleep, etc. All of this can stack the deck against us when it comes to long-term weight management. The key is understanding and actually EXPECTING this, so we can strategize our way around or through it. 

If you think you've hit a plateau, there are a few things you can do. First, go easy on yourself—this is something that happens to 85% or more of people who lose weight. And guess what? We will be talking about this in upcoming issues of this newsletter…A LOT!

Then revisit all the “controllables”: how much you’re sleeping (goal: 7-9 hours a night), how much you’re exercising (goal: a combo of weights and cardio, at least 150 minutes a week), what type of cardio you’re doing (goal: lower-intensity, longer-duration cardio), and what and when you’re eating. Making small tweaks to this list might get you going again.

Finally, if you’re concerned about your weight, it’s worth discussing your options with a physician who is either board-certified in obesity medicine or experienced in managing patients through weight loss and management. To find out if there is a board-certified obesity specialist in your area, check with obesitycareproviders.com or abom.org.

SYMPTOM SOLUTIONS

What to do when sex HURTS.

According to the American College of Obstetrics & Gynecology, 3 out of 4 women will experience painful sex at some point in their lives. One of the most frequent causes of painful intercourse is vaginal dryness, a common symptom of perimenopause and menopause. 

Estrogen and the vagina are inextricably linked: This hormone affects blood flow, integrity of genital tissues, pH of the vaginal microbiome and, indirectly, sensations and nerve function in the lower genital tract. So, the drop in estrogen that occurs in midlife will consequently affect the vagina. Beginning as early as 10 or more years before officially entering menopause (which could be as early as your 30s), a woman’s estrogen levels can fluctuate and start to decline, causing vaginal tissue to become more delicate and fragile, less flexible and lubricated, and more susceptible to infection. This can result in painful sex, either on initial or deep penetration, and many women will either try to avoid sex, or reduce the frequency of sex, or seek relief with over-the-counter lubricants.

Bottom line, the wetter you are, the better sex will feel. But here's the thing with the vast majority of OTC lubes: They're great in the heat of the moment, but in the long term, they can cause more harm than good. Why? Because no lube treats the root cause of midlife vaginal dryness, which is low estrogen. Using lube makes vaginal walls slippery but not strong and flexible; it's like having smooth ice on top of a cracked driveway.

If you need more lubrication, I recommend a range of options, from coconut or sunflower oil (yes, this can go in your vagina unless you're using condoms), to Revaree vaginal inserts (they're nonhormonal and available online), to vaginal estrogen, which is available by prescription; studies have shown that estrogen is the most effective way to restore the vitality to the vaginal tissues. Talk to your doctor about all the options. There are more than ever—the vagina can benefit from anti-aging treatments too! 

COMMUNITY

“I have heard that menopause
causes ADHD. Is this true?”

Good question! Is it brain fog—or something more? I asked our Core Expert, psychiatrist Dr. Sue Varma, to provide insight and answers.

It doesn’t cause it, exactly. Menopausal symptoms—and particularly brain fog—can mimic those of ADHD (attention deficit hyperactivity disorder). On top of that, declining estrogen levels can sometimes appear to worsen the symptoms of existing ADHD.

The problem is that ADHD often goes undiagnosed in girls and women. Anxiety and depression, which often accompany ADHD, may be what motivate a woman to seek treatment. But if she has ADHD, it could remain unrecognized because many primary care offices do not really screen for it. Add in the brain fog that can come with perimenopause, and it gets even harder to know what, exactly, is going on.

A thorough and detailed history is crucial to distinguish the onset of brain fog from undiagnosed ADHD. It should include a timeline of symptoms; what, if any, impairment exists across settings (home, work, school, etc.); input from family members; educational test records; and neuropsychological evaluations, if any. If the symptoms began in childhood and there has been a history of attention deficits prior to perimenopause, an evaluation for ADHD is probably in order.

On the other hand, brain fog symptoms normally do not appear until the onset of perimenopause, a time of life that can usher in a host of stressors—relationship issues, divorce, child-rearing, aging parents, career transitions—that can affect emotions and behaviors. And in some cases, brain fog and ADHD may even coexist! So, it’s important to discuss your symptoms with your OB-GYN, who can help determine whether hormone replacement therapy or an alternative might work for you. It may also be necessary to explore your options with a doctor who specializes in treating ADHD.

What you can do on your own: Prioritize quality sleep to help maximize your concentration. And get regular exercise. Walking, weight training, yoga—whatever you choose, it will promote and help maintain good musculoskeletal health, brain health, concentration, attention, and memory function as well as dial down the stresses in your life.

OUR CORE EXPERT

Sue Varma, M.D., PC, DFAPA, is a New York City-based psychiatrist and cognitive behavioral therapist and a Distinguished Fellow with the American Psychiatric Association (APA). A clinical assistant professor of psychiatry at New York University (NYU) Langone Health, Dr. Varma is author of Practical Optimism: The Art, Science, and Practice of Exceptional Well-Being. Buy it here.

ABOUT DR. JEN

In her roles as chief medical correspondent for ABC News and on-air cohost of “GMA3: What You Need to Know,” Dr. Jennifer Ashton—“Dr. Jen”—shares the latest health news and information with millions of viewers nationwide. As an OB-GYN, nutritionist, and board-certified obesity medicine specialist, she is passionate about promoting optimal health for “the whole woman.” She has written several books, including the best-selling The Self-Care Solution: A Year of Becoming Happier, Healthier & Fitter—One Month at a Time. And she has gone through menopause…

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