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Weight achieve is a standard incidence throughout menopause — and infrequently an unwelcome one.
In keeping with Mayo Clinic, girls have a tendency to note some weight achieve beginning within the years main as much as menopause, a interval known as perimenopause, and it’s frequent for ladies to realize about 1.5 kilos (lb) annually of her fifties.
Additional fats often seems across the stomach, and it’s more durable to shed these new additional kilos than it’s earlier in maturity, says Disha Narang, MD, the director of weight problems drugs at Northwestern Lake Forest Hospital in Evanston, Illinois.
Dr. Narang says weight reduction remedy may also help some individuals safely handle menopausal weight achieve when train and consuming a nutritious diet might not be sufficient.
“I see lots of girls on this part of life who’ve labored out and been wholesome their entire lives and are pissed off with the load achieve they’re experiencing now. Beginning remedy shouldn’t be a failure,” she says.
What Causes Menopausal Weight Achieve?
A number of components trigger weight achieve throughout the menopause transition.
“Our metabolism begins to decelerate, but in addition when our estradiol [estrogen] ranges drop, it additionally will increase stomach fats in our midsection,” Narang explains.
Menopause causes a big — and everlasting — shift in hormones. The massive ones are estrogen and progesterone, two hormones produced by the ovaries. Testosterone additionally decreases, however not as a lot as estrogen, based on the North American Menopause Society.
This skewed ratio is why menopausal weight achieve often collects across the stomach, says Joanne Dushay, MD, an endocrinologist at Beth Israel Deaconess Medical Heart in Boston.
“That sort of central distribution of physique fats is related together with your physique being much less attentive to insulin, and that may contribute to bother with weight reduction,” she says.
In keeping with Dr. Dushay, regular growing old is related to a slower metabolic price — the variety of energy your physique burns to maintain regular perform — in each women and men. A slower metabolic price means your resting physique burns fewer energy, which may contribute to weight achieve.
This regular course of may very well be protecting because the physique ages, she provides: “There could also be benefits to having a slower metabolic price as you become old.”
Can Semaglutide Assist With Menopausal Weight Achieve?
Lately when individuals speak about weight reduction medication, they’re often speaking a couple of class of medicines known as glucagon-like peptide-1 receptor agonists (GLP-1s). These embrace the three most typical injectable medicines: Wegovy — the one GLP-1 agonist accredited by the U.S. Meals and Drug Administration (FDA) for weight reduction — and Ozempic, that are each semaglutide; and Mounjaro, which prompts each the GLP-1 and gastric inhibitory polypeptide (GIP-R) receptors. Ozempic and Mounjaro are accredited medicines for sort 2 diabetes.
These medicines assist individuals shed pounds by suppressing the urge for food and reducing blood sugar ranges by prompting the pancreas to supply extra insulin, slowing the speed at which meals strikes via an individual’s digestive system and preserving them full longer.
Research counsel they’re efficient.
A double-blind medical trial revealed in 2021 within the New England Journal of Medication included practically 2,000 adults with weight problems who took semaglutide each week for over a 12 months along with exercising and consuming nicely. Three-quarters of the individuals have been feminine, and the identical quantity have been white. Their common age was 46, that they had a median BMI of about 38, which is taken into account overweight, and not one of the individuals had diabetes. These within the semaglutide group shed a median of 15 p.c of their physique weight after 68 weeks in contrast with lower than 3 p.c in a placebo group.
One other trial, revealed in 2022 within the journal Nature Medication, included simply over 300 individuals with a median age of 47 and confirmed comparable outcomes. All of the individuals on this examine have been both chubby or had weight problems, together with one weight-related medical situation, together with some who had sort 2 diabetes. Their common BMI was 38.5, practically 80 p.c have been feminine, and greater than 93 p.c have been white. Those that took semaglutide as soon as weekly for about six months misplaced about 15 p.c of their physique weight, in contrast with simply over 2.5 p.c within the placebo group.
As a result of there isn’t any information particularly on how post-menopausal girls responded to the drug, and most research on semaglutide are predominantly on white girls, it’s onerous to say for certain how individuals in these teams could reply otherwise to GLP-1s. “I would not say there’s a physiological argument for post-menopausal girls responding in a much less strong technique to GLP-1 agonists,” Dushay says.
There’s one caveat: “[These drugs] don’t sometimes assist with weight that’s centrally distributed,” she says. Meaning the medication could not assist lower fats deposits in particular areas, such because the stomach fats related to menopause weight achieve.
Older girls who’ve gone via pure menopause additionally might not be a part of a gaggle Dushay calls “tremendous responders.”
In her personal medical expertise, she thinks of individuals as tremendous responders if they’re able to lose 10 p.c or extra of their physique weight with semaglutide. From there, common responders sometimes lose about 5–10 p.c of their physique weight, and non-responders both see no change or lose lower than 5 p.c.
“I might say the post-menopausal girls I deal with should not sometimes tremendous responders,” she says.
A evaluate of FDA antagonistic occasions, revealed in 2022 in Frontiers in Public Health, which included practically 5,500 individuals who took semaglutide, discovered that individuals ages 18–65 have been extra prone to expertise digestive issues like nausea and vomiting than individuals who have been older than 65. The info didn’t decide if an individual was taking semaglutide for weight reduction or for sort 2 diabetes, however the information was collected after Wegovy was accredited for weight reduction, which means a few of these individuals could have been taking semaglutide as a weight reduction remedy.
However a 2018 medical trial that included practically 3,000 individuals taking semaglutide for sort 2 diabetes discovered that individuals over 65 have been extra prone to expertise nausea and vomiting, and have been extra prone to cease taking semaglutide due to these unintended effects.
No matter whether or not they expertise gastrointestinal unintended effects, Dushay says older individuals have to be significantly cautious about bone and muscle loss.
Physique composition adjustments with age. Individuals are likely to have extra fats and fewer muscle and bone density as they age, than once they have been youthful. In keeping with Dushay, bone density peaks in our thirties. After that it steadily declines together with muscle mass in addition to energy.
“You must take energetic steps to keep up your muscle mass as you age,” she says. “That’s very true with a medicine equivalent to a GLP-1 agonist that has the potential to trigger vital and at occasions fast weight reduction.”
Narang says when an individual loses a considerable quantity of weight, they don’t simply lose fats. Additionally they lose muscle specifically, which implies weight reduction medication can exacerbate pure muscle — and bone density — loss in post-menopausal girls.
“One thing we emphasize with medical weight administration is the significance of resistance train,” she says. Including weight coaching or physique weight workouts to your exercise routine as you age is necessary for everybody, however particularly individuals who use weight reduction medication.
Who Can Use Wegovy?
The FDA has accredited Wegovy for anybody who has each a BMI of over 27, which falls within the Facilities for Illness Management and Prevention’s chubby or overweight ranges (BMI of no less than 25), in addition to one obesity-related well being situation, equivalent to prediabetes. This implies not everybody will qualify for the remedy. However there could also be different circumstances your physician can consider.
“An attentive doctor will take all the things under consideration, not simply these established metabolic danger components,” says Dushay, noting that circumstances equivalent to despair and osteoarthritis could also be causes somebody could profit from weight reduction remedy.
The excessive value of the semaglutide — about $1,400 for a month’s provide — could make it tough to entry. There’s additionally a scarcity, which implies that even when somebody is prescribed Wegovy for weight reduction, they might not be capable of fill the prescription, Narang says.
“On the finish of the day, the remedy is only a useful resource and the approach to life side — exercising and consuming nicely — is extremely necessary to maintain over time,” she says.
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