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For many of us, shedding pounds becomes more challenging as we grow older. In fact, it’s common to gain an additional pound each year after hitting 35. Although a single pound may not seem significant, over several decades, it can accumulate to place us in the overweight or obese categories.
Your Metabolism Changes Dramatically After 50
The reasons behind weight gain with age are complex, but there are a few key factors. Most notably, our metabolism tends to slow down as we get older. This means we naturally burn less energy while at rest throughout the day.
This reduction is partly due to a decline in lean muscle mass that accompanies both time and aging. Nonetheless, the decrease in our basal metabolic rate, or BMR (the amount of energy expended while at rest), is more pronounced than what one would anticipate solely from muscle mass loss.
It appears that the tissues and organs in our bodies simply use less energy to keep the lights on than they did when we were younger. Beyond the BMR issues, people tend to be less active as they age, and this means that there is less movement or exercise-related burning of energy.
Finally, some individuals settle into unhealthy eating habits over time, particularly in association with life and work stresses. When these unhealthy patterns become solidified over the decades, it can contribute to weight gain as well.
However, as women age and progress through menopause, their hormones shift, and this affects their metabolism in ways that can make it even more difficult.
Insulin Resistance Plays a Bigger Role Than You Think
There is a lot more going on than simply a calorie surplus, with individuals taking in more calories than they are burning. It turns out that the majority of us develop metabolic dysfunction, manifesting as insulin resistance and high insulin levels, in our late teens and early twenties.
Insulin is the hormone that helps us to regulate blood sugar, but it also tells our body what to do in terms of storing versus burning energy. In essence, insulin tells us to store fat.
When someone develops insulin resistance, the cells of the body ignore the insulin. Even before sugar levels start to rise into the pre-diabetes or diabetes range, the body responds to this insulin resistance by releasing even more insulin. This can help to keep the sugar levels in check for a period of time.
However, the higher insulin levels are telling your body to put away energy and store it as fat, even in the absence of a calorie surplus.
Traditional Calorie-Cutting Sets You Up for Failure
For decades, physicians have told patients to lose weight by creating a calorie deficit. This means taking in less energy than you are burning over the course of the day. We have told people to eat less and exercise more.
This makes sense on the surface. After all, no one is debating the laws of thermodynamics. However, this approach sets people up for failure in the long term.
If you are trying to lose weight by eating less and exercising more, your body senses the energy deficit and goes into preservation mode. It thinks that you might be at risk of starving based on the calorie deficit.
In order to protect you from starvation, hunger and cravings increase in order to drive you to eat more. In addition, perceived energy goes down in order to encourage you to take it easy and not use up any more energy than is absolutely necessary.
Of course, this is the exact opposite of what you are trying to accomplish. You are trying to eat less and exercise more, while your body is telling you to eat more and exercise less. You are fighting your physiology. You simply cannot succeed in the long term by being hungry and fatigued all of the time.
Why Initial Weight Loss Doesn’t Last
Fighting your physiology to create a calorie deficit can help individuals lose weight for a short period of time. However, for most people, it is not sustainable.
This is what I witnessed in my clinical practice as I watched patient after patient have initial success but then experience the inevitable weight regain. Each and every one felt like they were failing themselves and even failing me.
However, they were doing what they were told. I now believe that we in medicine were failing them.
You’re Losing Precious Muscle Mass
All of us lose muscle mass as we age, as much as 10% or more per decade after the age of 35. And, if you are an individual who has tried to lose weight multiple times over the years with calorie restriction, it is likely that you might have lost even more muscle mass in the process.
Any time you lose weight, a fraction of the weight that is lost is from lean tissue rather than fat. However, in the setting of caloric restriction, and particularly severe caloric restriction, the proportion of lean tissue loss can be even higher.
The problem with this is that muscle tissue improves our metabolism. When we have more muscle, we burn more energy at rest, which is good from an energy balance standpoint. However, it goes beyond this.
Having more muscle combats insulin resistance. This means lower insulin levels and less weight gain. And it is not just about the weight. By improving your metabolic health and decreasing your insulin levels, having more muscle mass decreases the risk of developing metabolic syndrome and its associated cardiovascular risk.
Why Muscle Preservation Matters More as You Age
As we age and as organ function declines, it is even more important that our bodies have what they need to make what they need to produce their specific sets of molecules and enzymes to preserve muscle mass.
After the age of 35, we generally begin to lose muscle mass, and this accelerates after the age of 50. This can decrease our functionality and quality of life, can predispose us to injury, and can worsen our overall metabolic health (which can predispose us to conditions such as diabetes, heart disease, and even Alzheimer’s Disease).
In addition to exercise and resistance training, adequate protein intake is necessary for muscle mass preservation.
Your Hormones Are Working Against You
As with most things in medicine, the hormonal changes that occur with age are complex, and it turns out that some of these changes make weight loss and maintaining metabolic health even more challenging.
For men, testosterone levels go down with age. This is problematic, since testosterone promotes the building and maintenance of muscle mass. In addition, as testosterone levels go down in men, the ratio of estrogen to testosterone goes up, and this tends to promote weight gain due to fat storage.
For women, the changes in hormones that occur with menopause are profound and have a host of direct and indirect effects. When estrogen levels decrease, the ratio of testosterone to estrogen in women goes up. This tends to promote fat storage centrally, around the midsection, and in and around the organs.
This is a more dangerous form of fat storage, and it has been associated with increased insulin resistance and cardiovascular risk. In addition, the hormonal changes of menopause can significantly affect sleep and emotional health, and this can negatively impact lifestyle choices such as the foods that we eat and how much we exercise and move.
Women Face Unique Challenges with Belly Fat
Once estrogen levels go down with menopause, the increased ratio of testosterone to estrogen leads to changes in where excess weight is stored in the body. Women start to accumulate more fat in the midsection (belly fat and visceral fat), much as men do, even at younger ages.
This central obesity has been associated with several negative health consequences, including insulin resistance, increased inflammation, and even increased cardiovascular risk. The hormonal changes push women further toward metabolic dysfunction, and this means a higher risk for diabetes and related conditions.
Certainly, the hormonal changes that occur with age, for both men and women, negatively impact weight and metabolic health, and we cannot turn back the hormonal clock. The good news, however, is that we can take advantage of what we understand about physiology to deal with these issues directly when appropriate.
Work with Your Body, Not Against It
Rather than fighting physiology by focusing on the energy balance, it makes more sense to work with physiology to make it easier to lose weight. If you take advantage of what we know is happening with your metabolism, you can address the underlying factors head-on.
If part of the reason for your worsened metabolic health and the decrease in your BMR is the decrease in your muscle mass, you can combat this by doing strength training to build up your muscle. Since muscle is helpful for a healthy metabolism and uses more energy, even while you are at rest, it can help to balance the scales.
In addition, metabolic dysfunction and insulin resistance can be directly addressed by changing the types of foods that you are eating. If you eat foods that do not raise your blood sugar and do not raise your insulin levels, your body can transition from being in fat storage mode to being in fat-burning mode.
In other words, it makes more sense to focus on eating the right foods rather than simply eating less food.
What Actually Works for Weight Loss After 50
Creating a calorie deficit by eating less and exercising more is, at best, a short-term fix. It is fighting physiology rather than working with it. If you want long-term weight loss and weight maintenance success, it makes more sense to focus on working with your physiology, even as it ages.
Below are a few directions which you might want to pursue with the help of your medical team:
Incorporate strength training into your exercise regimen:
- Start slowly and build gradually with a goal of 2-3 sessions of 20-30 minutes per week
- If you don’t know where to begin, get help from a fitness trainer who understands metabolism or from your physician
Focus on what you are eating rather than how much you are eating:
- Listen to your body, and prioritize real foods that give your body what it needs without driving insulin levels higher
- This generally means eating more green, leafy, non-starchy vegetables, a good mix of healthy protein sources, and a good mix of healthy fats
- It also means trying to limit simple sugars and more processed carbohydrates
- Again, if you don’t know where to start, you can get help from your physician or from an outside resource
Listen to your body:
- If you are feeling hungry and craving all the time, or if you are feeling constantly fatigued, something is not right
- Even if you are losing weight, this approach will not be sustainable
- Ideally, you want to lose weight by eating real foods that you enjoy and just happen to work for your metabolism and physiology
Consider hormone therapy if appropriate:
- If you are an aging man and are wondering about possibly having low testosterone, you can speak with your physician about looking into this and deciding if an intervention is right for you
- Likewise, if you are an aging woman and are wondering if hormone therapy might be appropriate for you, you should speak with your physician to discuss your options
Set yourself up for long-term success:
- You want to be successful for years and decades, not weeks
- Once you find what is working for you, hardwire your new approach with habits and routines, and rituals
- Since willpower fails over time, it is better to take choice out of the equation
- Make your new approach the default, just the way that you do things, rather than being something that you have to choose or force every single day
