The topic of weight loss often surfaces in discussions about health and well-being, and celebrity weight loss journeys often garner significant attention. This article delves into the weight loss experience of actor Michael Knight, while also addressing the broader context of weight management, particularly for women experiencing menopause.
Michael Knight's Weight Loss
Michael Knight, the actor known from Seinfeld, shared some insights into his weight loss journey. The 69-year-old actor initially responded humorously when asked about the amount of weight he lost, exaggeratingly stating "7,000 pounds". He then clarified, “No, I lose 10. I gained 50." Knight also revealed that his weight loss had some negative impacts on his acting career. "It's just what it is,” he said, adding, “It takes time."
Weight Management and Menopause
Unwanted weight gain is a frequent complaint among women after menopause, leading many to seek solutions from primary care clinicians. As Stephanie Faubion, MD, medical director of The Menopause Society and director of the Mayo Clinic Center for Women's Health in Jacksonville, Florida, notes, "A lot of women are in tears because they have gained 10 or 15 pounds." While many may attribute this weight gain directly to menopause, aging plays a significant role. Research indicates that women tend to gain approximately 1.5 pounds per year, starting nearly a decade before menopause and continuing for about a decade afterward.
The Role of Estrogen
The loss of estrogen during menopause contributes to fat redistribution, shifting fat from the thighs, hips, and buttocks to the midsection, which is often more challenging to reduce. Additionally, women experience a natural decline in muscle mass as they age, partly due to estrogen's role in muscle function, according to Maria Daniela Hurtado Andrade, MD, PhD, assistant professor of medicine at Mayo Clinic Alix School of Medicine in Jacksonville, Florida. "Menopause compounds the changes associated with aging: It makes them worse," Hurtado Andrade said.
Health Risks Associated with Weight Gain
Mounting evidence suggests a link between obesity-related systemic inflammation and an increased risk of cardiovascular disease, including heart attacks and vascular damage. Michael Knight, MD, clinical associate professor of medicine and a weight loss specialist at the George Washington University in Washington, DC, estimates that over half of his patients are postmenopausal women. He recommends clinicians assess for adipose tissue dysfunction, which can lead to localized insulin resistance and affect metabolic health. Research suggests that clinicians can perform a basic metabolic panel, in addition to testing for triglyceride, low-density lipoprotein, and renal function levels. Several recent studies have pointed to using waist circumference, insulin resistance, or presence of metabolic syndrome to diagnose adipose tissue dysfunction.
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Strategies for Weight Management
Lifestyle Adjustments
Physicians should inquire about their patients' physical activity levels, dietary habits, and changes in daily movement, according to Knight. It's essential to consider a patient's culture when discussing healthier alternatives to their usual diet and to suggest simple changes to start, like eliminating simple carbohydrates - white bread, pasta, and white rice - as a good place to start.
Medical Interventions
Pharmacotherapy or surgical options should be considered for some patients, according to Karen Adams, MD, clinical professor of obstetrics and gynecology and a lifestyle medicine specialist at Stanford Medicine in Palo Alto, California. Postmenopausal women who want to lose more than 5%-10% of their body weight likely will need another modality in addition to diet and exercise. Glucagon-like peptide 1 receptor agonists like semaglutide or tirzepatide are some of the most effective drugs for obesity, according to Knight.
In addition to these drugs, hormone replacement therapy in combination with the weight loss drug semaglutide may improve weight loss and reduce cardiometabolic risk in postmenopausal women compared with semaglutide alone, as recently reported in a study Hurtado Andrade and Faubion recently coauthored. Improving vasomotor symptoms improved sleep, physical activity, and quality of life, which all can affect efforts to lose weight.
A Comprehensive Approach
Most patients who struggle to lose weight using diet and exercise methods alone usually do not maintain a healthy weight long term, according to Knight. Physicians need a comprehensive strategy to introduce options like medications or surgery when indicated for long-term, weight management solutions. Adams, a certified menopause specialist, uses the idea of "good enough" with her patients and suggests they think of weight loss as a journey, which may require different tools at various points.
Tips for Primary Care Clinicians
Here are some tips for primary care clinicians in helping postmenopausal women lose weight:
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- Develop an effective solution that works for your patient's lifestyle. If you don't have one, make a referral to a weight loss specialist.
- Educate patients about obesity and postmenopausal weight loss challenges, to help destigmatize the condition. Explain that obesity is a chronic disease, like hypertension or diabetes.
- Exercise suggestions should consider issues like walkable neighborhoods, access and affordability of gym membership, and home broadband access.
- Strength training should be recommended to counter loss of muscle mass that comes with aging.
- Consider a patient's culture when discussing healthier alternatives to their usual diet.
- Suggest simple changes to start, like eliminating simple carbohydrates - white bread, pasta, and white rice - as a good place to start.
Avoiding Weight Gain
The best approach is to try to avoid weight gain in the first place, which can be easier than trying to lose later, Faubion said. Clinicians should conduct a medication review and look for alternatives to drugs that are associated with weight gain. People in menopause or perimenopause are frequently prescribed weight-promoting drugs like antidepressants for mood swings or gabapentin for hot flashes. "You can't just exercise your way out of it," she said.
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