By Jana Klauer, M.D.

Research has shown that there are three time periods in a woman’s life when she is most prone to weight gain: adolescence, pregnancy and the peri- to post menopausal time period. And it is during the later period that women find losing weight to be the most difficult. Whereas during younger years weight is easily lost, around menopause the pounds tend to accumulate and do not respond as readily to dieting. And even if weight is maintained, it is often distributed in a different pattern--–with an enlarging waistline. What accounts for this change? Can anything be done?

IF YOU DON’T USE IT, YOU’LL LOSE IT; AND THIS MEANS MUSCLE!

Women naturally have more fat or adipose tissue than men do. This is believed to be an evolutionary trait that served the purpose of protecting the pregnant woman against starvation during times of prehistoric famine. Men, on the other hand, required more muscle mass for hunting. These traits insured the survival of our species. However, modern times require no such protection against starvation!

In addition to women having more adipose tissue to begin with, the metabolic rates of both men and women decline with age. In other words, the amount of calories that we burn at rest decreases. This is because our muscle mass decreases with age. Muscle is metabolically more active than fat–less muscle means fewer calories burned. Fewer calories burned means that they are stored as fat. The average 50-year-old woman even if she is at exactly the same weight that she was at 20 years old will require one quarter to one third fewer calories to maintain that weight. This is because a lower percentage of her weight is composed of the metabolically more active muscle.

The steady accumulation of weight predisposes women to many serious health risks: cardiovascular disease (including both coronary heart disease and stroke), adult onset diabetes, gallbladder disease, hypertension, osteoarthritis and certain cancers are all associated with excess weight.

But muscle mass can be maintained. The solution to this situation is quite simple, but amazingly, many people resist it. The answer is physical activity! The AMA has revised its original recommendation for aerobic exercise from 20 minutes three days per week to 30 minutes on most, if not all, days of the week. When you think of it, this really isn’t a large part of the day and given the fact that this can have enormous health benefits---it’s difficult to imagine why more people aren’t compliant with this. In addition, regular weight training can preserve the amazing fat burning machine–your muscles. We came into this world with arms and legs for a reason: to move!

WHAT EXERCISE WORKS BEST?

There are two types of physical activity: aerobic and resistive exercise. We require both aerobic and resistive exercise for maximal benefits. Aerobic exercise is the exercise is the exercise that makes us sweat and breathe heavily; this in turn has been shown to increase our cardiovascular fitness and to help our hearts pump blood more efficiently. We burn the most calories when we are performing aerobic exercise; this happens when we use the large muscle groups in our legs with activities like running, fast walking, playing tennis, etc. Resistive exercise means activities that require strength, like lifting weights. Resistive exercise makes us stronger and increases our muscle mass. And more muscle uses more calories. For each pound of muscle added by resistance training we burn an extra 50 calories per day. This can add up to a significant amount!

The AMA recommendation is that we get 30 minutes of aerobic exercise on most, if not all, days of the week. Resistive exercise is best performed every other day; or alternate upper body with lower body on a daily basis. This is because increases in muscle strength require a day of rest for the muscle to repair itself. The exceptions to this rule are the abdominal muscles-–they may be worked daily.

THE EXERCISE PRESCRIPTION

So to maximally burn calories I offer the following suggestions:

1. Aerobic activity: Run or walk fast outside or on the treadmill for at least 30 minutes per day. Cycling, swimming and normal walking don’t have as high intensity as running or fast walking. But the important thing is to pick an activity that you like. This point cannot be undermined. If you dread your daily exercise routine, you will be unlikely to stick with it. So, chose something you love, put on some music, make it fun for yourself and get moving. Find your target heart rate; the method most commonly recommended is 220 — your age x 60 to 80%. However, a recent study suggested that this figure might be understating the amount of exertion necessary and offered the following: 208 — (0.7 x your age) for finding your target heart rate. An easier way to find your aerobic zone is by how you feel: you should feel that you are working hard but that you are still able to carry a conversation. Start with a 5-minute warm up period and then increase your speed until your are in your zone for 30 minutes and then follow with a 5-minute cool down period. Do your resistive exercise after the aerobic portion.
2. Resistive exercise. I suggest that you consult a personal trainer before beginning to use weights. The potential is very strong for injury when one first begins to use weights and a personal trainer can make sure that your body is aligned properly. A couple of sessions are usually all that is necessary for you to learn the positions. Work you arms and chest one day and your legs and back the next day; and, of course, abdominals daily.
3. At the end of your entire routine, stretch all muscle groups; breathe deeply and hold the stretches for 30 seconds. Studies have shown that stretching after a workout will reduce injury, increase range of motion and even increase strength.

HAVE FUN

The most difficult part about beginning a new activity is just that, beginning it. If you haven’t been physically active before, get clearance from your physician. Then buy yourself a comfortable pair of sneakers and go, girl! It’s never too late to start. A recent study showed that men who had been inactive in middle age returned to the aerobic level that they had in their 20s after a vigorous exercise program.

You will find real satisfaction in seeing the fat melt away and the definition of muscles. Studies show that those who exercise on a regular basis report a lower perceived level of stress and feel that they are more in control of their lives.

You can do it, women can do anything!

WAIT A SECOND — WHAT ABOUT CALORIES?

There is no way around it, to get rid of extra pounds you have to cut back your calories. Exercise can do a lot for you but calories matter, and they matter a lot. To lose 1 pound of fat you must burn 3500 calories. Lower your caloric intake to 1200 to 1500 cal/day and you can expect to lose around 1 pound per week. This is a terrific and safe rate of weight loss. In 6 months this can add up to 25 pounds.

THE DIET PRESCRIPTION

Studies show that a diet high in complex carbohydrates, low in saturated fat and with adequate protein to sustain lean muscle mass is the best for lasting health and for weight loss. Studies also show that many small meals are better than one or two large meals. These two concepts are related in that complex carbohydrates (vegetables, fruits and whole grains) are high in fiber, which is absorbed more slowly, without the spike of glucose that occurs when simple carbohydrates are ingested. This allows the blood glucose to remain on a level plateau and eliminates large surges of insulin, an atherogenic factor. Consumption of several small meals has the same effect–blood glucose stays on an even plateau. Also, because the blood glucose never drops to a low point one does not feel the ravenous hunger that occurs with less sensible diets.

Specifically, a diet high in vegetables and fruits with approximately O.8 grams protein/kg body weight will give you all the energy and vitamins that you require. Protein should come from a high quality source, such as fish or chicken or legumes. And don’t forget to include 1200mg of calcium daily. Have 3 meals/day plus 3 snacks of fruits or vegetables and make water your new refreshment choice. This is not just a weight loss diet; it’s a prescription for health and weight maintenance.

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Dr. Jana Klauer attended Mt. Sinai School of Medicine and completed an internship in Internal Medicine and a residency in Physical Medicine and Rehabilitation at Mount Sinai Hospital in New York City. After her residency, Dr. Klauer obtained a Masters degree in Clinical Nutrition at Columbia University College of Physicians & Surgeons.

She is currently a research fellow at The New York Obesity Research Center at St. Luke’s-Roosevelt Hospital and Columbia Presbyterian Hospital and is actively involved in clinical research on obesity. Her private practice comes from a lifelong commitment to physical fitness and health and her desire to empower individuals to take control of their health so that they may live longer and more vital lives.

If you have a question for Dr. Klauer, you may email her at jklauermd@yahoo.com.