Dr. Michael Kaplan, MD, is the Founder and Chief Medical Officer for The Center for Medical Weight Loss, the largest network of non-surgical medical weight loss providers in the U.S., with more than 420 offices in 46 U.S. states. He live and works in New York.
Stop obsessing and read this.
Posted on April 13, 2011
Being FOF comes with so many great things--wisdom, levity, experience, humor.....And one not-so-great thing: belly fat.
So we paused in the middle of our daily sit-up regimen to speak with Dr. Michael Kaplan, one of the nation’s foremost experts on weight loss. Dr. Kaplan revealed the truth behind belly fat over fifty--why it’s there, what you can do about it, and why you should stop obsessing.
FOF: We hear it from FOFs all the time: ‘It’s so much harder for me to lose weight now, and I’m gaining in my belly area. What can I do?’
Dr. Kaplan: The unfortunate consequence of aging--for everyone--is that your metabolism slows by about 5-10 percent per decade. When women hit menopause, it slows an additional 5-10 percent. Many women spend their lives at a normal BMI [body mass index] of 23 or 24, and then they hit menopause and find themselves at a BMI of 27 or 28--ever so slightly overweight. And they can’t take off the pounds. Also, the body is programmed during menopause to lay down extra subcutaneous fat in the abdomen. So even if you’ve never had fat in your abdomen, all of a sudden you have a belly.
Ack. Why do our bodies suddenly put fat in the middle?
We don’t know, but it’s universal. It’s just kind of in our DNA that this is going to happen to a woman when she hits menopause.
Can you get rid of it?
Yes. But the truth is, a woman has to work really hard to get rid of it. First, you have to exercise more. Even if you went your whole life at a normal weight and you exercised, you have to start adding exercise as you approach menopause. I see patients who have never exercised in their lives, and then they start menopause and suddenly have to start in order to maintain their bodies. The average recommendation for a woman to really be doing well at this age is 5 hours per week.
That’s a lot of hours.
It absolutely is. In all studies I’ve ever read, you have to do about three hours a week to lose weight, but after menopause, it is definitely harder.
What about diet?
A woman’s metabolism once she hits menopause--if she’s normal weight--is usually about 1300 calories a day. That means she’s burning about 1300 calories every day, so she has to eat 1300 calories to maintain her weight. It’s pretty hard to lose weight at that rate, because you have give up 3500 calories to get rid of just one pound.
How do you give up 3500 calories if you can only eat 1300?!
It’s over time! So if you ate 1000 calories a day, you would lose 1 lb every 12 days. It’s really discouraging for a lot of women, and we usually see them after they’ve gone on multiple commercial programs and the weight isn’t coming off. Or it’s coming off so slowly that they’re discouraged...
What’s your approach?
As doctors, we have the advantage that we can prescribe a low-calorie diet. Anything under 1000 calories per day has to be medically prescribed--by law. We prescribe nutraceuticals--low calorie shakes, bars and soups that are made according to the same standards as pharmaceuticals. Each one is 160 calories and patients consume 5 daily. A woman can temporarily use these to get back to her pre-menopausal weight. While she’s doing that, we’re working on the behavioral issues that are going to keep the weight off long term.
So that helps you speed up the initial weight loss, but what’s the long-term strategy?
We try to figure out a day-to-day routine, Monday through Friday, where she can eat about 1100 calories a day. We’ll come up with meal options and an exercise plan. If we do that, we’re banking about 2000 calories for the weekend, so she can relax and go out on Saturday and Sunday. We also address the psychological issues--that’s a huge part of this. We help women figure out their triggers---what causes them to overeat.
If someone ups her exercise and changes her diet and deals with her psychological issues, is it possible that she still won’t lose her belly fat?
Yes. Often, a part of this isn’t going to go away. These fat cells develop and get bigger during menopause. You can make them smaller, but you can’t get rid of them completely. If you get down to the weight you’re happy at, but you still have belly fat that’s bothering you, I might suggest surgery. Liposuction would actually get the cells out. I recommend that as a last alternative.
It sounds like you’re saying, in a nutshell, if you want to want to completely lose that belly, you’re going to need to make it--and your weight--a major focus of your life.
Right, it has to become a battle that you’re fighting everyday.
Do you ever suggest that women just accept the extra pounds around their middles and stop obsessing?
You know, I have said that to people. There was a study published in the Archives of Internal Medicine a few years back that said women actually live the longest with a BMI of 27-28 over age 70. But what we run into is people who are used to having a certain look. And if you spend your whole life with a BMI of 24 or 25 and now you’re 27 or 28, psychologically you don’t feel right.
Are there certain foods that trigger belly weight?
I wish I could say yes to that question, because it would make things easier, but really, there aren’t. I will say that if you are insulin resistant you probably will feel hungrier and eat more when you eat carbohydrates. It’s not the carbs themselves, it’s how your body reacts to them. Many people have that problem.
How do you know if you’re insulin resistant?
If you’ve been diagnosed with PCOS, diabetes or pre-diabetes. Also, there’s a medical test we can do, but I came up with a test that anyone can do at home: One morning, eat 200 calories of carbs for breakfast--an English muffin with jelly, for example. Write down the time you eat and then the time when you feel hungry again. The following day, eat 200 calories of fat and protein for breakfast--2 eggs with a small amount of cheese, for example. Again, write down when you eat, and when you feel hungry again. If you find that you are hungry an hour or two earlier on the carbohydrate day, you’re probably insulin resistant.
Is that something you can fix, or do you just need to avoid carbs?
It could get better. Sometimes losing weight actually makes the insulin resistance better. There’s also a medication called Metformin than can help the cravings--we use this often and patients don’t feel as hungry. And of course, if you just avoid those foods, then you won’t have those cravings.
Is there any way to lose weight specifically in the belly area?
No. That’s a huge myth. If you lose weight, you lose fat everywhere. A pound of fat comes from every fat cell in your body--they all shrink a little bit.
I’ve heard there’s a connection between stress and belly fat. Is this true?
Stress is absolutely related to gaining weight, but not specifically in the belly. The stress response--secreting cortisol and epinephrine--does make us hungry and does make us crave food. Lack of sleep does the same thing. A lot of menopausal women have hot flashes and don’t sleep well as a result, which can make them hungrier the next day. So if you treat your menopause symptoms, you may experience weight loss as a result.
What about situps? Can those help get rid of your belly?
Another major myth. All sit-ups do is strengthen the abdominal muscles--they don’t get rid of fat. So in some cases they can actually make your abdomen look a little bigger. The ideal is to lose the fat and then strengthen the muscles to get definition.
So it sounds like there’s no magic bullet that gets rid of all belly fat.
Yes, but it’s not hopeless. People have definitely done it. The most important thing to recognize is that it is a factor of aging...it’s not anything you did wrong.