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Weight Debate: Women Losing Weight Maintaining Loss

Online Health Chat with Margaret McKenzie, MD

August 27, 2010 | Reviewed on February 6, 2014 by Margaret McKenzie, MD

Introduction

Cleveland_Clinic_Host: Margaret McKenzie, MD is a staff physician at Cleveland Clinic’s Center for Specialized Women’s Health in the Obstetrics and Gynecological Institute. Margaret McKenzie, MD is an assistant professor of Surgery at Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. She is the director for Medical Student Education, clerkship director in the Department of Ob/Gyn, and a staff member in Cleveland Clinic’s Center for Specialized Women’s Health.

Dr. McKenzie maintains a busy clinical practice, yet maintains active in student education and residency as well as community education. Her passion is health care for mid-life women and maintaining long-term wellness as women age. She dedicates much of her time to the reform of medical education and the design of the Ob/Gyn core clinical curriculum.

As a mother of two children herself, Dr. McKenzie has delivered over 8,000 babies. She and her husband believe life is a celebration. They believe that every day when you wake up you have a choice to live passionately and they choose to make that decision daily.

Dr. McKenzie received her medical degree from the Washington University School of Medicine in St. She has given many lectures at the National Medical Association, Speaking of Women’s Health and Universal Sisters conferences on female sexual health issues and “Why Weight?” a discussion on maintaining a healthy size for women. Her media appearances most recently include the Dr. Oz Show. She is a co-author in the current release by the “You Doctors,” Michael Roizen, MD, and Mehmet Oz, MD, in YOU: Having a Baby, now available at major book retailers and online at Amazon.com.

To make an appointment with Dr. McKenzie or any of the other specialists in our Center for Specialized Women’s Health at Cleveland Clinic, please call 216.444.4HER. You can also visit us online at clevelandclinic.org/womenshealth.

Cleveland_Clinic_Host: Welcome to our Online Health Chat with Dr. Margaret McKenzie. We are thrilled to have her here today for this chat. Let’s begin with the questions.


Weight Loss: Why is it so hard?

Patches: The older I get the harder it is to lose or even maintain my weight, what can I do?

Dr__Margaret_McKenzie: This is expected as we have 3 things working against us: our genes (what family members look like as they age), our habits (the poor food choices or portion sizes we have gotten used to) and our slowing metabolic rate (we can't use up food fast enough and so our bodies store the excess calories).

So our approach has to be 3 fold: if you have family members with weight issues (we all have), pay attention and note that this will be your tendency, so start with good habits early.

Secondly, we can no longer have the luxury of eating anything we want. We have to make choices about the number of calories we consume daily, and how and when we consume carbs as well as the amount of fat we consume.

Thirdly we have to move. Tailored regular exercise helps us to use up excess calories and stop the storage.

Once we lose the weight we have to then stick to an approach or program to keep it off. This is the hardest part, so getting a good support system like friends and family to verbally keep you on track when you are regaining, cheating etc., will help you stay on target. Journaling and paying attention to EVERYTHING you consume daily is very helpful as well as making exercise like brushing your teeth: first thing in the morning and don't leave home without doing it! Keeping track daily also helps me: I simply pinch my waist skin daily and so can keep track effortlessly of if I am gaining there again.

Weighing every day initially helps as well, until you get your hands around keeping the weight off long term.

Old rule: "balance what goes in (our mouth) with what you work off (exercise off)" - still is true.

Helpful website: Sparkpeople (I have no ties)

GiraffeGirl: I have hit a plateau with my weight loss - but I still need to take off at least 20 lbs. I am eating right, exercising etc. How can I get jump started again? I am getting discouraged

Dr__Margaret_McKenzie: Don't get discouraged! Kudos for losing so much! Plateaus mean we need to tweak something else. Usually it is carb consumption at the wrong time or hidden sugars in your food. Carbs are best consumed by noon as we slow down the rate at which we consume them as the day progresses. True for every human alive.

Also, this may be the time to introduce interval training thus mixing up your workout as your body is good at adapting to the same old workouts and meal patterns.

Here is where your doctor can help you! We could help with appetite suppressants and this can sometimes help. But don't give up. It is just time to re-analyze and reset new targets and patterns of eating and exercise.

Fitzie: I am menopausal and my waist line is thickening. It is harder to lose weight especially when I crave nothing but sweets. I am staying away from them and eating healthy - but why at this age is it so much harder?

Dr__Margaret_McKenzie: For the same reasons that we have been chatting about. Our metabolism simply slows down! Removing simple carbs from the diet removes the craving. See South Beach- he has a good program to help overcome the cravings. (no ties)

janeszk: It seems really hard losing weight since menopause. Any suggestions?

Dr__Margaret_McKenzie: Menopause is a time of slowing of our metabolism, both for reasons related to hormones and also aging. The best approach is to anticipate that you too will be a victim of this slowing metabolism and start a solid balanced exercise program, such as walking 45 -60 minutes daily and strength training 1 or 2 days a week.

We can no longer consume the same amount of food and the calorie dense foods we used to, without storing them, so modification is important. Check with a good nutritionist to help you plan for this inevitable change in all our lives.

Stella: Is it true that women gain weight after a hysterectomy? Does is matter whether or not you take hormone replacement therapy (HRT)?

Dr__Margaret_McKenzie: Only if the ovaries are removed at the same time, as you become postmenopausal instantly and your metabolism starts to slow down. Anticipate this and work out and mind the caloric intake and you can avoid it!


Reasons to Lose Weight

helpme: My extra weight is mostly in my stomach. How can you focus weight loss to that area? Normally when I diet I lose weight in my chest and butt. I don't want to lose weight there!

Dr__Margaret_McKenzie: Well, you must be an apple-shaped person! So am I! We struggle with this and we are at higher risk than out friends the pear shaped women for heart disease and diabetes. So carbohydrate timing is important. Don't omit them as we need them, but load up early in the day, prior to noon, combined with caloric restrictions and exercise. This is an excellent way to "have your cake and eat it too" Must keep track of pinching that area regularly to monitor, as it always wants to come back. You will have to exercise regularly for the rest of your life. So will I!

Silsby: My physician told me to lose weight for health reasons (diabetes, cholesterol) - but did not tell me how to get started. Do you have any suggestions?

Dr__Margaret_McKenzie: Depending on your age, get medical clearance first. Education is key! Go to programs and websites about those diseases you are trying to avoid. Understanding how they happen in the first place helps to empower you to take control. Knowing what the consequences of untreated disease are also helps. Then go to a website like Sparkpeople (I have no ties!)It is free and has good quality blogs ,food diary keeping and exercise monitoring and suggestions and the website even lists support groups in your area. In addition, use a phone app that helps to keep you on track as you are on the road, at a restaurant, etc. as you can keep track of what you eat, consult about a particular food or restaurant choice for calories etc. Support is key! you can't do it alone unless you are highly motivated and have a good support group. Get a partner so the days you don't want to exercise you can push each other. Having a date to exercise is harder to break if you know someone else is depending on you.

Join a program and when you have formed the new habits then go off on your own, but remember we are community people, we work better in teams, so find a team and share the experience.

K2: Why would I be told to lose weight before I have surgery?

Dr__Margaret_McKenzie: First of all, never take this personally. Your surgeon is interested in your welfare and your quick recovery after surgery. Overall you will be at lower risk!! Lower risk of postoperative infections, wound complications, forming blood clots in the legs- which we can break off from the legs and send to the lungs resulting in a life threatening condition known as pulmonary embolism .In addition the better visualization at at the time of surgery results in less risk of complications during the procedure. In addition, less anesthesia complications! Best wishes!

VPride1023: How does being overweight affect one’s ability to become pregnant?

Dr__Margaret_McKenzie: We make estrogen in our fatty tissue which shuts off your body's ability to develop eggs in the ovary in a normal fashion. Weight loss helps this mechanism to return to normal and voila! You get pregnant! We can help with drugs too but why not try it the natural way!

llucius_1: I had lost 70 lbs nine years ago eating bite sized candy bars all day long. I kept the weight off for seven years and only two years ago during a highly stressful period gained 40lbs. I eat 80% healthier than ever, workout daily, lift weights several times a week and cannot lose a lb. I believe I have created a insulin resistant body and would like to know what recommendations you would have. Reading, websites, etc.

Dr__Margaret_McKenzie: See an endocrinologist, and it is time to reassess your current dietary and exercise routines. You just need a kick start to get you over a hump. Medical management can help here.

llucius_1: What is the protocol for treating insulin resistance and PCOS?

Dr__Margaret_McKenzie: Well, you should definitely check with an endocrinologist for this one. Medications are available that help decrease insulin resistance. But other things that will help are "weight loss and exercise." Hope this helps.


Weight Loss & Exercise

BunnyOma: While walking for exercise, I injured my heel and Achilles tendon and my doctor says I have to be in an Aircast for 4 weeks and no exercise. How can you even try to lose weight, let alone maintain any weight loss with an injury that has you sidelined?

Dr__Margaret_McKenzie: Well, this takes masterful control, but we are women and good at that when we want to be. Think about that dress that costs ????, You don't have the money now but you will get that dress won't you? Same thing. Just really pare down on what you eat. Minimize animal protein and use more vegetable protein as they tend to have less hidden fats, and decrease your overall caloric consumption but not so low as to slow down your metabolic rate. You may also add a very strong upper body weight routine to maintain muscle mass. We can sit and lift weights and use machines. Be patient, once the cast is off you will be instructed on what exercises to incorporate as you rehabilitate that injured muscle group and you will be on task again. Don't give up. You still have some control!

wilderland: I am on disability and can't walk for a long time. Are there any exercises you can recommend for someone with a disability?

Dr__Margaret_McKenzie: Depends on the disability. Strength training comes to mind, but I would visit the gym , local YWCA or consult with an exercise guru to personalize it to your own disability to prevent further injury.

VPride1023: I would like to lose over 100 lbs. What would be a safe amount of weight to loss weekly?

Dr__Margaret_McKenzie: Well, in my experience, the patients who have this much weight to lose will do well with some form of partnering and/or medical management.

  • Initially, most of my patients are placed on a high protein, low carbohydrate approach (South Beach diet-no ties), with support.
  • Must exercise at least 3-4 times per week.
  • First week they lose 5-18 lbs and then it goes slower. Stay on the low side 2-4 lbs per week initially and then plateau to about 2-3 pounds with strict adherence and no cheating.

Healthy Eating Choices

AJ_s_mom: What foods do you recommend to be filling, low in calories and nutritious?

Dr__Margaret_McKenzie: Oh those vegetables – fibrous: brussel sprouts, cabbage, sweet peppers, romaine lettuce, onions, radishes, beets. Eat veggies with every meal and yes have all veggie days weekly. Get creative with flavors to help keep them not being so boring and try various prep methods such as stir fry, raw, broil after marinating, etc. Remember when we do raw we tend to add dressings, so stick with low calorie ones. (Note I did not say low fat)

maynarl: What advise can you offer someone who is extremely overweight that mostly eats proteins, fruits & veggies (pretty much lives on salads and vegetables) that cannot exercise except in a pool due to other health conditions?

Dr__Margaret_McKenzie: Limit the number of fruits per day to 2 - 1 in the morning 1 hour after breakfast and 1 hour after lunch. Make it a hard chew: apple, pear etc. Stay away from high sugar fruits like mandarin oranges, grapes, cherries, watermelon etc. as we tend to over eat them.


Metabolism

maynarl: What other factors might you contribute to a person averaging eating 1300 calories per day that weighs in excess of 350#?

Dr__Margaret_McKenzie: Slow metabolism! Just not consuming enough calories, you will be starving at this low caloric intake and then you will overeat at the next meal. Also, how much fiber is in those 1300 calories? The more the better!

Ask for help from a doctor and nutritionist, who usually treat weight challenged patients and they can help you figure this out.


Water Weight

Mariah: It seems like I am puffy - water weight. Does 'water weight' really make a difference and how can I get it off without medications.

Dr__Margaret_McKenzie: Water weight typically happens just before our period and is related to one of the hormones we make that cause us to retain. Consuming high sugar and high sodium foods also make us retain. Limiting sodium intake and switching to birth control pills to turn off those hormones are the only 2 things I know that helps. Many of my patients gain up to 5 lbs per month during this part of the cycle and plateau on weight loss programs during this week of the month. Knowing it will happen can help you keep your mind focused so you don't cheat if you perceive you are failing on your weight loss program. It usually resolves after the cycle. If it persists after, check with your doctor to see if any medical condition is contributing to this persistent water weight gain.If you are menopausal and your sodium intake is ok please check with your doctor to make sure no other medical condition exists.

challenged: When a person loses weight fast, someone always says - 'Oh, that's just water weight.' What exactly does this mean and is this true?

Dr__Margaret_McKenzie: Initially, when you first limit your calories, we tend to see most of the weight we lose is related to water weight just by cutting back. When you start exercising, this slows down and you may tend to even plateau or gain weight as you breakdown fat and build muscle.


Fact or Fiction?

Turner: Is there any merit to periodic fasting – say once a week?

Dr__Margaret_McKenzie: Well, current data suggest that frugal caloric intake is better for us. I am struggling with this one as I like to eat. But look at our friends who do it for religious reasons: they are no slimmer than we are but I do feel that giving our digestive system a rest for 1 day makes sense intuitively, but I have no data to back it up and no benefit I have seen either.

wilderland: Does Acai help with weight loss?

Dr__Margaret_McKenzie: Sorry but I don't know the data. However, if I thought it did, I would quit my job and go to every mall in America and every street corner and sell it. I would even wait outside Doctors offices and sell it to all their patients.

I wish it was that easy. Watch the calories you consume when you eat acai as it is sour and they flavor with sweeteners to make it more palatable.

Turner: What about the colonic cleanses that I see advertised. Are they helpful in losing weight?

Dr__Margaret_McKenzie: Colonic cleansing is not a way to lose weight. It is good for preop bowel preparations and colonoscopies!


Closing

Cleveland_Clinic_Host: I'm sorry to say that our time with Dr. Margaret McKenzie is now over. Thank you again Dr. McKenzie for taking the time to answer our questions today about Weight Debate: Women Losing Weight, Maintaining Loss.

Dr__Margaret_McKenzie: It has been great talking to you. Keep your questions as we will have more opportunities to answer them in this forum in the future.


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