267. Navigating Weight Gain in Perimenopause and Menopause
🎧 Episode Overview:
Dr. Ali Novitsky returns with renewed energy and exciting updates—including an upcoming trip to Japan and life with new chicks!
In this episode, she tackles a timely and often misunderstood issue: weight gain in lean women during perimenopause and menopause. Through personal insights and a detailed case study, she explores how hormonal shifts impact metabolism, body composition, and mental health—and how to approach this population with compassion and strategy.
1. Understanding Hormonal Shifts
· Estrogen & testosterone decline, cortisol increases
· Impact on muscle mass, fat distribution, energy, and anxiety
· Dr. Novitsky’s personal hormone journey
2. Case Study: Laura (Age 45)
· Lean, active woman experiencing weight gain
· Symptoms, lab results, and emotional impact
· Guided steps for clinical management
3. Tools for Tailored Assessment
· Importance of motivational interviewing
· Taking weight history and analyzing body composition
· Using InBody scans to assess fat/muscle distribution
4. Nutritional and Lifestyle Strategy
· Conducting a nutrition audit
· Realistic food tracking goals
· Importance of strength training in midlife
5. Addressing Resistance & Setting Expectations
· Normalizing frustration and resistance
· Setting achievable fat loss goals
· Supporting “naturally thin” women who are metabolically vulnerable
6. When Lifestyle Isn’t Enough
· Recognizing when medication may help
· Debunking stigma around pharmacologic support
· Advocating for early, proactive intervention
· Hormonal changes in perimenopause affect more than weight — they impact muscle, mood, and metabolism
· “Normal weight obesity” is real — body composition matters more than BMI
· Strength training is key for sustainable metabolic health
· Compassion + data = successful clinical care
🎤 Final Thought:
Dr. Novitsky reminds us that weight gain during perimenopause isn’t a personal failure — it’s biology. With compassionate care and science-backed strategies, women can navigate this life stage with confidence and clarity.
Listen to Episode 267 Here
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Chapters
00:00 – Summer update + trip to Japan
00:43 – Weight gain in lean perimenopausal women
05:05 – Case Study: Laura
09:47 – Motivational interviewing and trust-building
13:08 – Hormonal shifts: cortisol, testosterone, thyroid
15:00 – Sleep, hunger hormones, and weight
19:04 – Detailed weight history
22:03 – Body composition metrics that matter
29:08 – Nutrition audit tips
35:02 – Why strength training is essential
42:09 – When to consider medication
43:22 – Wrapping up and next week’s teaser
Resources:
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*Ali Novitsky MD, this podcast, and podcast write-up are NOT providing medical advice. We do not recommend you start any exercise program without first consulting with your doctor!*
