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

🕒 Timestamps:

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

🎤 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.

🎯 Ready to Personalize Your Health?

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