In their late forties, many women start to notice signs that menopause is around the corner. Irregular periods. Hot flashes. Many women also notice they’re gaining weight, even if nothing has changed about their diet or activity. Why?

We asked Dr. Brian Frank about it. He’s a family medicine doctor at OHSU, and also an expert in nutrition and preventive medicine.

“Gradually as we age, our metabolism slows down and we gain weight. For women, changing levels of estrogen in menopause can increase both body fat and body weight,” says Dr. Frank.

This weight gain is normal, but feeling anxious or upset about it is normal too.

Those feelings are real and distressing. But keep in mind that your weight is not the cause. The true cause is the fat bias that is everywhere in our society.

“Along with weight bias, we have an age bias. Our society tells us that as we get older, especially women, we become less desirable,” says Dr. Frank. “Fat bias and age bias together can create all sorts of body image issues that become more distressing as we age.”

Dr. Frank focuses on body health, not body weight, with his patients – and he is pushing the health care system to shift the focus from the way someone looks or the number on the scale to just being healthy.

Society isn’t changing overnight, of course. But one real way you can ease some of your own anxiety or stress around your body size is to focus on health goals rather than weight goals.

What is it you want your body to do? Do you want to hike on the weekends? Go skiing? Play with your dog without knee pain?

Your health care provider can help you choose activities to try or changes to make to the way you eat to meet your goals.

Dr. Frank also suggests these strategies for good health, in midlife and beyond:

• Eat food the natural way. Grapes are a good example. Eating a handful, you get anti-oxidants from the skin and fiber from throughout the fruit. A glass of 100% grape juice, however, is stripped of these nutrients – it’s basically just the sugar and water from the grapes.
• Eat food, don’t drink it. Soda, energy drinks, coffee drinks, and juice are full of sugar. Even drinks with fruits and vegetables are often missing the healthiest parts of those foods, like fiber.
• Avoid fad diets. A whole new diet can be exciting at first, but dramatically altering how or what you eat is hard to maintain for very long. Even when it works for a while, a fad diet can ultimately cause so much stress and guilt that it works against the goal of just being healthy.
• Be active. It doesn’t matter if you do spin class, hike, or work in your garden as long as you move your body every day. It keeps your heart healthy and it also keeps your bones and muscles strong which is so important as you get older.
• Get lots of sleep. Different people need different amounts of sleep, but most people need at least seven hours each night.
• Don’t blame yourself. Remember that many, many barriers to having a healthy body are beyond our control. Working two jobs, food insecurity, chronic stress from systemic sexism or racism and more can made it harder to be healthy.