The Secret to Weight Loss After 40

What is it with women's waistlines? Even if you work out and watch what you eat—and even if you have always been reasonably trim—at around age 40, your midsection starts expanding and the pounds start creeping upward. This frustrating experi-ence often is due to a metabolic disorder that I call Syndrome W. It is responsible for midlife weight gain in most women who eat sensibly and exercise regularly.

A woman's risk for this condition is influenced by genetics. Having this syndrome greatly in-creases the chances of developing diabetes.

Fortunately, with the right treatment, you can get back into the pants that fit you at age 40—and improve your overall health, too.

What Is Syndrome W?

Based on research involving more than 800 patients, my colleagues and I conclude that Syndrome W affects at least one in five women. It typically develops during perimenopause, the years leading up to menopause. The defining characteristics that give Syndrome W its name include weight gain and waist gain (an accumulation of fat at the waistline). The disorder can also involves high blood pressure.

Women with Syndrome W have elevated levels of insulin (the hormone produced in the pancreas that is responsible for regulating blood sugar levels), even though their blood sugar is normal. Evidence suggests that this can pro-duce an increase in appetite that makes it hard to control eating.

If a woman has gained more than 20 pounds or gone up more than two clothing sizes since her 20s, Syndrome W may be to blame. Untreated, she may progress to metabolic syndrome, a combination of obesity and abnormalities in blood sugar, blood pressure and blood fats.

As women approach menopause, declining levels of estrogen, progesterone and other hormones appear to trigger a buildup of fatty tissue. Fat cells in and around the abdomen secrete hormones that adversely affect metabolic rate and cause insulin resistance—the inability of the body's cells to use insulin. Genetics and other unknown factors can cause a disproportionate amount of fat to accumulate around the midsection—so women with insulin resistance start to resemble eggs rather than hourglasses.

As these women gain additional weight, insulin resistance worsens—so the pancreas produces more insulin to compensate. This sets off a cycle of progressive hunger and weight gain as the women experience a dramatic increase in ap-petite, especially for sweets and carbohydrates. Insulin resistance also is believed to contribute to the blood pressure elevations seen in women with Syndrome W.

Even when Syndrome W women are disci-plined about diet and exercise. they suddenly find that the same health strategies they used in their 20s and 30s no longer keep them slim. Each heroic effort to lose weight ends in failure.

The W Diagnosis

The best way to confirm a diagnosis of Syndrome W is with simultaneous glucose tolerance and insulin level measurements. Blood tests measure both glucose and insulin before and again 30, 60 and 120 minutes after you swallow a glucose solution. Elevated insulin levels combined with normal blood sugar levels indicate Syndrome W.

Catching and treating the disorder before weight gain gets too out of hand enhances the chances of avoiding diabetes. Among my pa-tients, the vast majority of women who have been treated with a unique combination of medication and diet have lost 10% to 15% of their body weight. Only a very small percentage of these women have progressed to diabetes.

Added benefit: Successful treatment of Syn-drome W also may lower the risk for heart dis-ease and cancer.

The Treatment That Works

My colleagues and I have developed an effective protocol for treating Syndrome W by normalizing insulin levels, which in turn makes it possible to lose weight. The protocol also helps to lower blood pressure.

First step: The prescription drug metformin (Glucophage), which lowers blood sugar and increases the cells' ability to use insulin. This drug is approved by the FDA as an oral treat-ment for diabetes.

Bonus: Published studies show that metfor-min reduces hunger and food cravings.

Typically, a doctor prescribes a low dose of metfonnin at the start, increasing the dosage gradually until the patient detects changes in appetite and a corresponding weight loss. Pa-tients usually need long-term metformin therapy. Side effects are rare but can include stomach upset and/or diarrhea. Metformin can raise the risk for a rare but dangerous disorder called lactic acidosis, in which lactic acid builds up in the bloodstream—so the doctor should monitor the patient's kidney function.

Caution: People who have kidney problems should not take metformin. Alcohol should be avoided while taking metformin.

Second step: Adopt a unique eating regi-men that reduces insulin levels, staves off hun-ger pangs and promotes weight loss. It is based on six simple guidelines…

1. Eliminate the "four Cs"—candy, cookies, cakes and cereal. Avoid foods that list sugar, sucrose, fructose, dextrose, sorbitol, corn syr-up or honey among the first three ingredients. Artificially sweetened treats can be eaten in moderation.

2. Save complex carbohydrates—bread, rice, pasta—for after 4 pm cog): Studies show that daily food intake increases far more when carps are eaten early in the day.

3. Include vegetables with every meal and snack. Veggies at breakfast? Try an egg-white omelet or quiche made with chopped mush-rooms, onions and spinach. 4. Eat lots of low-fat protein, such as skinless chicken or turkey, beans, lentils and egg whites. Fish is fine—but limit serving sizes to two or three ounces for fatty fishes, such as salmon, tuna and herring.

5. Choose low-fat dairy products, such as skim milk, fat-free yogurt and low-fat cottage cheese.

6. For desert, select fruit—especially high-fi-ber ones, such as oranges, berries and the stone fruits (peaches, plums, apricots). Avoid fruit juic-es and dried fruits.

After the first two weeks on this regimen, allow yourself a once-a-week treat—a slice of pizza, a piece of pie—so you wont feel deprived. Otherwise, stick to the plan. It is very effective at triggering weight loss in women with Syndrome W, so you'll find that it is well worth the effort...and it is flexible enough to follow for the rest of your life.