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The Menopausal Appetite

The Menopausal Appetite

By Nancy Maes

For some women the triumvirate of binge eating, weight gain and menopause are intricately intertwined. This excessive uncontrollable overeating, the accumulation of too much body fat and the changes that occur during the natural biological process of menopause influence each other in various ways and become part of a never-ending cycle.

“Binge eating during menopause can be triggered by life stressors that women in middle age often experience such as transition, emptiness, sadness or loss in their lives,” says Megan Roehrig, clinical psychologist at NorthShore University HealthSystem. “Perhaps it is the kids leaving home, a divorce [or] aging parents that trigger feelings of depression that result in coping with those negative emotions by binge eating.

“Women going through menopause have to deal with their changing bodies and aging in a society that glorifies youth, which only adds to the predisposition of some women to feel negatively about their bodies. So they try strategies such as dieting to change their bodies or their appearance, but that only fuels the cycle of binge eating that makes them feel bad about themselves for what they have done and fuels the cycle even more,” she says.

Studies have found that cognitive behavioral therapy (CBT) is an effective treatment for binge eating problems. “’Cognitive’ is another word for thinking, so we pay a lot of attention to the thoughts leading up to the behavior and the thinking patterns following the behavior,” Roehrig explains.

“We spend a lot of time identifying the emotional triggers or cues of binge eating. Many people use food to avoid dealing with their emotions, so part of the healing process is acknowledging the emotions they feel and dealing with the underlying issues, whether they be marital problems, stressful interpersonal dynamics with friends or family, or feeling lonely and learning ways to cope with the problems—[rather than] using food as a way to escape them.”

Some women find that writing a journal is helpful; others find supportive friends and family; while others take up yoga or other kinds of physical activity, and they often learn what Roehrig calls healthy selfishness.

“Women need to allow themselves the time to take care of themselves in a healthy way because they’re often taught that everyone else should come first.”

Julie Friedman, director of the Insight Behavioral Health Centers’ weight management program in Chicago and Northbrook, says women in middle age who come to see her to lose weight fall into two categories.

“Some patients have unknowingly struggled with binge-eating disorder for quite some time, and are diagnosed by us when they come seeking treatment for weight loss or overweight/obesity,” she says. “Others have experienced new, postmenopausal weight gain, and their self-designed diet plans are so restrictive that they lapse into serious binge-eating episodes to compensate.”

In addition, Friedman points out, “There is some evidence that some women respond in a negative way to changes in the amount of available estrogen in their bodies across time. These changes might include increased anxiety or negative mood, both of which can contribute to binge eating.

“Most of my patients have been very relieved when we identify the problem as binge eating because it’s relatively easy to treat, and we can explain what the solution is,” she says.

Friedman also uses CBT to treat her patients with binge-eating problems and help them lose weight. “People might overeat because they’re tired or stressed or anxious, so we work on identifying these emotional states and then finding alternative pleasurable activities to manage them that don’t include food,” she says. “We teach people that, while binge eating might decrease short-term negative moods, there are long-term negative consequences. We teach people to better tolerate negative moods and to think and behave in ways that can make those moods better without resorting to binge eating.”

One of Roehrig’s patients, Lisa*, said that she probably had a problem with binge eating her whole adult life but was never aware of it. She went to see the psychologist because she was dieting but wasn’t losing any weight.

“I’m 61 years old with a slow metabolism, and even if I ate appropriately for six days a week, if I pigged out one day, I’d gain one, two or three pounds that day,” she says. “Generally when I overate, I’d do it alone because I was afraid it would look piggy, and then I would get angry with myself for doing it.

“I found that the number one trigger for my compulsive eating was getting overtired. I’m more of an activity addict than a food addict, but I turned to food as my source of comfort.”

Lisa has learned to take a break every day. “I need 30 minutes of stillness and silence—no books, no TV, no phone—in order to recharge. And if I do that, I’m able to manage my compulsive eating.” She also discovered that she eats compulsively if she is overstimulated, so she has learned to alleviate that problem by never nibbling while she’s cooking and to eat only when she’s sitting down at a table where she can carry on a conversation during the meal but never read, write, listen to music or watch TV while she’s eating.

Friedman says her patients respond quickly to treatment. “We can make a significant dent in binge eating in the first month with weekly sessions. And 95 percent of my binge eaters lose one to two pounds a week.”

Bad news, they say, comes in threes. With menopause, weight gain and binge eating, it’s true. Awareness, it seems is the best tool required to cope.

 

*Name changed at the source’s request.

 Published in Chicago Health Summer/Fall 2013

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