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Why Your Body Composition Changes in Midlife (Even If the Scale Doesn't) · Clearly Hormonal

• 0:01
  Dr. Komal Patil-Sisodia: Welcome to Clearly Hormonal, the podcast where we stop googling our symptoms at midnight and actually start understanding what's going on in our bodies.
• 0:09
  Dr. Komal Patil-Sisodia: I'm Dr.
• 0:10
  Dr. Komal Patil-Sisodia: Komal Patil-Sisodia, an endocrinologist, internist, obesity medicine specialist, and a Menopause Society certified practitioner, which is really just a whole lot of words to say hormones are kind of my jam.
• 0:21
  Dr. Komal Patil-Sisodia: I've spent 17 years watching women try to navigate their hormonal health without ever having been taught the language for what's happening in their own bodies, and then meeting clinicians who want nothing more than to help them figure it out, but are up against 10-minute appointments and a system that just wasn't built for it.
• 0:37
  Dr. Komal Patil-Sisodia: This podcast is my answer to that gap.
• 0:40
  Dr. Komal Patil-Sisodia: We'll cover menopause, metabolism, hormones, and everything in between with real evidence, not trends, and without the overwhelm.
• 0:48
  Dr. Komal Patil-Sisodia: A quick disclaimer.
• 0:49
  Dr. Komal Patil-Sisodia: I'm a physician, but this is education, not personalized medical advice.
• 0:53
  Dr. Komal Patil-Sisodia: Take what resonates and discuss it with your own healthcare team.
• 0:56
  Dr. Komal Patil-Sisodia: Now, let's get into it and talk about what's clearly hormonal and what's not.
• 1:04
  Dr. Komal Patil-Sisodia: Before we jump into today's episode, I want to share something I created from both my experience as a physician and my own delayed diagnosis of PMOS, formerly known as PCOS.
• 1:15
  Dr. Komal Patil-Sisodia: The PMOS conversation you deserve is live today with all six modules ready to watch.
• 1:21
  Dr. Komal Patil-Sisodia: The course includes a practical workbook and three months of access with monthly live Q&A calls with me to help you understand your condition and feel more prepared for your healthcare visits.
• 1:32
  Dr. Komal Patil-Sisodia: Introductory pricing is available through October 20th, and our first live Q&A call is October 21st.
• 1:38
  Dr. Komal Patil-Sisodia: You'll find the link in the show notes of the episode today.
• 1:41
  Dr. Komal Patil-Sisodia: Now, let's talk about why your body composition changes in midlife One of the most common concerns that I hear in my office is that the scale hasn't changed, but my body has.
• 1:52
  Dr. Komal Patil-Sisodia: And let me tell you how real that feels.
• 1:55
  Dr. Komal Patil-Sisodia: After my hysterectomy in October 2024, I started to feel my body composition shift despite all the prehabbing I had done.
• 2:04
  Dr. Komal Patil-Sisodia: We know that in people who are in perimenopause and undergo hysterectomy, you can go through menopause earlier than you probably would have otherwise.
• 2:14
  Dr. Komal Patil-Sisodia: And it was fascinating to me that I started to see my muscle mass go down despite trying to keep up with my workouts, and I started to notice my body composition changing.
• 2:27
  Dr. Komal Patil-Sisodia: So it can be a really disheartening experience when you are putting in the work and the time.
• 2:33
  Dr. Komal Patil-Sisodia: And I remember getting on the scale and being like,"Oh my gosh, my weight is the same, but I look different.
• 2:40
  Dr. Komal Patil-Sisodia: My body looks different." Initially, I thought,"Okay.
• 2:43
  Dr. Komal Patil-Sisodia: I just need to take it easy.
• 2:44
  Dr. Komal Patil-Sisodia: I'm rehabbing from surgery.
• 2:47
  Dr. Komal Patil-Sisodia: That's probably why stuff is changing." But even after I was three months out from my surgery, it wasn't quite going back to the way that it was.
• 2:56
  Dr. Komal Patil-Sisodia: So what I want to say is this is a common experience.
• 3:00
  Dr. Komal Patil-Sisodia: And I had all the same questions that my patients have.
• 3:03
  Dr. Komal Patil-Sisodia: Is this menopause?
• 3:04
  Dr. Komal Patil-Sisodia: Is this aging?
• 3:05
  Dr. Komal Patil-Sisodia: Is this poor sleep?
• 3:06
  Dr. Komal Patil-Sisodia: What can I do about it?
• 3:08
  Dr. Komal Patil-Sisodia: Last week, we talked about recognizing perimenopause and why normal hormone tests do not rule it out.
• 3:14
  Dr. Komal Patil-Sisodia: Today, we're gonna talk about the body changes that can begin during this transition.
• 3:19
  Dr. Komal Patil-Sisodia: I'm Dr.
• 3:20
  Dr. Komal Patil-Sisodia: Patil-Sisodia.
• 3:21
  Dr. Komal Patil-Sisodia: I'm a triple board certified endocrinologist, obesity medicine specialist, and a women's health expert.
• 3:27
  Dr. Komal Patil-Sisodia: And what I want you to know is that these changes that you are noticing in your body deserve a conversation and not blame, because you can be doing all the things right and still have these changes pop up.
• 3:41
  Dr. Komal Patil-Sisodia: First, I wanna talk a bit about what body composition is.
• 3:45
  Dr. Komal Patil-Sisodia: Everybody's talking about body composition, muscle preservation, fat loss.
• 3:49
  Dr. Komal Patil-Sisodia: It can be really confusing when you keep hearing all of those terms and you don't understand how it all fits together.
• 3:56
  Dr. Komal Patil-Sisodia: Your total weight when you get on a scale will include the weight of your muscle, your fat, your bones, the organs in your body, water.
• 4:04
  Dr. Komal Patil-Sisodia: Total body composition is what percentage of each is contributing to your weight.
• 4:10
  Dr. Komal Patil-Sisodia: And here's three things that I want you to remember.
• 4:14
  Dr. Komal Patil-Sisodia: You can gain fat and lose lean tissue without seeing a large change on the scale.
• 4:20
  Dr. Komal Patil-Sisodia: Lean tissue includes muscle, but it also includes other tissues like your organs, water, connective tissue, so when you see a decrease in lean mass, it doesn't necessarily mean that you're losing muscle.
• 4:34
  Dr. Komal Patil-Sisodia: And then lastly, where your body stores fat can change even if your weight stays similar.
• 4:40
  Dr. Komal Patil-Sisodia: So for example, in the SWAN study, fat gain increased and lean mass declined during the menopause transition.
• 4:49
  Dr. Komal Patil-Sisodia: Weight gain did not speed up in the same way.
• 4:51
  Dr. Komal Patil-Sisodia: So what we were seeing was not necessarily weight gain, but a change in the body composition.
• 4:57
  Dr. Komal Patil-Sisodia: So the scale will tell you your total weight.
• 5:00
  Dr. Komal Patil-Sisodia: It cannot tell you the whole story.
• 5:03
  Dr. Komal Patil-Sisodia: So let's talk about what's hormonal and what else is contributing to all of this.
• 5:08
  Dr. Komal Patil-Sisodia: When it comes to hormonal changes, the menopause transition, that decline in estrogen and progesterone will shift us, but that decline in estrogen will shift fat storage towards your abdomen.
• 5:20
  Dr. Komal Patil-Sisodia: These changes can start before your periods stop, which is what makes it so confusing and so frustrating because you know living in your body every day that those changes are happening and you feel them, but people are potentially brushing them off as,"Oh, you need to eat more protein.
• 5:39
  Dr. Komal Patil-Sisodia: You need to eat more fiber.
• 5:40
  Dr. Komal Patil-Sisodia: You need to hydrate more.
• 5:41
  Dr. Komal Patil-Sisodia: You need to move your body more." It can be partially that, but if you're doing all the same things, then your hormones may changing, and you need a different conversation.
• 5:51
  Dr. Komal Patil-Sisodia: Aging and activity can contribute to body composition changes as well.
• 5:54
  Dr. Komal Patil-Sisodia: So aging will contribute to changes in your muscles and what your energy needs are overall in your body, and then your activity level may be changed by things like increased joint pain, injuries being really busy at work, caregiving, and all of that can make just getting baseline movement much harder.
• 6:16
  Dr. Komal Patil-Sisodia: Your sleep can play a role.
• 6:18
  Dr. Komal Patil-Sisodia: You can have night sweats and disrupted sleep that affect your energy, your appetite, how your routines are, whether you can get up in the morning and go do your workout or not.
• 6:29
  Dr. Komal Patil-Sisodia: Other things like stress, medications, and other health conditions like hypothyroidism or pre-diabetes or insulin resistance can also start contributing.
• 6:39
  Dr. Komal Patil-Sisodia: Your hormones matter in this conversation, but so do sleep, aging, medications, and what's happening in your life.
• 6:47
  Dr. Komal Patil-Sisodia: We usually can't just point to one cause to explain everything.
• 6:50
  Dr. Komal Patil-Sisodia: Everything contributes in little chunks, and so we have to start working on all of those different things.
• 6:55
  Dr. Komal Patil-Sisodia: But it can't be explained by just one bucket, which is my point.
• 6:59
  Dr. Komal Patil-Sisodia: Now, why do we talk about body composition?
• 7:01
  Dr. Komal Patil-Sisodia: It's because there are changes to the type of fat that your body puts on and the possibility your muscle is declining.
• 7:08
  Dr. Komal Patil-Sisodia: So there's two major types of abdominal fat, and I talked about a little earlier in the episode.
• 7:13
  Dr. Komal Patil-Sisodia: We have fat under the skin, which is the fat you can pinch on your body, and that's what we call subcutaneous fat.
• 7:20
  Dr. Komal Patil-Sisodia: And that fat is not as inflammatory or as metabolically concerning as what we call visceral fat, which is that deeper fat inside your abdominal cavity that's stored around all those internal organs.
• 7:33
  Dr. Komal Patil-Sisodia: Visceral fat is associated with higher risks of diabetes and cardiovascular disease.
• 7:39
  Dr. Komal Patil-Sisodia: And one of the things that can really offer a clue is if you take a measuring tape and you measure your waist size, even though your weight may be the same, if your waist size is expanding, that is a sign that you may have more increased visceral fat.
• 7:53
  Dr. Komal Patil-Sisodia: And it's not a perfect method because you can also still develop some fat under the skin in that area.
• 7:59
  Dr. Komal Patil-Sisodia: Now let's talk a little bit about insulin resistance, which develops when you start having more visceral fat show up in your body.
• 8:08
  Dr. Komal Patil-Sisodia: Insulin generally helps move sugar from your bloodstream into your cells.
• 8:14
  Dr. Komal Patil-Sisodia: Insulin resistance means your cells don't respond to that signal particularly well.
• 8:20
  Dr. Komal Patil-Sisodia: I used to use an analogy that I would give people, and I just realize now that people are too young to understand my analogy, so that just makes me feel really old.
• 8:29
  Dr. Komal Patil-Sisodia: But I'm gonna give it to y'all anyways.
• 8:31
  Dr. Komal Patil-Sisodia: So one of my favorite shows when I was growing up was I Love Lucy.
• 8:34
  Dr. Komal Patil-Sisodia: My favorite is the iconic chocolate factory episode where Lucy and Ethel are in the chocolate factory.
• 8:40
  Dr. Komal Patil-Sisodia: If you remember that episode, you'll remember that they're working at a factory assembly line and the conveyor belt is speeding up, and as it keeps getting faster and faster, they have more work to do.
• 8:51
  Dr. Komal Patil-Sisodia: With insulin resistance, your pancreas also faces a bigger workload.
• 8:56
  Dr. Komal Patil-Sisodia: It needs to make more insulin because your cells aren't responding as well, and it may keep up for years, but if it can't make enough to meet that demand, the blood sugar rises.
• 9:06
  Dr. Komal Patil-Sisodia: And that is what I always parallel to how Lucy and Ethel can't keep up with the speed of that assembly line.
• 9:18
  Dr. Komal Patil-Sisodia: The chocolates are flying.
• 9:19
  Dr. Komal Patil-Sisodia: They can't wrap everything up properly.
• 9:21
  Dr. Komal Patil-Sisodia: They're like shoving chocolates in their mouths, their shirts under their hats, everything.
• 9:24
  Dr. Komal Patil-Sisodia: And really that's where we start to see the mismatch.
• 9:28
  Dr. Komal Patil-Sisodia: Your muscle is fed by that glucose that gets stored inside cells, so if you're losing muscle or lean mass during the menopause transition and you don't have as much muscle to consume the glucose that's there, so muscle will support walking, and lifting, and your balance, and your independence overall, and it also helps your body use up the blood sugar.
• 9:51
  Dr. Komal Patil-Sisodia: So if you have less muscle, you're using less of the sugar in your bloodstream.
• 9:56
  Dr. Komal Patil-Sisodia: And all of the changes that are happening in the body, the visceral fat gain that some people have or the decrease in the lean mass or the muscle mass, that will change and vary from person to person.
• 10:06
  Dr. Komal Patil-Sisodia: I think a lot of it is dependent on genetics.
• 10:08
  Dr. Komal Patil-Sisodia: A lot of it is dependent on lifestyle.
• 10:10
  Dr. Komal Patil-Sisodia: And insulin resistance is not inevitable for everybody.
• 10:13
  Dr. Komal Patil-Sisodia: I think people who have preexisting metabolic disease like PCOS, PMOS pre-diabetes, Type 2 diabetes, overweight or obesity, they're all going to be at higher risk for developing insulin resistance.
• 10:27
  Dr. Komal Patil-Sisodia: So when you are observing these changes in your body, I really want you to pay attention to how your strength might be changing, how sleep might be changing, any shifts in your blood pressure or cholesterol or blood sugar, along with any changes in your weight or your waist size.
• 10:46
  Dr. Komal Patil-Sisodia: These are the things that you need to be paying attention to in midlife to get an understanding of whether you're going to be at risk for metabolic disease, because all of these things contribute.
• 10:59
  Dr. Komal Patil-Sisodia: So let's talk a little bit about what can help, and I wanna help you build a realistic foundation for what this looks like.
• 11:06
  Dr. Komal Patil-Sisodia: First on my list is always strength and movement.
• 11:10
  Dr. Komal Patil-Sisodia: I generally recommend strength training at least twice a week to be able to maintain the muscle that you have, and it doesn't have to be, like, huge, heavy amounts of lifting, right?
• 11:21
  Dr. Komal Patil-Sisodia: One of the biggest issues I see is that people will read all this stuff online, they really haven't worked out in a very long time, and they try and lift heavy or go do something, and they end up injuring themselves.
• 11:33
  Dr. Komal Patil-Sisodia: So your workouts can start off with lighter weight as you build your tolerance and your capacity up, and you can do things like resistance bands.
• 11:42
  Dr. Komal Patil-Sisodia: You can use body weight to do your squats and your strength training.
• 11:47
  Dr. Komal Patil-Sisodia: You can use free weights that are a bit lighter.
• 11:50
  Dr. Komal Patil-Sisodia: You can use a chair to help you with squats.
• 11:52
  Dr. Komal Patil-Sisodia: You can do wall pushups.
• 11:53
  Dr. Komal Patil-Sisodia: All of those things are working your muscles.
• 11:56
  Dr. Komal Patil-Sisodia: Initially, Work towards 150 minutes of moderate activity each week.
• 12:01
  Dr. Komal Patil-Sisodia: And eventually work up to 300 minutes of moderate activity per week, like brisk walking, swimming, or cycling, for additional health benefits If you do happen to get injured or you develop pain or you're feeling like you can't perform in the same way that you usually do, talk to your doctor and potentially go see physical therapy.
• 12:22
  Dr. Komal Patil-Sisodia: Because sometimes you need help strengthening your body in the appropriate way so that you don't injure yourself or you heal an injury and you can continue on your way.
• 12:30
  Dr. Komal Patil-Sisodia: Strength training will help you build the ability to do the things that you want and need to do.
• 12:36
  Dr. Komal Patil-Sisodia: Next on my list is nutrition.
• 12:40
  Dr. Komal Patil-Sisodia: I always recommend including a protein source at meals, and that can be things like eggs, yogurt, tofu, beans, fish, and meat.
• 12:49
  Dr. Komal Patil-Sisodia: You also wanna include a lot of fiber in your diet, like vegetables, fruits, beans, whole grains.
• 12:54
  Dr. Komal Patil-Sisodia: All of that fiber is gonna help slow the absorption of some of the starches that are in your food, and so that can actually help lower your blood sugar.
• 13:03
  Dr. Komal Patil-Sisodia: Then you really want to look at what your personal protein needs are, rather than just following a target that you see online.
• 13:10
  Dr. Komal Patil-Sisodia: When people come into my office, I will calculate, based on what their height, weight, and body composition is, what I think they need in order to get to a healthier place, and that's what I give them as a target recommendation.
• 13:23
  Dr. Komal Patil-Sisodia: On average, we're aiming for a range, and I think that makes it a little bit easier.
• 13:28
  Dr. Komal Patil-Sisodia: And I really don't love it when people restrict what they can eat.
• 13:32
  Dr. Komal Patil-Sisodia: I am a big believer that everything can fit into a meal plan.
• 13:36
  Dr. Komal Patil-Sisodia: It just has to be the right amount so it doesn't throw your health goals off the rails.
• 13:41
  Dr. Komal Patil-Sisodia: This is where talking to a registered dietician who knows what they're doing and can help you plan these meals can be really helpful.
• 13:50
  Dr. Komal Patil-Sisodia: And you really have to think about what your body needs to stay strong, alongside any weight or health goals that you might have Third on my list is sleep.
• 14:01
  Dr. Komal Patil-Sisodia: We always want to make sure that sleep is adequate.
• 14:04
  Dr. Komal Patil-Sisodia: And, in today's world where we have screens and phones and devices, I know how hard it is to just do the right amount of preparation in order to get to fall asleep.
• 14:16
  Dr. Komal Patil-Sisodia: A lot of times when you are exposed to that blue light or you're distracting your mind with screens or devices, it can become very hard to fall asleep.
• 14:24
  Dr. Komal Patil-Sisodia: That's one part of the issue.
• 14:26
  Dr. Komal Patil-Sisodia: The other thing is that you can have symptoms of the midlife transition or menopause transition that are starting to affect the quality of your sleep.
• 14:34
  Dr. Komal Patil-Sisodia: There can be night sweats and insomnia.
• 14:36
  Dr. Komal Patil-Sisodia: Sleep apnea becomes more common because of the decline in the hormones.
• 14:41
  Dr. Komal Patil-Sisodia: If there is concern about sleep, then consider talking to your doctor about a sleep study And lastly, I look at what are the barriers in your life that are keeping you from doing this, like making regular meals, moving regularly, getting enough rest, and what can we do to modify some of those factors.
• 14:57
  Dr. Komal Patil-Sisodia: You have to create a plan that is sustainable.
• 15:01
  Dr. Komal Patil-Sisodia: Trust me, I have made plans for all these things probably since I was 12 when I first started noticing and thinking about my weight.
• 15:10
  Dr. Komal Patil-Sisodia: But what I have learned over the years is the plan has to fit my life in a way that I can keep doing it.
• 15:17
  Dr. Komal Patil-Sisodia: It has to be sustainable.
• 15:20
  Dr. Komal Patil-Sisodia: So you can plan all you want, but if it doesn't work for your life, it's not gonna work for you.
• 15:25
  Dr. Komal Patil-Sisodia: And lastly, let's talk about where hormone therapy and obesity medications fit into addressing these body composition changes.
• 15:34
  Dr. Komal Patil-Sisodia: So let's talk about menopause hormone therapy first.
• 15:38
  Dr. Komal Patil-Sisodia: A lot of people will ask me,"If I start hormone therapy, will it help me lose weight?" Here's the thing, menopause hormone therapy is not a weight loss treatment, and we don't prescribe it for that purpose.
• 15:50
  Dr. Komal Patil-Sisodia: But it doesn't mean that it doesn't affect your body composition.
• 15:53
  Dr. Komal Patil-Sisodia: There are some studies that suggest it may lessen the shift towards storing more fat around the middle, so that visceral fat.
• 16:03
  Dr. Komal Patil-Sisodia: In a smaller study within the Women's Health Initiative, women who were taking estrogen and a progestin lost less lean tissue and had a smaller change in their body composition over three years.
• 16:15
  Dr. Komal Patil-Sisodia: The differences were really small, but it was an interesting observation that suggests that it may help with body composition.
• 16:23
  Dr. Komal Patil-Sisodia: Those findings do not guarantee weight loss.
• 16:26
  Dr. Komal Patil-Sisodia: They don't guarantee that you're gonna have reversal of abdominal fat, and they don't guarantee that your muscles are going to be preserved.
• 16:33
  Dr. Komal Patil-Sisodia: Hormone therapy decisions, should be looking at whether you have a significant amount of symptoms, what your medical history is, and what benefits and risks you have by taking it.
• 16:44
  Dr. Komal Patil-Sisodia: This is a really important conversation to have with your doctor let's talk a little bit about obesity medicines now.
• 16:49
  Dr. Komal Patil-Sisodia: There are medications like semaglutide or tirzepatide that might be appropriate for some people.
• 16:56
  Dr. Komal Patil-Sisodia: I look at BMI, I look at comorbidities or what we call other accompanying conditions like high blood pressure, high cholesterol, prediabetes, diabetes, PCOS, sleep apnea, and preexisting heart disease or a history of stroke, and those may be indications to consider if you want to lose weight and that you're not seeing any improvement when a person's symptoms from menopause are improved and they're able to move more.
• 17:25
  Dr. Komal Patil-Sisodia: So menopause alone doesn't mean you need an obesity medication, but if you meet those other parameters, it may be a great option for you.
• 17:34
  Dr. Komal Patil-Sisodia: So I'll always discuss, those different parameters with my patients, what their health history looks like, what their family history looks like.
• 17:41
  Dr. Komal Patil-Sisodia: We talk about the benefits, whether it's covered by insurance.
• 17:44
  Dr. Komal Patil-Sisodia: We talk about side effects.
• 17:46
  Dr. Komal Patil-Sisodia: We talk about how often they should be following up.
• 17:48
  Dr. Komal Patil-Sisodia: And really, if you choose to exercise that option, you need some pretty close follow-up just to make sure that you're responding well.
• 17:59
  Dr. Komal Patil-Sisodia: So really treatment should consider your health, your goals, and what you can sustain, and then help you decide which medication route to go, one or the other, or potentially both.
• 18:11
  Dr. Komal Patil-Sisodia: I also wanted to talk about the breast health connection to body composition.
• 18:17
  Dr. Komal Patil-Sisodia: It's Breast Cancer Awareness Month in addition to it being Menopause Awareness Month, and there's a few key things that you need to know about how your body composition can affect your breast cancer risk.
• 18:28
  Dr. Komal Patil-Sisodia: Higher body fat is associated with an increased risk of breast cancer after menopause, and there are potential contributors, including estrogen production in the fat tissue and inflammation that's happening because of the underlying insulin resistance.
• 18:44
  Dr. Komal Patil-Sisodia: But even though there is an increased risk, it's not the only explanation for why somebody may develop a breast cancer.
• 18:52
  Dr. Komal Patil-Sisodia: We have to be careful that when we're having a conversation around risk factors, we're not using that to blame someone for a cancer diagnosis they end up with.
• 19:01
  Dr. Komal Patil-Sisodia: As we close out this episode, I want you to remember three key takeaways.
• 19:07
  Dr. Komal Patil-Sisodia: Number one, your body composition can change even when your weight does not.
• 19:12
  Dr. Komal Patil-Sisodia: Number two, hormones, aging, sleep, a decrease in physical activity, and other factors can all contribute to the change in your body composition.
• 19:22
  Dr. Komal Patil-Sisodia: And number three, your care plan should support your strength and your metabolic health alongside your symptoms and what your healthcare goals are.
• 19:30
  Dr. Komal Patil-Sisodia: Before your next appointment, I want you to write down what has changed, how your clothes fit, your strength, your sleep, and how you feel during everyday activities.
• 19:42
  Dr. Komal Patil-Sisodia: I want you to think about the questions what might be contributing to these changes, and what plan makes sense for me?" These are questions that you can bring to your healthcare team to help figure out a plan that works well for you.
• 19:55
  Dr. Komal Patil-Sisodia: Next week, we're going to talk about menopause hormone therapy and what the evidence tells us and how to make an informed decision about your care.
• 20:03
  Dr. Komal Patil-Sisodia: Thank you for joining me today on Clearly Hormonal.
• 20:05
  Dr. Komal Patil-Sisodia: I'll see you on the next episode