In this episode of PodMD, Endocrinologist A/Prof Kevin Lee will be discussing the topic of Weight Management in Peri-Menopause with Dr Pritinesh Singh and Caroline Chaplin. They discuss weight management in peri-menopause, hormone therapies, stigmas associated with peri-menopause, and more.
- Transcript
Please note this is a machine generated transcription and may contain some errors.
*As always, all in this PodMD podcast is intended for health professionals and the comments are of a general nature. Information given is not intended as specific medical advice pertaining to any given patient. If you have a clinical issue with one of your patients please seek appropriate advice from a colleague with expertise in the area.
Today, I’d like to welcome back to the Pod M.D. Studio Associate Professor Kevin Lee and Doctor Pritinesh Singh.
Kevin is an endocrinologist and medical researcher interested in hormonal dysregulation and the study of weight management in perimenopause. Joining Kevin will be Pritinesh, an experienced GP with a holistic approach, and who not only has a strong interest in women’s health but has herself been through perimenopause and realizes the need for education in this space to treat the condition holistically. So, in this episode, we’ll explore weight management in perimenopause. And just to remind you, this is episode 2 of the perimenopause series with Dr. Lee and Dr. Singh.
We do hope you enjoy this podcast, but please remember that the advice here is given of a general nature and is not intended as specific advice about a given patient. The views and opinions expressed in this podcast are those of the doctor and not PodMD. If you have a patient on whom you require specific advice, then please ask advice from a colleague with appropriate expertise in that area.
Caroline: So, today I welcome back to the PodMD studio, Kevin and Nesh. How are you both? How have you both been?
Nesh: I’ve actually had a very busy few months, but it’s great to be back on board again.
Caroline: Lovely to have you. Kevin?
Kevin: Likewise, I’ve been well and been very busy, but I’m very glad to be able to finally make episode 2.
Caroline: Very difficult for two doctors to find time, so we’re very grateful. So today we’re talking about weight management during perimenopause. So, Kevin, perhaps over to you to start us off today.
Kevin: Yeah, so many women that go through perimenopause don’t just experience the symptoms that we typically talk about in terms of hot flushes and head fog or memory issues, head fog, all that kind of stuff. But, weight gain actually often is something that happens and they don’t realise that it’s something that we can do a lot about. And it’s really nice, that Nesh you’re here because you’ve had your own journey as well. And I think if you could help perhaps shed light on what that journey was like.
Nesh: Yeah, I think a lot has to do with the way my body has changed its shape over the years, I think is one of the things that I have noticed and it would be the way the clothes fit now compared to it was. And, you know, having a look at myself at some of the photos from before to now and, you know, perhaps, maybe there’s a muffin top that’s happening now, which wasn’t there in the past, or, you know, the love handles seem to be a bit more prominent. The weight may look the same on the scales, but the clothes don’t fit the same or something else is hanging out, when it shouldn’t be. So, it has been a bit more different and a bit more difficult and I think when I look back, it’s more about, “is it the tone?” ” Is it the muscle mass?” “Is it the body fat distribution?” like it’s one of those things that I’m trying to get my head around.
Kevin: It probably was a combination of that, but was your weight an issue as a teenager?
Nesh: So as a teenager, I was pretty active and sporty, and I think there were fluctuations looking back at childhood, and that will be periods of inactivity, potentially when I was in primary school. And then in high school, I did a lot of swimming, rowing, and sort of other sporty things. So, I had more of an athletic, slender sort of tone then, and then I transitioned from high school to uni, and I think that’s when, you know, you start to socialise a bit more and nights at the pub and so forth.
Caroline: Correct.
Nesh: And, you know, you hang out with friends, and you eat naughty things, and you’ve moved away from home, and I suppose you rely more on takeaways. So, I noticed that a bit more weight had started to come on, but I wasn’t as active either, started driving to places instead of catching public transport and walking like I used to. So, I realised that the weight had come on then. And then I transitioned, well, clearly, I’m a doctor, so internship I lost a whole heap of weight because I was always running around after all the consultants in the hospital, doing a lot of shift work. So, then naturally some weight came off then. But, then transitioned again into shift work, into night shift and that’s when the weight came on again. So, it was more, I think, a lot of the late-night snacking.
Caroline: The comfort eating.
Nesh: The comfort eating and the sweets that were left in quick sugar foods that would give you the energy to sustain you, erratic sleep-wake cycle.
Kevin: Yeah, in fact, I think there’s a lot of research now showing that those people that engage with night shift, night duties, not only do they change the pattern of eating, but metabolically they also get affected and weight gain is quite common.
Nesh: So, and that’s what I noticed was, you know, I was always tired, fatigued, and didn’t have a good night’s sleep. I was running on adrenaline and stress. Then I would sort of make choices where I’d be looking at things that were quick and easy, high energy, carbs, sugary, just to get me going. That’s when I noticed the whole evil weight started coming on. It was mostly when I was doing shift work, and then I found it harder and harder to take to get that off. But then, not making excuses, but I found it hard to get out to exercise, because I was just fatigued and tired coming off night shift, trying to get my sleep-wake cycle right.
Kevin: And being busy.
Nesh: And just being busy.
Kevin: Just being busy, life getting in the way.
Caroline: Absolutely, then you’re on for everyone else and forgetting about yourself.
Nesh: Correct, and then I’d look at all the latest bad things there were, then I’d get out to the 10-week program or the 12-week program, go out and have this massive shopping list, do all these weight loss programs, you know, get onto this challenge and that challenge. I’d lose 10 kilos or 12 kilos, I’d stick to it, but it was not sustainable
Kevin: And did you find that it, as you said, it was getting harder and harder, but did you find that perimenopause was even more difficult?
Nesh: Absolutely. So, what I realised was whatever I could do back in my 20s for 10 weeks to lose the 12 kg, If I did that now in my 40s, I found doing the same thing, I’d barely shift two kilos or three kilos. Just as intensively, if I did exactly everything, it would barely move, barely change. So, I would get quite frustrated.
Kevin: Yeah, and I hear a lot of women actually tell me that when they talk to their doctors about this phenomenon, where they find that, eating right and exercising just as they had before, and it’s not shifting their weight, their doctors don’t quite believe them. They almost sort of think that now you’re actually somehow cheating somewhere, perhaps. And did you find that that was the case?
Nesh: Oh, absolutely. And you know what? And that’s what’s made me love this space and getting into bariatric medicine or bariatric physician stuff myself, and I’ve got a keen interest in it now, as I believe these women, because I am one of those women, yes. And I totally believe it, because it’s like the more you do it, you kind of go, well, it’s… It’s not shifting, it’s not working. But there’s so many moving parts as we know. And this is where I’ve come to you for help as well, Kevin.
Kevin: Yeah, and the research now is quite clear that we don’t have to disbelieve these women because we now know what the pattern is and what the mechanisms are as well. So, typically, in large cohort studies, they see that before, even eight years before the final menstrual period, so during perimenopause when it starts, women already start to progressively increase fat mass. And the challenge also is that muscle mass also starts to drop down at the same time. So, body composition is clearly shifting and the body shape as you have alluded to, is quite a different weight gain compared to, say, before perimenopause. And it’s more central weight gain rather than subcutaneous or overall weight gain.
Nesh: So is this the weight around the…
Kevin: Around the tummy, yeah. And many women, they suffer in silence because they think that it’s not worthy of attention by their doctor when we know that central weight gain is actually what we call toxic fat, in vague terms and that’s the one that increases cardiovascular.
Nesh: So, you’re saying any amount of sit-ups is not going to get rid of that?
Kevin: Unfortunately, not. So, I suppose, you know, they often don’t seek help, and I quite proactively ask them if that is a concern, and I inevitably get a big nod or sometimes even tears that, oh my god, you actually are interested in what my true concerns are, that I can’t actually help shift my weight when previously I could.
Nesh: Is that also one of the reasons why potentially, because of the decrease in muscle mass, that women are more prone to injuries when they’re starting off?
Kevin: Potentially.
Nesh: Like new programs. Cause I’ve found that it’s like every time I get started in a new program, I tend to sort of find that I get more fatigued, more tired, and tend to be more prone to injuries.
Kevin: Potentially, that might be a mechanism, but there’s also a lot of changes physiologically when the estrogen is starting to disappear from the system. Being an endocrinologist, I’m obviously quite endocentric in my view of how important hormones are and they have multiple effects on brain function, nerve function. Many women will talk about fatigue and not being able to focus, not being able to concentrate as easily, having memory issues. So many of them will say things like, “I used to be much sharper, I used to be able to remember things that now I can’t.”
Nesh: Yes. Oh, I find that all the time. I forgot where the keys were, or what am I supposed to be doing today?
Kevin: Yeah, and it’s not just a momentary thing, it just keeps going. We all have moments when we’re stressed, and we just get more forgetful, but this is sort of a long-term thing, and they just see that it’s not coming and going, this system.
Caroline: Which really starts to affect people at work as well.
Kevin: Exactly.
Caroline: You feel somewhat ashamed. I know that’s happened to me lots of times where you’ve just had a blank. Particularly giving, I give presentations in the middle of a presentation and it’s embarrassing.
Nesh: Yes, absolutely.
Kevin: Well, many of my patients are very high-functioning women like yourselves and it’s really quite unfair, sitting in a boardroom with their male colleagues and not only do they have that sort of head fog and things, but they start to flush when they get stressed and, you know, as though they’re doing something wrong, and they’re sweating. So, it’s quite a challenging time for many of them.
Nesh: And you know, the other thing that I find embarrassing or that I’ve found as part of this whole perimenopause thing is that I can’t regulate my body temperature. One of the things, but also my pelvic floor or my urinary sort of, you know, trying to not have, trying to find, you know, the nearest bathroom when I’m going to places and things and just being very wary of where the nearest toilets are just in case I need to go. It’s all part and parcel of this perimenopause period too, right?
Kevin: Yeah.
Nesh: It impacts your exercise.
Kevin: Oh, yes, it does, for sure.
Nesh: Yeah.
Kevin: And I think that’s partly why it’s so important to look at not just the first episode with all the hormonal therapies that we talked about, but in this episode also, I think, learning about the importance of managing weight in this period is important. We mentioned cardiometabolic risk reduction, but also there is, unbeknownst to many, the rates of cancers do go up for weight gain. And in, for example, in the menopausal period, we all are concerned about hormone therapies with progestogens, increasing breast cancer. But if you’re actually overweight or obese, that rate is actually more than double that of hormone therapy. So, if you’re concerned about hormone therapy and cancer risk, which I’m always asked about, the elephant in the room often is the weight, obesity.
Nesh: Obesity, yes. Because doesn’t it increase the risk of breast cancer, but also endometrial cancer as well?
Kevin: Yes, correct. So, I suppose one of the things that I like to help my patient understand is that this is not, the weight gain is not about a lack of discipline or somehow just being lesser than they were before, it’s purely a physiological thing and once they understand that it’s a physiological thing and that the set point is actually increasing, and it can be a depressing story to understand that you have a set point that is increasing, but at the same time it can be liberating as well, because once you understand how the set point works, then you can actually reduce the weight without bringing in that sort of moralistic judgment. Yeah, so I think understanding that the physiological changes are actually affecting the set point, then that takes away the moralistic judgments and helps patients work towards correcting what is physiologically inevitable in a woman’s life.
Nesh: So, when we’re talking about set points, the fact that I have lost and gained, lost and gained during my lifespan so far, does that affect my set point as I get older?
Kevin: It does as well. And we know from studies, like say The Biggest Loser, where they actually follow these patients that lose 50% of their weight, and they do amazing things to get there. However, following it over a long period of time, and I’m talking about years here, they often regain the weight, and they regain higher than when they started. And when they actually measure the basal metabolic rate in these patients, they found that per kilo weight, they actually reduced their metabolic potential, and that is called metabolic adaptation.
Nesh: Okay. Yeah. So, in terms of yo-yoing’s, not a good thing either.
Kevin: Yeah, exactly. So, one of the key messages is not to… yo-yo dieting so when we help patients lose weight, we want them to just lose weight and not regain it because going back and forth is not a good thing.
Caroline: Okay and when you say yo-yo dieting about the swing of how many kilos are you actually talking about?
Kevin: Yeah, we’re talking no more than say you know several kilos we’re not talking about tens of kilos going back up that’s just a bad thing, so normally, for example when we use medications for weight loss, we actually look at sometimes cessation of medications to help with weight loss. And if patients notice that they regain two or three kilos, they go back onto the medication.
Caroline: Right.
Nesh: Okay.
Caroline: So, it can be as small as two or three, and then you want to get it under control again.
Kevin: Correct. Yes.
Nesh: So, can you explain how and why weight gain actually happens?
Kevin: Yeah. So, the explanation I give to doctors is a bit different to what I say to the patients, because I think it’s quite a complicated physiological endocrine phenomenon. So, the main thing is that the body has a set point, and when you deviate from the set point, it has ways to actually bring you back to where it was. And one of the ways is to basically look at this component of metabolism called non-exercise activity thermogenesis, or NEAT for short. So, if you start to lose weight, the body will start to decrease this component. So, you’ll basically be fidgeting less, just the little movements during your day get dampened, and this is quite a proven phenomenon. And the other thing that also happens is there’s another component of metabolism called adaptive thermogenesis, and this is where when you eat, your body can trigger increase in a thermic response to food and through the sympathetic nervous system. And brown fat has a role in this, and we now know that adults also have brown fat, not just children, not just babies, and that the adipose tissue actually has less thermic potential without estrogen. And then the third thing, and perhaps the most important one, is that sleep disruption is often something that affects weight. And people often just think about diet and exercise, but sleep is a really important component. And as we were talking before about people that do night shift, they will find weight loss quite challenging.
Nesh: Absolutely.
Kevin: And with sleep, if you’re having hot flushes, and you’re having disrupted sleep, and not having deep sleep, or the slow wave sleep, which is the deep component of sleep, you’re not going to feel restored when you wake up. And a myriad of things happen, not just comfort food eating and stress eating, but also metabolic changes as well. And so, helping women overcome those disruptions in their sleep is important, and sometimes it might not be hot flushes. Some women actually just say they don’t get hot flushes, but they just feel like they toss the sheets off and then they get cold and they bring it back in. So, all through the night, they’re doing this tossing off, bringing it back in, and they… will say that I don’t get hot flushes, but that there’s a thermic disruption, if you like.
Nesh: Oh, 100%. I totally identify with that. I’m a very restless sleeper when it comes to that. I just find that I am someone who has dysregulation of temperature.
Caroline: Or just sometimes waking up a lot.
Nesh: Yes, absolutely.
Kevin: That’s all it is.
Caroline: And thinking, there’s no reason. Why am I waking up? But clearly there is a reason. We think there’s no reason.
Kevin: Yeah, exactly.
Caroline: That’s it.
Nesh: And it’s bizarre because I’ll have the air conditioning on in winter and still have like a draw sheet on. It’s just, yeah. Is this one of those?
Kevin: And frequently I have male partners that actually thank me for putting patients either on hormone therapy or also the neurokinin inhibitors or SSRIs that can actually ameliorate the symptom because they go, oh my God, thank God, you know, my wife doesn’t have to put the air conditioning on anymore in winter.
Nesh: So, we talked about dealing with temperature dysregulation in the last podcast, did you want to just summarise what is happening there?
Kevin: Yeah, so with the temperature dysregulation, I think I suppose one of the key things that is triggering it is not just in sleep, but also stress as well during the day. And I think just learning that the temperature regulatory centre is actually in the hypothalamus and that we now have a very specific medication that targets it called the neurokinin inhibitor. Veosa is the name of the medication that’s currently available on TGA, but not on PBS as yet. And for women that can’t tolerate hormone therapy, it’s a very viable option and it doesn’t confer the same increased risk of breast cancer, for example, that is a concern for some of my patients. I think also that if the patient is not keen on trying any of these medications, even a low dose SSRI is quite useful. But not to also forget that there are some supplements that actually have evidence-based that actually help reduce mild to moderate symptoms.
Nesh: Can you tell us what do we do about this weight gain then after patients have tried lifestyle changes?
Kevin: Yeah. So, virtually all the patients I’ve seen have already attempted to modify their lifestyle and to try and do something that used to work that unfortunately doesn’t quite work anymore and they get frustrated and they often internalise that frustration and it sort of fits a bit battering I think to their self-esteem. And I think in these situations, they often either give up or they get into a very bad pattern where they start to deprive themselves even more and then get into sort of a swinging between deprivation and then they find the cravings are too strong and then they sort of get into an indulgent eating behaviour. And this sort of swinging is actually a bad pattern for so many reasons, including setting up someone for eating disorders as well. So, I think it’s really important to let patients know that eating the proper way, and that is having macronutrient balanced meals that are regularized across the day, is going to be a better way to deal with weight gain and perimenopause than actually starving or one of the fasting type diets. So, whilst I’m a proponent also of diets like the 16, 8 and the 5, 2, it can work much better in men and in pre-menopause rather than perimenopause or post-menopausal women.
Nesh: So, what’s all this hype about protein?
Kevin: Yeah, so there’s a lot of hype about protein because I suppose it’s something that many patients neglect when they try to lose weight. If they were just using lifestyle alone and they deprived themselves of eating, they often, when they get into the indulgent phase, following a deprivation phase, they will lean more on carbs. But, also, with the era of GLP-1s, many patients that use GLP-1s to take away the hunger signal, they just don’t eat and so they don’t eat enough protein and they end up losing muscle mass when they do that kind of weight loss, and that’s really bad because you’re already losing weight in perimenopause in terms of muscle. You don’t want to lose even more muscle by not eating enough protein. So, generally, I recommend that patients have a strong focus on eating not just regular meals, but meals that are high protein as well. And the protein recommendations by the CSIRO are quite high, and I normally start my patients off at a reasonable level around 20 grams or so to begin with, and that’s already a high amount. So, we’re looking at, you know, three eggs, three large eggs, you know, in say the first meal, like for breakfast. Sometimes it’s a bit hard for them to stomach all that and they might have to use a high-protein yogurt with some nuts in it. Just simple, practical things that I try, and bring into their lives. But, if they’re on a GLP-1, and this is the other thing that many of them will use, is that they don’t feel hungry at the start of the day. So, then what I tell them is that whilst you may not eat breakfast, just make sure you still have three little meals that are high protein, about 20 grams. And so, if your first meal is brunch or lunch, just make sure that somehow, you’re getting the 20 grams. And then later on, I’ll build them up to 25, 30 grams if I can.
Nesh: Yeah. And do you know, what I’ve initially, when I used to have this conversation with patients and say, ensure you have enough protein. It was quite interesting that a lot of people thought, you know, 100 grams of chicken is 100 grams of protein.
Kevin: It’s not.
Nesh: 100 grams of chicken is not 100 grams of protein. So please, no, it’s not.
Caroline: I think it’s great that you’re saying that you build it up because, you know, as somebody who tries to eat enough protein, if somebody says to you, oh, I’ve got to have 100 grams a day, it’s quite overwhelming and you can start to feel like, oh, throw in the towel, I can’t do this. 20 grams per meal is certainly achievable.
Nesh: Absolutely. Now a couple of other things is you know when people say oh you know I’ve now started to lose hair. Can you tell me why that would happen?
Caroline: And also gained facial hair at the same time.
Nesh: Is life cruel?
Kevin: Yes, I know it’s cruel right. There’s also a physiological reason behind that too. So, any weight loss, if it’s restrictive to a point, will cause hair loss. So, it doesn’t matter how you do it.
Nesh: Yes.
Kevin: And coupled on top of that, you’re getting estrogen withdrawal. So relative to testosterone, the estrogen is lower, and so that’s another time when hair loss can occur as well in these fluctuations of hormones. Unfortunately, you know, it’s also dependent on your genetics too. So, how your mother went through menopause will be reflected to an extent as to what the pattern looks like for you as well.
Caroline: And the point to raise there, I think, I experienced was that the older generation don’t want to talk about it anyway. My mother never mentioned anything, and she’s unfortunately gone now, so I never learned anything about her menopause journey because it was a little bit taboo to say anything.
Nesh: Absolutely, mine’s in heaven too now, so I didn’t really get much there either.
Kevin: No, often I would ask women, they wonder, because initially in the perimenopausal period, they wonder whether they are going through perimenopause. And so, one of my first questions is, what was your mom’s age when she went through it? And many of them will say to me, I have no idea, because it was never spoken about.
Nesh: Yeah, I was just actually, the other thing that I find a little fascinating in my journey with women that I talk to about weight loss is their relationship with alcohol. When I’m doing my history taking, I have come to find that a lot of the women in perimenopause drink a fair bit of alcohol, and this would equate to anywhere from two to three glasses of wine a day, seven days a week, or two to three bottles of wine a week. Is this also an issue when it comes to weight and weight management?
Kevin: Yes, of course, and in fact, when we… do a medical history, and we find that someone is saying they’re not drinking much and yet they are doing everything that we recommend in terms of lifestyle, and they’re on a GLP one for weight loss, and they are not following the typical trajectory, alcohol use is one of the things we actually question. So, we then say, can you actually document how much alcohol you’re actually having so that I can get a clear indication as to whether it is a contributor to the weight gain?
Nesh: Yes, and because that is what I’m finding at times is we are doing everything. But, the weight is either plateauing or not shifting, and there are on doses, but then alcohol seems to be the hidden little.
Kevin: So, alcohol is one of the hidden factors that usually doesn’t come out in the first consult, usually in subsequent forms, follow-up reviews when they’re not following the trajectory you expect. But, the other thing also that I look at is their sleep, whether or not they truly are getting good restorative sleep. And the third thing is also stress. So, stress is actually a very real phenomenon in terms of making weight loss much harder. And the issue about stress is something that is in a woman’s life around perimenopause, a big topic which I am hoping to cover in the third podcast because this is a time when many women are going either through empty nest syndrome or that they are becoming carers for parents. They are at the peak of their careers often in high pressure jobs and they’re juggling all that. Perimenopause is a time when lots of transitions are happening, not just physiological ones, but also psychological transitions, and how that all integrates together, and how do you set up a patient so that they then have the next half of their lives fully looked out for both physiologically, psychologically, but also preventing all the usual things like osteoporosis, reducing cardiovascular risk, that is all part of the perimenopause conversation.
Nesh: Absolutely. And, I think one of the other things that I tease out in some of my consults is usually when the house is quiet, and everything else is done and dusted, the kids have gone to bed, it’s the eight o’clock to midnight where is the danger zone for most women. It’s the me time and the snack time.
Kevin: Correct, yeah. And because they kind of want that time to wind down and relax.
Nesh: Correct.
Kevin: And once again, that’s related to the stress during the day and how they wind down and how you then make comfort foods into healthy foods.
Nesh: Correct.
Kevin: So, then I once again talk about macronutrient balance even for comfort foods. So, I talk through what types of comfort foods they like. Is it usually a sweet or a savoury type comfort food and I usually use my own example so that I don’t have a sort of a patient that feels like I’m judging him or her about comfort foods so I say and in my case I’m more savoury comfort food eater and I generally have it late at night and I prefer chips so I would often pair it to a protein so it might be a strange thing like opening a tin of tuna and some nuts and having chips or I might have a protein shake with the chips with a bit of better fibre in it. So, it’s always macronutriently replete. And, what happens is that I also ask them to experiment and do the chips without the macronutrient pairing and do it with the pairing and see how they feel the next day. They will find that they get hungrier the next day if they don’t have the right pairing. But if they actually pair it right, they will have satiation and they’ll find that it’s actually more moderated in terms of the glycaemic excursions and all that that happens.
Nesh: Yeah. So, there’s so much to learn from in this space, isn’t there?
Kevin: There is, and there’s a lot of options for patients as well. So, it’s never about deprivation. I think deprivation is sometimes a strategy for some people, but it’s not a long-term viable option. It’s better to learn how to be more moderate and how to actually enjoy food, whether it’s a carb or a comfort food.
Nesh: Absolutely. And I think one of the other things that is important to address is if there’s any underlying eating disorders as well, because that is one of the things that I also find that if we are to help our patients along for lifelong sustainable changes as well as weight maintenance, it is useful to identify if there has been an underlying eating disorder in the past.
Kevin: I totally agree. In fact, I would say that that’s another component that sometimes is uncovered when they’re not responding how you think they should respond, even with a GLP-1, like Mounjaro or Wegovy, and you go, Hmm, you’re not quite following the trajectory I normally see. And, then sometimes that eating disorder takes a bit of time for the patient to feel comfortable enough to divulge that. But, and that’s kind of why again I say that it’s nice to use my own example to tell patients this is what I do when I’m stressed. This is my habit and this is how I try and overcome it, “What do you do?” If someone ever tells me they never comfort food eat, then I know that I’m not on a real interaction yet level if you like, so, I’ll wait.
Caroline: Absolutely. Well, again, it’s just something else that’s associated with shame, isn’t it?
Nesh: Yes, absolutely. And it’s the stigma associated with, and same thing with body dysmorphia. I do find patients when they’re sort of, you look at them and you go, “oh my God, you look fantastic. You’ve come so far, you’ve lost this 30 kg, or you’re now at a BMI of 22” or whatever gains that you’ve made, but they look at themselves and they go, “No, I’m not done yet. I can’t see it. I can’t see it. I still feel the same.” Those are some of the challenges that we do see, but I suppose that would probably be for some other podcasts in the future.
Caroline: Absolutely.
Nesh: Yes.
Caroline: All right, so we’ve covered a lot of topics today in relation to weight management and perimenopause in particular. I look forward to the next topic. What’s the next topic you think we might talk about as well in this podcast?
Nesh: I think we should look at the transitions through, like Kevin was saying, in terms of the empty nest syndrome, looking at bone health, cardiovascular health.
Kevin: The things that set you up for long-term success and not just the immediate sorting out the hot flush or absolutely hitting the weight down, but actually looking at perimenopause as an opportunity to reset a second phase.
Nesh: In menopause and beyond.
Caroline: Absolutely, absolutely. That sounds great. Nesh, thanks so much for sharing your journey as well. As a layperson, it’s nice to hear that a doctor also has their struggles when we go to your, knock on your office or any doctor and feel that shame sort of spiral start.
Nesh: I think lived experience gives you so much more insight and so much more empathy for your patients.
Kevin: And I can vouch for the fact that that makes Nesh a truly amazing doctor. Like, we have amazing doctors around us. But, because of the lived experience, I think that makes you not only understand the experience, the journey the patients are going through, but you can actually bring the science and the compassion into it, and that creation of a strong relationship with our patients is what’s needed because this is not a quick fix.
Nesh: Oh no, absolutely not.
Kevin: It’s a thing that requires strong connections.
Caroline: Yes, absolutely. The education is growing and that is really valuable to all women at all ages, I think, as well as we go through these hormonal changes. Thank you both for your time today I really enjoyed that topic.
Nesh: Absolute pleasure it’s all about empowering women, supporting women and just you know giving everyone the best shot we can.
Kevin: Cool thanks Caroline. Thanks, Nesh.
Nesh: Thank you.
