Not quite menopause. Throwing blankets off at night, keeping awake. Fatigue and irritation punctuated throughout the day by heat dissipating from every pore, clouding thoughts, reinforcing forgetfulness. Hair falling out so stubbornly fast. Clothes choosing when to fit. Flooding periods coming sporadically, unexpectedly. They call it “the change of life” – but I feel like a different person altogether. What is happening?
In perimenopause, the physiological landscape is subject to tremendous change with estradiol and progesterone at the heart of the transition. Progesterone levels fall quickly – no ovulation – no corpus luteum – no progesterone. Estradiol, on the other hand, does not give up so easily. Estradiol levels continue to rise and fall – reliable, steady, wave-like – a biological rollercoaster – approaching the halting rhythms of reproductive senescence. In the context of very low progesterone, these dramatic peaks and troughs in estradiol levels, give rise to systemic consequences and unrelenting symptoms of the menopausal transition.
Hot flashes, synonymous with menopause, commonly co-occur with other neurological symptoms – mood changes, sleep disturbances and decline in cognitive function. Many of these are naturally attributed to the shifting hormonal milieu. Although historically ascribed to strictly reproductive functions, hormones serve as important neural substrates. For example, adequate estradiol levels are essential to neuronal health with its neuroprotective and antioxidant properties. As estradiol levels plummet in menopause, neurological dysfunction arises from the impaired glucose homeostasis, mitochondrial dysregulation, and attenuated ATP production.
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In a study of couples in which each spouse weighed about 200 pounds (91 kg) and one spouse either underwent a 6-month national weight-loss program (Weight Watchers) or received a weight-loss pamphlet and tried to lose weight themselves, the untreated spouse was also likely to drop some pounds, in a ripple effect.
Specifically, at 6 months a third of the untreated spouses had lost 3% or more of their initial weight, deemed to be a meaningful weight loss.
The findings were published online February 1 in Obesity by Amy A Gorin, PhD, Professor of Psychological Sciences at the Institute for Collaboration on Health, Intervention, and Policy at the University of Connecticut, Storrs, and colleagues.
"This study adds to the growing literature suggesting that weight and weight change within married couples is highly interdependent [and] widely available lifestyle programs have weight-loss effects beyond the treated individual," according to the researchers.
"Exploring ways to actively involve spouses in treatment to more effectively harness household and social dynamics to promote clinically significant weight loss could improve the reach and cost-effectiveness of weight management," they suggest.
Invited to comment, Nia S Mitchell, MD, MPH, Assistant Professor of General Internal Medicine at Duke University in Durham, North Carolina, told Medscape Medical News that it's already established that when the person who buys and prepares food begins a weight-loss program, " people in the house tend to eat differently" and can lose weight, as this study showed.
But the untreated spouse also has to be willing to lose weight, she cautioned. It won't magically happen. In the current study, the untreated spouses knew they would be weighed after 3 and 6 months, which may have influenced them.
Earlier research suggested that if one partner in a cohabitating couple lost weight, the other partner also lost weight in a ripple effect, but many of the studies, especially those looking at bariatric surgery, were not randomized, lacked a control group, or were not done in a real-world setting.
To investigate this, Dr Gorin and colleagues recruited and enrolled 130 overweight or obese cohabiting couples in which one spouse was willing to participate in a weight-loss program while the other agreed to only attend the assessments.
Participants had to be 25 to 75 years old, and those treated had to have a BMI of 27 to 40 kg/m2, whereas their partners only had to have a BMI ≥ 25 kg/m2.
Among the treated participants, 65 were randomized to the Weight Watchers program for 6 months. Another 65 participants were randomized to the control group and received a 4-page handout with information about healthy eating, exercise, and weight control strategies (eg, a low calorie, low fat diet, and portion control), but were otherwise left to try to lose weight by themselves.
Most couples (93%) were married, and four couples were in same-sex relationships; most of the treated spouses were women (68%).
Participants were a mean age of about 54 years and almost all (94%) were white. They had a mean BMI of 34 kg/m2 and a mean initial weight of about 207 pounds (94 kg).
The Weight Watchers group had free access to the program for 6 months, which included in-person meetings and online tools. Overall, 37% attended one or more in-person meetings and, on average, went to 12 meetings.
At 3 months, participants in the Weight Watchers program on average lost significantly more weight than those in the control group: 7.4 vs 4.3 pounds, or 3.6% vs 2.1% of their initial weight (P < .05).
Their untreated spouses had lost about 3.2 pounds, or 1.5% of their initial weight.
However, at 6 months, participants in the Weight Watchers group had not lost significantly more weight than those in the control group: 9.5 vs 6.8 pounds or 4.5% vs 3.2% of their initial weight.
Their untreated spouses had lost about 4 pounds, or 2% of their initial weight.
Typically, maximum weight loss occurs between 3 and 6 months, and then people tend to slowly regain weight, Dr Mitchell noted. The National Academy of Medicine deems weight-loss to be long term after 1 year.
"When one person changes their behavior, the people around them change," said Dr Gorin, a behavioral psychologist, in a University of Connecticut statement.
"Whether the patient works with their health care provider, joins a community-based, lifestyle approach like Weight Watchers, or tries to lose weight on their own, their new healthy behaviors can benefit others in their lives," she added.
The 2013 AHA/ACC/TOS guidelines for the management of overweight and obesity in adults (Circulation 2014;129:S102-S38) "recommend a 3% weight loss to achieve measurable health benefits; across both conditions, this criterion was achieved by 32% of untreated spouses," Dr Gorin and colleagues report.
"If you look at someone who weighs 200 pounds, would they be happy losing 6 pounds if they are looking to lose weight?" she asked rhetorically.
"In my clinical experience, people are not likely to be happy with that amount of weight loss. For most people, a size of clothing is about 10 pounds [and] they really want to be able to drop a clothing size, or two or three."
But if, for example, someone has type 2 diabetes and you can show the patient that with this weight loss they might be on less insulin, they might find that appealing.
"This paper talks about the ripple effect in spouses," she said, "but I also think the ripple effect may be more likely to be seen in children who are less likely to be able to get and prepare their own food."
According to Dr Mitchell, "It's not impossible, but it is helpful if the partner is on board with the weight change . . . but we also don't want someone to be nagging the person."
It is clear that "people do better with weight management when they have supportive people around them, whether it be their spouse, partner, family members, or even friends and coworkers."
The study was funded by Weight Watchers International. Dr Mitchell has reported no relevant financial relationships.