Women's midlife challenges.
Bernadette is a sensitive, successful but overworked 56-year-old client of mine. When she came to me 2 years ago, she was emotionally distraught and desperate to change her body, her energy level and her outlook on life. In addition to holding a demanding job, she was struggling with the onset of menopause. Hot flashes continually interrupted her sleep, and her workaholic behavior left little time to relax. She was also frustrated by her inability to lose weight despite constant dieting and was self-conscious about what she called her “strange, new body.” All of these issues contributed to her chronic state of emotional stress and exhaustion.
In the future, fitness professionals will probably encounter more and more middle-aged female clients like Bernadette who are dealing with new and unsettling emotional issues spurred on by midlife changes. In fact, scientists are just beginning to discover that chronic emotional stress can be a contributing factor in age-related weight gain in older women. As a fitness professional, you cannot exceed your scope of practice by recommending specific diets or counseling older female clients on psychological matters. None-theless, there are things you can do to help these women navigate more easily through their middle years.
Women in their 40s and 50s face perhaps the most emotionally charged—and quite possibly the most frustrating—time of their lives in terms of trying to maintain an ideal body weight. They may also be seeing daily changes to their faces and bodies that make them feel more vulnerable in a society that places such a high value on women’s physical appearance.
Emotional issues that may have been suppressed for years can surface during midlife. Divorce, financial burdens, retirement, career moves and residential changes often occur, along with unpleasant menopause symptoms, such as hot flashes, memory loss, slowed metabolism, mood swings, redistribution of body weight and sexual difficulties.
With their children now grown, many of these “empty nesters” begin to question their own identity, which was typically being the family caretaker. They may also be in the unsettling position of becoming the “parent” to their own ill or aging parents. Everything becomes subject to question, from their career status to their personal relationships, and many find themselves regretting past decisions and unaccomplished goals. Many women feel stuck in a less-than-fulfilling life, paralyzed by the fear of making changes.
Each woman experiences this time differently. The midlife years can be either a time when women rejoice at their newfound freedom and the opportunity to create life anew or a time filled with remorse and regret over unfulfilled dreams. This midlife emotional roller coaster ride can significantly impact a client’s ability to handle stress and maintain a healthy weight.
Most experts define emotional stress as a person’s reaction to any situation that places special physical or psychological demands on the person so as to unbalance his or her equilibrium (Nieman 1998). These demands give rise to feelings of fear, anger, anxiety or worry as the body responds to the perceived threat to its well-being. Emotional stress is difficult to measure because it is highly subjective and influenced by personality and experience; every person has a different sensitivity to stressful events (American College of Sports Medicine [ACSM] 2001).
According to Hans Selye, MD, who pioneered the concept of emotional stress, the sympathetic nervous system sets in motion a series of physiological responses to a situation perceived as stressful. Hormones produced by the adrenal cortex, including cortisol and epinephrine, prepare the body for an instant state of readiness in what is known as the classic “fight or flight” response.
Selye also theorized that once the stress-invoking threat has passed, the body returns to a state of homeostasis, or normalcy and balance. However, recent research shows that chronic outpouring of stress hormones may result in undesirable body changes. For example, some researchers believe that chronically elevated cortisol levels can lead to weight gain, especially in the belly.
One study of pre-, peri- and postmenopausal women found that emotions like anger, depression and anxiety increase the risk of developing metabolic syndrome, a prediabetic condition characterized by high triglyceride levels, elevated blood pressure, high blood sugar levels, low HDL cholesterol levels and fat deposition in the midsection (Raikkonen, Matthews & Kuller 2002). Other studies have confirmed that chronic stress can cause excessive intra-abdominal fat (Martin et al. 1992; Bjornthorp, Rossner & Udden 2001), while other researchers have established a link between stress and poor health (Adams et al. 1998; Cohen et al. 1998; Davis et al. 1999; Raikkonen, Matthews & Kuller 2001).
Some scientists have suggested that insulin resistance is the actual cause of cortisol-induced intra-abdominal weight gain (Keltikangas-Jarvinen et al. 1996; Raikkonen et al. 1996; Raikkonen et al. 1999; Drapeau et al. 2003). According to these researchers, chronic emotional stress can lead to too much sugar in the bloodstream, with the excess sugar then being converted to fat and deposited in the abdominal area.
Complicating all this is the fact that many women reach for food as comfort when feeling sad, angry, afraid, hurt, worried, lonely, frustrated or depressed. While there is definitely a psychological basis for emotional eating, physiological issues also play a role here. A recent groundbreaking study showed that foods high in fat and carbohydrate may actually fight stress by reducing cortisol levels in the body (Dallman et al. 2003). Other researchers have found that ingesting carbohydrate foods releases the amino acid tryptophan into the brain, which then manufactures serotonin, a chemical that imparts feelings of calmness, peace and well-being (Wurtman 1986).
If food served merely as sustenance, people would eat exactly what they needed and most would have no problem maintaining a healthy weight. However, food is also a great source of psychological fulfillment. We are taught from infancy that love and food are intertwined. Throughout our lives, we associate food with holidays, celebrations and happy times. It is no wonder that as adults we have come to equate food with positive feelings.
When emotionally stressed, some people strive to recapture those happy feelings by comforting themselves with food. It has recently been shown that the more basic one’s unfulfilled emotional needs (e.g., security, love or belonging), the more likely one is to engage in emotional eating (Timmerman & Acton 2001). Chronic depression and anxiety also tend to cause emotional eating, and people in these states are especially prone to crave sweet and fatty foods (Krauchi, Reich & Wirz-Justice 1997; Oliver, Wardle & Gibson 2000; Dallman et al. 2003).
Also, many parents mistakenly use food as a reward for positive behavior: “If you are a good girl today, you’ll get a treat.” Unfortunately, this all-too-familiar strategy may create a lasting unconscious desire to reward oneself with sweet, high-calorie foods when under emotional stress.
Overweight children can grow up with damaged self-esteem from years of ridicule from their peers. As adults, they may unconsciously believe they are indeed the fat, lazy, unlovable and weak persons everyone said they were. They may then develop unhealthy eating habits to justify those deep-rooted beliefs, so that being overweight becomes a self-fulfilling prophecy.
Deeper emotional issues can be the underlying reason for weight gain, as well. Unconsciously, a layer of fat on the body may serve to prevent other people from getting too close (Greeson 1993). Women may harbor unresolved issues well into midlife and beyond, perhaps striving to remain “fat-protected” and thereby rendering future weight loss efforts futile.
These issues are only made worse by the constant barrage of unhealthy and unrealistic images foisted on women by the media. The message is loud and clear: If you are thin, you are successful, lovable, intelligent and sexy. Failure to meet society’s ideal female body image can be yet another major source of emotional stress for older women.
For all these physiological and psychological reasons, many midlife women find themselves in a self-perpetuating cycle of stress-eat-stress-eat that they feel helpless to change. Sadly, once this vicious cycle begins, all efforts to lose weight are destined to fail until the underlying physiological and/or psychological reasons behind the weight gain are addressed.
Fitness professionals are educated in anatomy, physiology and biomechanics. Most are also well versed in proper exercise technique, sets, reps, mode, frequency, intensity and duration. Yet this knowledge alone is probably not enough to develop successful weight loss programs for our midlife female clients.
The truth is that professionals in the fitness industry also need to learn and develop empathy, patience and active- listening, nonverbal communication skills. They need to learn how to be nonjudgmental in order to truly understand and support clients as they address their emotional issues (ACSM 2001).
However, a word of caution is necessary here. As a fitness professional, you must stay within your scope of practice and avoid any attempts to “counsel” clients. Fitness professionals are not trained psychotherapists and must remain aware of their own professional and legal limitations. If a client of yours has a deep emotional problem, such as an eating disorder, it is imperative that you refer that person to a qualified health professional.
That said, there are some steps you can take to help midlife clients struggling with emotional weight gain. While personal fitness trainers are in a unique position to help on a one-on-one basis, group fitness instructors can also play a role in educating these women. The first step is to learn how to recognize a chronically stressed client.
A simple way to assess emotional stress is to use a questionnaire, which is probably most useful in the personal training setting (see “Emotional Stress Assessment Questionnaire” on page 53). Clients may be more candid about sensitive issues when expressing them on paper rather than in a face-to-face discussion.
The questionnaire should include a common list of midlife events and changes, as well as a rating scale to assess how frequently such events cause emotional stress. Explain to clients how chronic emotional stress can be a significant factor in their weight gain. The very act of completing the questionnaire can invoke thought and introspection, creating an awareness of the role that stress is playing in their lives.
While you need to avoid counseling clients, it is fine to suggest mental and physical activities that will help relieve emotional stress. For example, mind-body disciplines, such as yoga and tai chi, should be encouraged, as they are great stress management tools. Meditation, breathing techniques, biofeedback, relaxation tapes, guided imagery, journal writing and other forms of self-expression are likewise quite effective stress busters.
You can also be a source of information for your clients, providing a list of recommended stress management seminars and serving as a connection to local social workers and psychologists. You may even want to create a support group for midlife women, where they can share their issues with their peers. Studies have found that such groups can achieve better results than one-on-one interventions (Perri 2001).
Self-monitoring has also proved one of the most effective ways to manage and lose weight (Rich 2004). You might want to suggest that clients keep an “emotional eating” diary, where they record what they eat and when they eat it each day, along with any feelings they experience at the time. In doing so, they will become aware of how and when their emotions affect their eating patterns and food choices.
Other ways you can assist midlife clients are by designing exercise programs and offering general healthy-eating guidelines, based on the clients’ personal preferences, capabilities, schedules, medical conditions and goals. Teach clients that healthy meals and snacks eaten at regular intervals will keep their blood sugar levels in check and prevent hunger. And remind them that occasionally indulging in their favorite treats will prevent binge eating. Encourage all of these women to formally schedule time for themselves every day to take a class, read, relax in a bathtub or engage in some other form of self-nurturance that doesn’t involve food.
Exercise is a powerful tamer of emotional stress (Cramer, Nieman & Lee 1991; Blumenthal et al. 1999) and menopausal symptoms (Slaven & Lee 1997). Midlife women can benefit from a fitness program that includes cardiorespiratory activity and strength training to help them lose body fat, build confidence, alleviate anxiety and depression and boost self-esteem. However, be sure to steer clients away from obsessing about losing a certain number of pounds; instead, stress goals like improving health and well-being.
It is also essential that you serve as a source of praise and encouragement along the way. Reward clients for their efforts (rather than results) through verbal affirmations, encouraging e-mails, funny stickers on workout cards or other forms of recognition.
The midlife years can be particularly challenging for women. Often called the second adolescence, these years can be a time of reevaluation and self-reflection. The physical and psychological changes that occur can cause emotional stress, which may lead to unwanted weight gain.
Fitness professionals can help by offering clients nonjudgmental support and encouragement and by referring them to qualified medical professionals when appropriate. Creating specialized fitness programs, providing social opportunities and showering clients with praise can help these women reach their weight loss goals and even help them see midlife in a much more positive light: as a wonderful, once-in-a-lifetime opportunity to create life anew.