Why don't most popular diet plans work for post-menopausal women; and if they do, why do women have to work at it three times as hard and four times as long to lose half the weight a man does? Dr Elizabeth Lee Vliet answers the questions in a groundbreaking book that will be a godsend to every woman who has tried and failed to stop the dreaded 'inevitable' weight gain that comes with mid-life. In this book Dr Vliet explains how and why hormone imbalances are the major factor in the mid-life woman's inability to lose weight and how balanced hormonal production combined with exercise and a proper diet can lead to a breakthrough in mid-life fitness, health and well-being.

Elizabeth Lee Vliet, M.D. is a leading specialist in women's health with a focus on preventive and climacteric medicine. She is the founder and medical director of Her Place: The Women's Center for Health Enhancement and Renewal, Inc.

Chapter One

MY STORY

I started looking like a little balloon in the third grade. I hated being fat. I hated being teased. I hated not being able to climb trees easily like my friends. And then, to make it worse, I had to get glasses. Four-eyes and fat. You can imagine what the other kids did with that. My parents couldn't quite figure out why I suddenly started gaining weight, since everyone else in the family was slender. My mother didn't allow much in the way of junk food, and the family meals were a healthy combination of fresh vegetables from the garden, meats or fish or chicken, and fruits.

    We were also active children. I was not a couch potato (or computer-potato as we call it today), and we weren't allowed to spend hours in front of the TV instead of being outside playing. So why on earth was I getting so fat? I didn't put it all together at the time, but of all my cousins, it was only my two female cousins who got fat at about the age of third grade. None of the boys did. Hmmm ... mmm. Could there be something hormonal here in this picture? Stay tuned. It took me years to put the pieces of the puzzle together in a way that made some sense about this pattern in my family tree, and what can affect women in general to make us fatter.

    Then in adolescence, puberty arrived, and with a healthy diet and more exercise I slimmed down, though taunts from childhood and the fear of being fat lingered in my soul. Overall, high school was a time of lots of activity, a healthy body, and a desirable body weight. Then college came, along with the "freshman fifteen"--you know, those pounds that suddenly appear as soon as you hit dorm life? My friends and I quickly discovered that if we started smoking cigarettes, we could be cool and lose weight all at the same time. I did that for a few years until I realized smoking was dumb and dangerous, and I quit. But overall, with the physical activity of walking around campus, appetite-suppression through smoking, lots of dancing on the weekends, and the ubiquitous "quick fix" diets, I kept the weight under control in college and was generally pleased with how I looked and felt. (The young can get away with "dumb" health decisions, but eventually, age and body changes dictate that smarter decisions are necessary.)

    After college, my twenties were filled with working full time, graduate school, a busy social life, parties, eating out, and enjoying my new hobby of gourmet cooking, and the pounds seemed to stick to my body like flies to glue. I wasn't exercising at all then, and I was taking birth control pills , which I didn't realize were adding to my struggles. I was on a high progestin pill that made me hungrier than ever and made my blood sugar swings worse. Another fifteen pounds added. A friend said, "Why don't you run after work?" I said to myself, "What do you mean, go out and run after work. Are you nuts? I don't have the energy to put one foot in front of the other, much less exercise ." Little did I know then what I know now: Exercise revs up your energy and helps fight fatigue!

    During this time, I tried every diet in the book, from Atkins to Zen and everything in between. Like many of you, I would lose a few pounds, hit that plateau, get frustrated, and go back to what I normally ate; the pounds would come flying back with a vengeance. Each time I went on a crash diet, I lost more muscle, and when the weight came back later, it was all fat. Then my metabolism was even slower than before, so it was harder to lose the next time. What a vicious cycle. Recognize this pattern? I had no way to evaluate the fad diets I tried or to understand my body chemistry and hormone balance so I could figure out the best approach for my body.

    Then at age 28 I started medical school. Talk about stress . Living away from my husband in order to attend school, I felt lonely and overwhelmed with the work load of a three-year, year-round curriculum. Chocolate became my consolation and solace, and I gained thirty pounds the first year--all-night studying, turning pages with one hand and emptying chocolate-chip-cookie boxes with the other.

    I finally came to my senses and realized I couldn't continue this crazy pattern. A classmate encouraged me to start jogging with her. Of course, she was thin, fit, and ran three-plus miles a day! That seemed pretty overwhelming to the "cookie monster" me, barely able to walk a mile, much less run one. Finally, Colleen's coaxing won out. I started by walking the mile lap around the neighborhood, and then slowly jogged the last block. Each week, I added one more block for the jogging part, until finally, after ten weeks, I had built up to being able to jog the entire mile. I was thrilled with my success and accomplishment! I kept up the jogging through my medical school years, and also ate much more reasonably. As a result, the excess pounds slowly dropped away, and I felt tons better. I had more energy, I slept well, and I had more stamina and concentration for studying. I noticed very quickly that when you are pulling all those pounds along on the jog, the cookies and ice cream don't seem nearly as desirable. Plus, I got my brain cleared and my body refreshed with movement instead of becoming lethargic from overeating. My present to myself on my thirtieth birthday was to run five miles, something I had not been able to do even at eighteen, much less twenty or twenty-five. It made me proud.

    My postresidency years were marked by a new job, the stress of leaving friends and family, moving across the country, noticing more of those premenstrual chocolate cravings (and giving in to them), and getting out of the exercise habit and into the Häagen-Dazs habit. The pounds piled back on. I pretended I didn't notice, but after awhile, I couldn't hide the body changes anymore. I got together with a friend who was also out of shape and overfat and we went back to exercising. This time instead of jogging, I went to aerobic dance classes that were terrific fun, even though I felt awkward being there at my size. Progress was slower, since I was older now, though I hadn't fully made that connection at the time.

    This time I again began to lose weight through exercise and healthy eating, going down to a size 8-10 and 22 percent body fat. I was understanding the mind-body connections better now, and I felt so much better about myself being fit than fat. I wasn't a size 4 or even a 6, but I sure did feel good. I decided those Madison Avenue types weren't going to make me feel less of a woman because I was bigger than a 6. I took perverse delight in surprising the "perfect body" exercise instructors with my level of fitness and stamina in the classes.

    A few years went by, I sustained these positive changes, and I felt great. Then something seemed to go awry. The PMS was getting worse, the chocolate cravings were back in force, my energy was down, I wasn't sleeping as well. My clothes didn't fit the same; all the waists seemed to be shrinking at the same time. Now the low-fat diet just wasn't working, even though I was scrupulous about cutting out the fat and focusing on the complex carbs, healthy pasta, bread without any butter or margarine. These previously successful approaches suddenly weren't working ... which meant more weight gain, less energy, sluggishness, and I didn't feel like exercising. My formerly boundless energy seemed to have gotten up and gone. I felt like I was dragging though my days. I was getting older though I hadn't really paid attention to that. Though I was "only" in my mid-thirties, no one--including me, who had developed a special program for helping women with PMS--had thought to check my own PMS. Along with heart palpitations, I spent night after night waking up looking at the clock and wondering when I would fall asleep and stay asleep. I went to my doctors, who felt I must just be "stressed" from a busy medical practice and needed to take more time off. Does any of this sound familiar?

    Then I had two different surgeries for herniated disks in my neck. I was out of work for months, couldn't exercise as intensively as I had been, and those "@#*!#%" pounds piled on again . Before I could finish the full rehabilitation from my neck surgeries, I found I needed a hysterectomy, bringing on a sudden menopause many years before I thought I would face that milestone. What a shock.

    While I struggled to find the right hormone balance, I gained even more weight. The middle body fat problem escalated, and hypothyroidism, insulin resistance, and glucose intolerance resulted. I went through it all, in part made worse by a low-fat, high-carb meal plan. Boy, after the hysterectomy, that approach really didn't work! (I'll share more about why as you take the journey with me through the pages of this book.)

    After a lifetime of searching, and reading and trying every diet there is, I have several conclusions to report--some of which you have probably already figured out on your own:

* Weight loss is difficult. Period.

* There is no "magic pill" after all.

* Men lose weight easier than women, at all ages throughout life (decidedly unfair!).

* Diets that work like "magic" for men, don't work for women, or if they do, you have to work at it three times as hard and four times as long as a man to lose half the weight he did!

* Deep inside, you and I both know that "diets" don't work in the long run. (Haven't you always regained the weight you lost?)

* We get fatter as we get older (women blame this on "hormones"; men blame this on "beer").

* Women think--and tell me every day in my office--"Hormone therapy at menopause causes weight gain--I don't want to take hormones." What I will show you in this book is that this "conclusion" is wrong. Hormone imbalance causes weight gain.

    Maintaining a healthy body takes work. Many times, I get tired of "working" at it, just like you probably do. I think I have always wanted to find a "cure" or miracle diet that would take the weight off easily, permanently, and without a lot of bother or fuss or effort. Have I found a "magic pill"? No.

    Have I finally found some clues that will help you put the "weight problem" in better perspective for you as a woman? Yes.

    Have I found some ways to deal with "midlife middle management" with greater success? Yes.

    Have I found some ways to help you "take hormones" and not gain more fat? Yes.

    Is there some good news to follow my earlier statement that weight loss is difficult? Yes.

    It has taken me twenty years of detective work; study; and searching the international medical literature on hormones, weight, nutrition, and exercise to come to the understandings that I will be sharing in this book.

    Finally, I feel better equipped to put all these life lessons together into a rational plan that will help you, and me, keep the pounds off as we head into the second half of our lives. And that's why I decided I had to write this book. I want to help women like me, who struggle every day with unwanted weight and can't seem to find a way out of the maze of conflicting information and meal plans.

    There are answers to help you in your struggles. You need this book, just as I needed all of this information to help me . There's a lot to share with you on all this, and I hope you will find the journey through this book to be both exciting and encouraging. There is hope for keeping your weight down without letting diets rule your life and destroy your energy. Come with me on the journey and find out the real story behind the "hormones-and-weight hoopla."

Excerpted from Women, Weight, and Hormones by Elizabeth Lee Vliet, M.D.. Copyright © 2001 by Elizabeth Lee Vliet, M.D.. Excerpted by permission. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.