Marie Savard, M.D., is a doctor, educator, and former ABC News medical contributor. She is the founder of the Savard System for managing and controlling your healthcare. Dr. Savard is the author of five books, focusing on women’s health and wellness.
A native of Philadelphia, she received a bachelor’s degree in nursing and a medical degree from the University of Pennsylvania. She formerly served as the director of the Center for Women's Health at the Medical College of Pennsylvania, technical adviser to the United Nations' Fourth World Conference on Women in Beijing, adviser to the American Board of Internal Medicine Subcommittee on Clinical Competency in Women's Health, health columnist for Woman's Day magazine, and senior medical consultant to Lifetime Television's "Strong Medicine."
In this podcast on body fat, weight, and weight loss, Dr. Savard explains what women, especially postmenopausal women, can do to prevent weight gain and lose some pounds that may have been gained. Listen to the podcast to hear her explain:
- why women tend to gain weight and change shape after menopause
- steps you can take to reduce the risk of gaining weight after menopause
- the top four things she recommends to a woman who wants to lose weight
Running time: 23:30
Show Full Transcript
Jamie DePolo: Hello, everyone, I’m Jamie DePolo, senior editor at Breastcancer.org. Our podcast guest today is Dr. Marie Savard. She’s a doctor, educator, and former ABC News medical contributor. She’s the founder of the Savard System for managing and controlling your healthcare. Dr. Savard is also the author of five books focusing on women’s health and wellness. A native of Philadelphia, she received a bachelor’s degree in nursing and a medical degree from the University of Pennsylvania. She formerly served as the director of the Center for Women’s Health at the Medical College of Pennsylvania, technical advisor to the United Nations Fourth World Conference on Women in Beijing, advisor to the American Board of Internal Medicine’s subcommittee on clinical competency on women’s health, health columnist for Women’s Day magazine, and senior medical consultant to Lifetime television’s “Strong Medicine.”
Today she joins us to talk about body fat, weight, and weight loss. Dr. Savard, welcome to the podcast.
Marie Savard: Thank you, thank you for having me.
Jamie DePolo: So, our audience, many of the women have been diagnosed with breast cancer. Many of them are postmenopausal, either naturally or through treatment, and many of these women say they’ve gained weight after menopause. So can you talk about the processes in the body that can cause that, because it’s a troubling problem for a lot of women.
Marie Savard: It is true. Most women do gain weight after menopause, but the truth is, it’s not actually menopause itself that’s causing weight gain. It’s the changes in our lifestyle and part of the aging process. If you think about it, what menopause does is actually shift our body’s shape, and that’s the important thing to focus on.
What is happening to the body in menopause? So our estrogen level naturally goes down as our ovaries age, or as a result of chemotherapy, our estrogen levels naturally go down as a result of the treatment for breast cancer. And when you lower that estrogen level, the body naturally goes from storing fat in the lower half — the sort of butts, hips, and thighs, the kind of classic pear shape — and suddenly you start storing extra fat above the waist, in your upper body, in your abdomen, in your shoulders, maybe even in your neck. And as that weight shifts, the shape of your body shifts, and I think that’s what most troubling to women. They suddenly have a large waistline when they didn’t have that before.
So really, the focus I talk to women about is, recognize, be prepared. Your body’s shape will change. That’s not something you can necessarily do anything about, but maybe even laugh about it. I kind of think that the most important thing in life and even in medicine is to have a positive, can-do attitude. This is what you expect. But on the other hand, there are lots of things you can do for that slow, gradual, subtle weight gain that occurs…really related to a change in your lifestyle.
Jamie DePolo: Can you talk a little bit, too… what exactly is the process? Why does the drop in estrogen make the fat move up?
Marie Savard: So most women tend to naturally… One of my earlier books, Apples and Pears, was written about the use of your body shape to predict or forecast your health future. So we know that a lot of women are naturally pear-shaped. So that means they store all their fat below their waist, in their butt, hips, and thighs. But there are some women, even before menopause, who will naturally, as a virtue of their genetic profile, for example, or their ethnic background, will naturally store fat more around the waist and the upper body.
And the difference in where you store fat is everything. So, lower body fat is kind of an inactive fat. It’s fat that really doesn’t have much of a metabolism. Once you store it, it’s hard to get rid of, and estrogen seems to be the trigger to store fat preferably in that lower body. On the other hand, fat gets stored in the middle, and the fact that we all will develop as we age and go through menopause, that visceral fat — and that’s the word for organ fat or fat around the waist — that visceral fat, or belly fat, is very active metabolically. That kind of means that it’s producing enzymes and inflammation factors and hormones and proteins, which lead to actually a higher level of inflammation. And we all know inflammation is now the source of many chronic diseases, everything from diabetes to heart disease to even cancers, including breast cancer. So that fat that is stored in our middle is producing these enzymes, is very active, and is this kind of source for… increasing our risk for even things like breast cancer and certainly heart disease and everything else.
So, again, I think knowing the role of body shape is one thing, understanding it is another. I try to give people some sense of encouragement. There are lots of things we can do to change. You know, not exactly turn back the clock, but we can start changing our lifestyle early on to kind of address some of the factors. That’s what I love to inspire people about, is what they can do.
Jamie DePolo: Excellent! So let’s talk a little bit about that, because as you said, being overweight is a risk for breast cancer. Also the location of the fat makes a difference and can increase the risk. So are there lifestyle changes, diet changes that a woman can do even before menopause, thinking about, “This is going to happen, it’s pretty much inevitable if you’re a woman.” Are there things she can do before menopause to kind of lessen the weight gain?
Marie Savard: Yes! Absolutely. In fact, I would argue if you are younger and listening to this podcast, think of the things — just imagine that if you could avoid adding on any extra fat cells before you go through menopause, you will be doing a lot to sort of advance or improve the likelihood of you doing well beyond menopause. Women who gain weight before menopause really do have an increased risk of breast cancer later on in life because again, that upper body fat is what will produce the inflammation and estrogen hormones, etc.
So how do any of us avoid weight gain at any time, but especially before menopause? I would always say just think of it this way: exercise, when it comes to weight loss and health, is king, and diet is queen. And we can talk a little bit about that. And I’ve added to that, because the role of sleep is so incredibly important that sleep becomes prince or princess, depending on who you are. It’s those three together are amazingly important.
So, talking about exercise first, what happens to us as we age? We become less active. Our kids are grown. We’re not picking them up, we’re not schlepping things up and down the stairs to the same degree. We’re not naturally quite as physically active as we might think we are. And I know many of you are thinking, “Well, I already go to the gym and I’m still gaining weight.” Think about how active you are during the day at other times. Are you sitting behind a desk, sitting at a computer all day? We now know that the activity level that we have on a continuous basis is more important than just signing up to go to a gym. So just being aware of being active is so important.
Also, I think I would start first with the role of increasing exercise, and it’s not just aerobic exercise that’s important. It’s sort of a combination of aerobic, the sort of heart-strengthening, getting-your-heart-rate-up exercise, being active, with the type of exercise that has to do with using weights, resistance exercise, gaining muscle mass. Because another thing which I didn’t talk about but it’s so important, is the role of our muscles. When we’re young — and actually men have an advantage to women in this case.
And actually, we’ll talk about men for a second. Men make testosterone, the male hormone that really fuels muscle mass. So they naturally have greater muscle mass than women. And muscle, as opposed to fat, is a metabolic engine. It sort of fuels calories and quickly helps us burn excess calories. So men have a much easier time at it when it comes to losing weight and avoiding weight gain in the first place. But what we can do as women instead of, “As we age, what muscle mass we have gradually will dwindle,” we can counteract that. We can do so much to build muscle mass. So another way to think about preventing weight gain is to just simply increase your muscle mass, because that alone will do so much to help reduce the effect of any added calories we might have in our diet.
When it comes to diet, we all want to think there’s one diet that’s going to suit just our needs, is going to be perfect. The truth is, there’s no one diet that’s going to fit everyone, and there’s no one diet that necessarily is even going to work for you. The truth is, you have to come up with what’s important to you. I think that thinking about eating healthy and eating for health will gradually help you lose weight more than what’s the specific diet that you’re on. One more diet book, you know, it may work for a while, but studies have shown whatever it is that you stick to, unless you change your life — and that refers to all the other things that are so important, whether it’s sleep, adding exercise, stress management — unless you change those factors, how you eat and keeping off weight is just not going to work. I think we really need to focus on our health rather than specific numbers of what’s on the scale.
And I think we need to figure out ‘what are things that we can do, that we can control,’ more than ‘what are these gimmicks.’ And if there’s any message that I feel about the research that’s coming out now, and there’s a lot of research on different types of diets, is, too, knowing generally about the Mediterranean diet, sticking to fruit, vegetables, healthy plant-based food primarily, healthy fats, limiting the amount of animal products is a general rule of thumb, and we certainly know that all promotes health.
The other thing is the idea of fasting. Everybody’s curious about these fasting diets and what’s the science behind that. If you think about how we evolved, they were meant to have long periods of not eating. And if you want a sort of shortcut to every day having a period of not eating, think about from sundown at night to sunup in the morning, try not to eat during that period of time. If you just give your body maybe a 12-hour fasting period, you allow those insulin levels to go down. You allow all the good sort of fat burning to occur during that time, and you are really doing a lot to accelerate that lifelong sort of weight loss that you want to think about. So eat well, eat 12 hours during the day, sun up to sun down, and then fast from there out, and I think pretty much you will address all the new research, all the fancy studies that you might read about, all the fancy diets that you might go on. You can just think about those common-sense rules, and I think that’ll go a long way to help you manage that perimenopausal weight loss, not to mention weight loss as we get even well through menopause and beyond.
I would love to talk to you more about my thoughts on eating and diet, but that’s number two. And then you know, let’s not forget sleep. Getting that 7 to 8 hours of sleep, we now know, will lessen the changes in our body shape as we get older, will make insulin work better, will absolutely make it easier for us to lose weight. So it’s critical.
Jamie DePolo: And I just want to clarify just in case any listeners are confused. When you talk about aerobic exercise, you’re talking about things like running, walking, dancing, anything that gets the heart rate up, and you’re kind of moving but not necessarily carrying weight, although lifting weights can get your heart rate up as well, correct?
Marie Savard: Good point. So let’s make the distinction. So, what is recommended is sort of two forms of exercise for all of us. Pretty much all the guidelines will say we need a minimum of 30 minutes, maybe up to 5 times a week, of heart-racing exercise. Whether that’s walking quickly, getting on an elliptical trainer, which is something I like to do, getting on a treadmill, which as I’ve gotten older I’m less excited about. Whatever it is that gets our heart rate going by us doing large areas of exercise, rowing, getting on a rowing bike, getting on a bike — that is the aerobic exercise. Anything that increases burning that oxygen by breathing fast, getting your heart rate up. And doing it a lot — maybe as much as 5 days a week for 30 minutes. I will talk in a minute about the high intensity, shorter, brisk exercise. That’s pretty interesting research, too, but generally speaking, just being as active as possible is the aerobic exercise.
The other component is the resistance exercise that I mentioned. And that is really the weight lifting, the weight training. Carrying things, anything that may or may not get your heart rate up, but it’s something that’s actually strengthening muscles and building muscles. You don’t need to do that every day. If anything, your muscles will fatigue and talk to you and you will have a hard time doing it every day. The recommendation is maybe as much as 2 to 3 times a week, doing a series of exercises focusing on your large muscle groups. And that means everything from pushups, if you can — I have to do the cheating version but it works — to squats. There’s so many great programs online that you can find.
But it’s finding something that works for you. Every one of us is different. We bring to the table so many different choices about how we want to work out, how we want to, you know, live our lives, but it really is important that we think about the role of exercise in avoiding that unnecessary weight gain. It’s not going to change your body. You can’t shift the shape of your body by doing exercise, but you sure can shift your health by doing that exercise a lot.
Jamie DePolo: Ok. And just in case anyone who’s listening is concerned, there are concerns among some women who’ve had breast cancer surgery about lifting things, making lymphedema worse, or bringing on a lymphedema episode. But there are things you can do, as you said, squatting. Somebody could just do a squat, stand from a low chair and get up and down, and you’re still working all those muscles. And you can do light weights like soup cans, sitting in a chair to isolate some muscles. So I don’t want anyone to be concerned that you’re going to hurt yourself. Definitely, somebody should talk to a trainer if they’re concerned, but there are resistance exercises that everyone can do.
Marie Savard: You raise a really good point. So, if you’re worried about your upper body for any reason, and certainly lymphedema and having had surgery before, there’s plenty of reasons, even arthritis as we get older in our hands, and that’s actually something I’ve had to experience. Upper body exercise for strengthening and lifting may not be so easy, and if you think about it, it’s much less necessary than the lower body. Our large muscle groups are in the lower half of our body. So our butt, our gluteus muscles, our hips, our quads in the back, our hamstrings — those large muscle groups are the muscle groups that will [be the fuel] to be the greatest metabolic engine to burn calories, but they’re also what’s going to keep our balance, our gait, our walking. It’s really what’s going to keep us strong and prevent us as we get older from being frail and being worried about trips and falls.
So if I had to say to a woman – and I hadn’t thought of this until your question — if you had a choice, what type of weight lifting exercises to do for aging? And I’m really passionate about preventing frailty as people get older. It’s the lower body exercises that are by far most important. So I think for your audience, for anybody who’s worried about upper body, you’re not going to lose by not doing a lot of upper body exercises. If you’re active, you move your arms, you lift, you’re bringing in groceries, that may be enough to sort of just keep conditioning them. But certainly, walking around is just not enough to strengthen the lower muscles and keep your body toned and sort of burn those calories. I think it’s the lower body that’s critical, and fortunately, I think pretty much everybody can do that.
Jamie DePolo: Excellent. It reminds me of a quote there from some Olympic bobsledders, because they were always talking about their glutes were their power pack. I think that’s kind of what you’re talking about as well.
Marie Savard: Yes.
Jamie DePolo: So what are the top four things you would recommend to a woman who is postmenopausal who wants to lose weight? I guess it doesn’t have to be postmenopausal, but if there would be differences, say, between a woman who’s premenopausal and one who’s postmenopausal, what would your tips be for either?
Marie Savard: Alright, I try to keep it really simple. I have four Fs — F, as in my husband’s last name, Fenton — that I talk about. The first is what type of food you eat, and we’re going to get into that. The second is fiber — and we’re going to talk about fiber — fats, and fitness. What are all those things that are important? So the first is the type of food that we eat, and I follow Michael Pollan, who I think many of you may have heard about. He is a journalist who has written about food, and he has said, and it’s been repeated so many times, “Eat real food, mostly plants, and not too much.”
So what does that mean? Real food means eating unprocessed food, not eating foods in packages and long ingredients, etc. So eating real food, natural food. Eating mostly plants. In eating mostly plants you’re gaining fiber, and fiber is so critical because it has all those phytonutrients and other things that are going to reduce our future risk of a second cancer or reduce our risk of heart disease. It helps our colon function, our bowel function. Fiber does so much, and it’s filling. It really helps people as they get older as they eat. And if you need to eat dessert, eat that fiber food first and then followed by dessert because it lowers … if you have a lot of fiber in your diet and a lot of plant-based foods and then you follow it with some sugar, some dessert, you will lessen that sugar effect, you’ll lessen that insulin surge that occurs as a result. So I think it’s really important to think about why it is that we need to eat mostly plant-based foods.
I talk about fluids a little bit because fluids are important as to what you should avoid generally. You should generally avoid too much alcohol. As we get older, obviously we know alcohol too much plays a role in breast cancer and other cancers, and, yes, it is true that a little bit is good. A little bit protects our heart, but a lot does not. So we have to be really careful about alcohol, and I think that’s something that older people tend to rely on a lot more. It’s sort of a hidden epidemic, sometimes, for older women. So that’s something to think about. And then the other fluid is diet soda. I used to, when I was on ABC, “Good Morning America,” primarily talk about diet soda all the time and the role of diet soda in increasing our waist size, in increasing the risk of developing some of these metabolic diseases like diabetes, etc., and it may not make sense but it does. So we have to be careful about the diet sodas that we drink.
And then finally, fitness. What does fitness mean? First, fitness means fitness of sleep, making sure you get 7 to 8 hours of sleep a night. Fitness of mind/body, so the mind in terms of meditation and stress reduction. Lowering stress lowers waist size and does so much to help handle the extra calories that we consume or help us manage our diets better. And fitness also means sex. It was my father-in law that when he first heard my presentation about fitness, he said to me that I didn’t include the most important thing that older women care about, and that’s — he kind of had a twinkle in his eye — what happens in the bedroom. And I said, “Oh!” And he was talking about an F word for that, and of course we’re on a podcast and I would never say what is that F word around sex, but we all know what that is. Sex actually plays such an important role, and it takes different forms as we get older, and we can be very creative, but it’s really important in terms of our ensuring sleep, ensuring our peace of mind, peace of body, and helping with our weight. And the bottom line is if we feel good about our body and we feel good about who we are, even if we can’t fully control our weight, we can control how we feel about ourselves, that makes sex so much more enjoyable. And again, as my father-in-law said, it’s a good part of life and getting older, something else to think about.
So the four Fs, food and fiber. Fat, I didn’t really mention, but healthy fats are important. Unhealthy fats, we all know what they are — butter, animal products, etc. — are not. And then the fluids to drink and to avoid, and the fitness of all aspects of our lives are the way to go. And I guess that fifth F word, which we won’t say on the air. That’s it.
Jamie DePolo: [laughs] Excellent! Dr. Savard, thank you so much! I really appreciate your insights.
Marie Savard: Great, and thank you so much for having me.