What Women Need to Know About Midlife Weight Gain, Hormones, and Metabolism

What if midlife weight gain isn’t simply about willpower?

In this episode of Therapist Unplugged, Laurie Poole sits down with Dr. Richa Mittal of Radiant Health Weight Loss and Wellness to talk about the complex relationship between hormones, metabolism, and weight during midlife. Together, they explore what many women experience during perimenopause and menopause—changes in sleep, mood, energy, and body composition that can feel confusing and frustrating.

Dr. Mittal explains why the common advice to simply “eat less and move more” often misses the bigger picture. From hormonal shifts and visceral fat to the role of nutrition, sleep, and muscle mass, this conversation reframes midlife weight gain through the lens of metabolic health rather than blame.

You’ll hear:

• Why hormonal changes can affect weight, mood, and energy
• The difference between visceral fat and other types of body fat
• How nutrition, sleep, and gut health influence mental and physical wellbeing
• The role of GLP-1 medications and when they may be helpful
• Why self-compassion matters more than diet culture during midlife

If you’ve ever felt like your body suddenly started playing by different rules, this episode offers clarity, science, and a more compassionate way to think about midlife health.

Learn more about Dr. Mittal’s practice, Radiant Health Weight Loss and Wellness, at myradianthealth.com

She also writes about midlife wellness, nutrition, and metabolic health on her blog Life, Fully Nourished, which you can find at richamittalmd.com

🎙️ Therapist Unplugged is produced by The Montfort Group, a boutique therapy practice based in Plano, Texas, helping individuals, couples, and families build emotionally intelligent, connected lives.

Subscribe for real conversations with real therapists, because healing doesn’t happen in perfect soundbites.

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Transcript

Laurie Poole 0:28

Well, hello everyone, and welcome to Therapist Unplugged. I'm your host, Lori Poole, licensed professional counselor in Dallas. And today I am delighted to introduce our guest, Dr. Richard, Richard Mithel, who I have crossed paths with in my own weight loss journey and midlife everything. And so I am so delighted to have Dr. Mithel as a guest today to talk about women, midlife,

Meet Dr. Mithel And Her Why

Laurie Poole 0:56

weight gain, hormonal shifts, all kinds of things that those of us who've gone through that period of time understand pretty well. Dr. Mithel is an internist, a diplomat of the boards of Obesity, Medicine, and Lifestyle Medicine, a menopause society certified provider, as well as a culinary coach. She provides comprehensive and personalized preventative health, medical weight management, and menopause care to patients in her practice, radiant health, weight loss, and wellness. She is a strong advocate for evidence-based weight wellness, lifestyle medicine, and women's metabolic health during all stages of life, especially the menopause transition. She educates through her social media platforms and midlife women's blog, Life Fully Nourished. Welcome, Dr. Mithel. I am just so excited to talk about all of these things today.

Dr. Richa Mittal 1:55

Me too. Thank you so much for having me.

Laurie Poole 1:58

Oh, it's my pleasure. So tell me, what drew you to working with midlife women around weight and hormone health?

Dr. Richa Mittal 2:06

It started out more preventative health in terms of metabolic health issues. I personally have dealt with them. I have a very strong family history of heart disease and diabetes. And I used to work on the inpatient side in the hospital. And it was very much, it felt like very important work, but it was also very transient. And I wanted to be more on the preventative side of things. And then, you know, in my 40s, um, I entered

Naming The Midlife “Something Feels Off”

Dr. Richa Mittal 2:34

perimenopause myself. And I think as I shifted in my own life, my practice also became more interested in that side of things as I worked with women and realized what a big change that is that occurs for women in their lives.

Laurie Poole 2:52

Well, you know, do you hear things like when women come in to you to see you? Will they describe it as like something just feels off or I don't feel myself? And if so, what do you think they're actually describing?

Dr. Richa Mittal 3:07

Yeah, I think they're describing a lot of different symptoms, and it can really vary woman to woman. Um, you know, I think the common ones are sleep problems, uh, brain fog, not feeling like myself, weight gain is one that they notice a lot. Uh, their labs change, like maybe they were kind of going along, and then all of a sudden they got told, like, hey, you have uh high cholesterol or you have high blood sugar. Uh, so it can really vary quite a bit. And, you know, I think that a lot of times they're just like piecing it together and it just never really was evident to them, like, hey, this could all have kind of a commonality to it.

Laurie Poole 3:48

Right. And I, you know, it's so interesting too, because I think at some point you can feel as though something's not right, but I don't exactly know what it is. And then I remember in my own experience going into CU and finding out, oh, I had this, this, this, and this, contributing to how I felt. And it was a relief in a way, because there were physiological sources for how I was feeling, you know, and and so that made a huge difference to me. I'm wondering about hormonal shifts in perimenopause and menopause and how that affects like weight, energy, mood, tolerance, those things that seem to surface.

Dr. Richa Mittal 4:29

Yeah, it's a big piece of the puzzle. And that's why I felt like, you know, as I started working with women, I became certified in menopause care because I was missing that piece. And of course, I could direct them to get help elsewhere,

Perimenopause As A Hormone Roller Coaster

Dr. Richa Mittal 4:44

but it plays a very big role. And how is because number one, it's not like it declares itself. So, you know, women are kind of going along and then all of a sudden they're uh experiencing different symptoms and things aren't working the way they used to, or maybe the things they used to do to maintain weight, or um, especially midsection, maybe changes in their body, sleep problems, uh, stress, mood, how we cope with things. These are all very uh closely related to our hormone health. What makes it hard is that perimenopause is this very vague years long, maybe seven to ten years long time frame for women. Of course, we all know, like, oh, okay, one day we lose our period. Well, the last day that you have a period, you don't even know that that's going to be your last one. And then 12 months from then, it's called menopause. Yeah. So perimenopause is tricky because it's not that there's a simple solution like, hey, check my hormones. You know, a lot of people come in thinking, hey, I'll just ask for my hormones to be checked. They're all over the place because it's a roller coaster time. Your brain and the ovaries are uh communicating, and there's all sorts of things happening in terms of your estrogen levels and your progesterone levels. And it's not as easy as just doing a blood test. But also, all of these fluctuations affect mood for a lot of women, um, especially women who've had a history of maybe depression or anxiety in the past or even postpartum depression. I've had postpartum depression and I know that it wasn't in my control. And during perimenopause, a lot of those things that were maybe well controlled or hadn't showed themselves in a while can start to play a role. And of course, how we feel mentally impacts everything else.

Laurie Poole 6:44

Absolutely. Absolutely. I'm wondering, you know, um something that I hear frequently is the things that worked for me in my 30s and 40s often stop working. Like I'm I'm just gaining weight more easily, I can't lose the weight as easily as I used to. And they get very people get very discouraged and hopeless about that. Um why do you think that happens? Is that related to the hormonal shifts?

Dr. Richa Mittal 7:15

Multifactorial. Okay. Um, number one, as far as the hormone shifts are concerned, estrogen drops and the fact that it's kind of a roller coaster does lead to potentially emotional ability and problems with mood, also can lead to hot flashes. Um, and of course, that can have an impact on how a person sleeps and how they feel in terms of their quality of life. Brain fog, cognitive function

Why Weight Shifts To The Midsection

Dr. Richa Mittal 7:45

is also impacted by the drop in estrogen. And then as far as weight is concerned, of course, all those things contribute to weight because you don't feel good, but also the drop in estrogen impacts where we carry body weight. So even though if you look at the SWAN study, which is a study looking at women over the spectrum of perimenopause and menopause, and is looking at health across the nation, it's not that there's necessarily just weight gain during that time, but specifically we're carrying weight in our midsection area. So women may notice that their body shape has changed, but that type of fat, unfortunately, in our visceral fat compartment, is also much more uh negative in terms of its impact on our long-term health, like heart disease risk, diabetes, and blood pressure and all of that.

Laurie Poole 8:42

What is visceral fat? Just for our listeners, so we have a sense of what the what the challenge is.

Dr. Richa Mittal 8:50

Yeah, so we carry fat in different compartments in our body. We have subcutaneous fat, which is right underneath the layer of our skin. And oftentimes when people gain weight there, they may notice it might bother them, but that compartment of fat is not as dangerous to our overall health. When we

Visceral Fat And Health Risks

Dr. Richa Mittal 9:11

think about visceral fat, it's the fat that's around our intra-abdominal organs, around our liver, our heart, pancreas. And it's not really just measurable always by the visual inspection of someone. So they can be in a quote unquote normal BMI range and be carrying more of the visceral fat because it's internal. So some of the testing that we do is one called a bioimpedance scale that we use in our practice. It sends an electrical current through. You can now get home scales that measure that. Or a DEXA scan can also look for that type of fat. And visceral fat leads to issues with cholesterol, blood pressure, insulin sensitivity, meaning diabetes risk and cardiovascular heart attack and stroke risk long-term.

Laurie Poole 10:05

So that's the kind of fat you don't want to be carrying around your midsection.

Dr. Richa Mittal 10:09

Correct. And then with the hormone changes, if there's sleep disruption, if there's change in mood, maybe we're eating excess calories, maybe we don't feel great. So we're not doing our resistance training. And, you know, both men and women, starting at the age of 30, start to lose muscle mass. Well, if you're not feeling great, you're not necessarily in the gym, and therefore you might lose muscle mass faster.

Laurie Poole 10:35

Yes. Oh, I've I've experienced that.

Muscle Loss, Sleep, And Stress

Laurie Poole 10:38

I understand that. Tell me something. In your practice, how do you approach weight loss without blame or the diet culture? Like, what do you think your approach is that maybe is different than what other folks might experience in a dirt in another practice?

Dr. Richa Mittal 10:56

I think it's so important to take a step back and honor the fact that our bodies can change over our lifespan. We're not gonna look like always like we were in our teens and 20s. However, you

A Compassionate, Anti‑Diet Approach

Dr. Richa Mittal 11:09

know, I think loving ourselves and coming from a place of self-compassion and not judging is a great start to change because some factors are in our control, some factors are not. We can't hate ourselves into shape, you know, that just doesn't work. And diet culture is about restriction. And I would love for women in this phase of life, and myself included, like I deal with the same challenges that everyone else does on some level. Of course, everybody has their own journeys, but if we can come from a place of body recomposition as a priority and health habits as a priority, looking at our health not just by the measurement on the scale, the full weight number, but looking at how is our muscle mass doing? What is our visceral fat level? How do my labs look? Am I fueling my body with the food that it needs to build muscle? Am I expressing love to myself just through food or alcohol? Or are there other ways that I can show myself love and compassion? Then we can come up with more of a reasonable uh weight management goal that takes into account much more than just the number on the scale.

Laurie Poole 12:35

Yes. And I think that especially for women, and I don't know if you notice the difference between men and women in your practice, but I think that women can have a whole negative rhetoric in their head, a whole narrative that's critical, that is blaming, that feels shame, all these negative emotions. And it can kind of spiral into a negative cycle where it just, well, I might as well just eat what I want because I'm never gonna get out of this hole anyway.

Dr. Richa Mittal 13:04

Yeah, it can feel pretty futile. I would say, number one, you know, again, build a uh narrative in your own mind too that fosters that type. What would you say to your best friend? What would you say to your daughter? You probably wouldn't say the stuff to them that you would that you say to yourself. I think, you know, that's a big piece. Recognizing that there's this kind of um as we have grown up in our lives and even now on in celebrity culture and social media, uh, you know, there's a lot we're told a lot about what we should be doing, what we should look like. And those standards are not always necessarily realistic. And we don't know what cost that person has been paying in terms of disordered eating and frailty to achieve some type of worth through thinness, you know. So I think there's cultural shifts needed, shifts in our own mindset, celebrating what our bodies can do, not just what they look like on surface level. Um, and you know, I think that I want to break the cycle for future generations to know their worth is way more than some,

Culture, Shame, And Self‑Talk

Dr. Richa Mittal 14:19

you know, silly standard that some man came up with. Sorry.

Laurie Poole 14:26

How do you I you know, can you talk a little bit about GLP1 medication and hormones and you know how they might work together in your practice, or when does sort of one approach work with one one patient and maybe something a little different with another patient? Because the GLP1 medications, as you know, have been uh very prominent in the press. And some people are, you know, a

GLP‑1s, HRT, And Tailored Care

Laurie Poole 14:54

little reluctant or they don't trust or whatever. Anyway, I I would love to hear your opinion and and how you practice that with the with also now hormone treatment.

Dr. Richa Mittal 15:05

Yeah, so you know, nothing is just all good or all bad. I think it's important to recognize that it's a medication like any other medication. It's not a quick fix, it's a tool to be used along with all the lifestyle changes and foundational health habits. And there's probably a lot of people on them that shouldn't be. And there's a huge amount of people that probably would benefit who aren't. And that's because the medication gets stigmatized. You know, the use of the medication gets stigmatized. It's not to achieve a number on the scale, but it's a it's a medication that helps metabolic health, meaning it helps your blood sugar control, they lower blood pressure and cholesterol, they can help with fatty liver and reducing risks for heart attacks. Yes, they help with food noise and reducing appetite and thoughts around food, but they need to be dosed carefully in the right person with proper monitoring because the side effects can be pretty nasty.

Laurie Poole 16:07

Yes, they can.

Dr. Richa Mittal 16:09

And I think that sometimes people feel like, oh, this is just the way it's supposed to work. And it's like, no, no, we don't really need you feeling like crap. Um, you need to be able to eat and feel your body. But to answer your question about the hormones, you know, um, even though the hormone changes contribute in midlife to weight gain, there is not really good science or data to show that hormone replacement leads to weight loss. And I know that's kind of shocking to some people because they think like, oh, I'll just go on hormone therapy like estrogen and progesterone and I'll lose weight. And it doesn't work that way. But what it does do is two things. Number one, it helps you feel better so you can have quality of life and do the things that you need to be doing. Number two, we have some small observational studies now showing that GLP1 medications in tandem with hormone therapy, women lose more body weight when they combine them rather than just GLP1s alone. So that is something for us to consider. And I would say that hormone therapy is so that you can have quality of life, so you don't have as many hot flashes, your improvement in sleep. There is some evidence that it helps to lower visceral fat. So that is important. And then GLP1 medication, whether to use it or not, and then how it's prescribed, that's a separate issue. And I think that they're very important medications in our toolkit. They're not the only medication. You know, we do forget the fact that many of us were practicing medical weight management before GLP1s came to the scene. Right. So, you know, we do have other options, and that can be sorted through working with an obesity specialist. But I would say that they're a pretty great tool when used in the right way.

Laurie Poole 18:05

Okay. Well, I, you know, it seems to me it's made that the GLP1 medications have made a huge change for many people in a very positive way. Um, I'm wondering about, you know, your practice and how you approach these options with patients, because I get the sense that it's very, it's much more individualized based on what the patient needs, what the goals are, what the presenting symptoms are versus okay, you want to lose weight, you want to feel better. Here's here's the script, here's what we're gonna do, that it's really very tailored to the needs of the patient.

Dr. Richa Mittal 18:47

Absolutely, just like any other medical concern, but you know, I think when it comes to weight management, there's this sometimes mentality of number one, just diet and exercise. Uh, when do medications come into play? Well, medications come into play if, first of all, someone has been in the cycle of losing and regaining, we need to think about why that's happening. You know, there's certain mechanisms in place in our body that work against people in maintenance so that they're

When Medications Or Surgery Make Sense

Dr. Richa Mittal 19:15

not able to maintain the weight loss. It body sees that as a threat, the the body weight loss. Number two, did they take drastic measures that weren't sustainable, right? Or maybe they have hunger and a derangement in the appetite and um uh satiety-related hormones that are going to be addressed through medication. Do they have medical issues that are gonna improve with body fat loss? And there are quite a few conditions like sleep apnea, fatty liver, blood pressure, uh, type 2 diabetes, prediabetes, then we know, hey, we're starting to stack up here and the benefits outweigh some of the risks for this person. When we're choosing medication, we're looking at medical issues, but we're also looking at the amount of weight loss desired. And that's where even surgery can come into the picture. If someone has more than, you know, 100 pounds, or maybe they're they maybe for them they need to be in the category of 40 to 50 percent weight loss. Um, that's going to be more achievable through bariatric surgery, but medications have a certain amount that we on average see in terms of the studies. Of course, people are different. We want to think about existing medications they're on. Are there contraindications to the different medicines? So it's a much more complicated picture than just, you know, sending a prescription. But the bottom line is, you know, a tailored approach allows for making sure you're not going to have side effects or contraindications to current medications. And number two, you have the full spectrum of options and one can try one and move to another. You know, it's it's not set in stone.

Laurie Poole 21:08

Right. And I think the other piece of it, too, which we haven't talked about it yet, is nutrition. Oh, yes. And the and and the impact of proper nutrition, tracking what you're eating from a point of view of how much fiber and so on. Can you speak to that a bit? Because I'm really curious about that as it relates also to mental health.

Dr. Richa Mittal 21:30

Absolutely. Uh, you know, we are what we eat, right? Is like kind of that simplistic term. Uh, but even for

Nutrition, Protein, Fiber, And Mood

Dr. Richa Mittal 21:37

people using GLP1s, one of my major concerns is malnutrition. So, you know, the point isn't to starve people, right? So we want to make sure that whether you're using medication or not, you're building a foundation of again fueling your body with what it needs. And mood-related issues, of course, you can speak to that more. There's a lot of science around uh mood and nutrition too. And we want to, number one, give our bodies adequate nutrition, meaning we need to be getting protein to maintain muscles and enzymes in our body. We want to include healthy fats that we need. Of course, fiber is a big focus that we talk about, a foundation of fruits and vegetables that nourish our body. Maintain adequate amounts of antioxidants that work in our body to help you know lower inflammation, but even in the gut. So the connection between brain and body appears to exist in the gut. We have all these trillions of bacteria that live in our gut. And that gut microbiome, if you will, is responsible for the production of neurotransmitters like serotonin, dopamine that are involved in our mental health and emotional well-being. And when we eat foods that give that bacteria, again, all the foods I just mentioned, the nutrition, reducing alcohol, you know, maintaining physical activity and sleep also has impacts on our gut microbiome. It helps to build that foundation. And when we're in a weight loss journey, we want to move our mindset away from restriction and more on how I can have a more balanced diet approach that makes sure I'm getting what I need, but not being in a calorie excess or maybe being in a deficit during the time when we're looking for body fat loss and then eventually in maintenance, being able to eat enough to fuel our bodies.

Laurie Poole 23:51

That makes me, it just what strikes me about what you've just said is what a profoundly different approach that is to weight loss and to well-being, that it's the overall well-being, radiant and optimum health, right? Is it's not just about losing the weight, it's having balance. Are you sleeping? Are you exercising enough? I had a conversation last week with a psychiatrist, and I asked him, what's the one thing you would recommend in terms of uh fighting against depression and anxiety? And he said, absolutely 150 minutes a week of physical exercise, whatever that means for you. It's inexpensive and it's something everybody can do. So you you put really good new balanced nutrition in tandem with that to feed the microbiome that you're talking about. And then the whole mind-body connection gets snapped to it, it gets recalibrated.

Dr. Richa Mittal 24:51

Yep. And I would say, I love that they brought up movement. I would say sleep to me. Um, personally,

Sleep First, Then Movement

Dr. Richa Mittal 24:59

I've struggled with it with hormone changes. Yeah. For midlife women, that is so hard. And when the sleep falls out of uh the routines or it's really hard to achieve, well, of course it affects what we eat, whether we have the bandwidth to exercise, to prepare meals, uh, what we may reach for instead. So I would say if you had to pick one thing, it was just one thing, maybe I would start with sleep and then let the other dominoes fall into place.

Laurie Poole 25:29

Okay. So let's start with sleep. I think that's a very good, I think that's a very good place to start. Maybe where most people will say, ah, I'm always tired. I never feel like I get enough sleep. What's one thing you wish women knew before they started blaming themselves about how icky they feel?

Dr. Richa Mittal 25:51

I think that it's not as simple as eat less and move more. And that's a narrative that we've all been told. And of course, eating less and moving more or not eating in excess is important, but that's such a simplistic view. And it doesn't take into account genetics and mental well-being and all those foundational, you know, health parameters that we're talking about today. And, you know, our bodies are in an environment, if you will, that's what's called obesogenic, meaning we're sitting too much, we're not sleeping, we're not moving, maybe we're surrounded by, you know, high-calorie food that makes us feel good in the moment, but it's not nourishing. And, you know, it's not as simple as just telling someone, hey, just don't eat as much. Like

Beyond “Eat Less, Move More”

Dr. Richa Mittal 26:42

there's so much more to it.

Laurie Poole 26:44

You know, there's so much judgment about obesity. It seems to me that um there is an overall, there's a kind of disdain. And when you say, you know, eat less, exercise more, that's that's something that's brought up for me is I think, man, you know, we we point to someone who's carrying a lot of weight and we make, oh, they must be lazy, they eat too much. There's these just disparaging social comments that are made about obesity. And I think it's through practitioners such as yourself and more education and awareness that hopefully we can get away from that because it's it's just not that easy. As you've said, there's many factors that contribute to uh improving our lifestyle and our overall well-being, especially as we're living longer. You know, my goal is to live well into my 90s and have most of those years the best ones.

Dr. Richa Mittal 27:44

Yes, absolutely. Um so I I uh I really appreciate not only your practice, but your approach and your messages to people because, and especially women, because I think we can be very, very hard on ourselves and the harshest critic is often in our head. And if we can find ways to change that and to link emotional, mental health, physical health, spiritual health, all of that converges when we think of living the best versions of ourselves. I love how you put that. Dr. Mittal, if if our listeners would like to contact you or learn more about your practice, where can they find you? So on all social media platforms, uh, Instagram, Facebook, YouTube, TikTok, it's @richamittalmd. Uh, my practice website is myradianthealth.com, and I can see people all throughout Texas. And regarding the blog that you mentioned in the beginning, Life

How To Reach Dr. Mithel

Dr. Richa Mittal 28:45

Fully Nourished, it's at richamittalmd.com.

Laurie Poole 28:49

Beautiful. I love that. Well, thank you so much for your time today. This is going to resonate with uh a large number of our listeners, and I love your messages, and I have benefited from being a patient in your practice and can speak uh fully to the benefits that I've enjoyed. So thank you so much for your time today, and um, I look forward to talking with you again.

Dr. Richa Mittal 29:16

Thank you so much for having me. Take care.