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An interview with Pamela Peeke, MD

First, you notice shopping for clothes isn't as fun or simple as it used to be. Next comes the "muffin top" spilling over the jeans. Then the scale delivers dire news: You're 10, 15, maybe 20 pounds beyond your "normal" weight.

Midlife weight gain is common. Many Americans gain a pound or so every year as they make their way through young adulthood, ending up fat and flabby at age 40 and beyond.

But it is not inevitable, says Pamela Peeke, MD, MPH, the author of the best-seller Fight FatAfter Forty. Peeke also serves as the chief medical correspondent for Discovery Health TV and often appears as a medical commentator on television news and talk shows.

Why do so many people gain weight in midlife?

Blame it on hormones in convergence with poor lifestyle choices, overeating, not exercising enough, and stress.

But hormones only account for about 2 to 5 pounds. The rest is the result of overeating, poor lifestyle choices -- such as not exercising enough -- and stress.

How can I not be one of those people who gains?

The keys are three: mind, mouth, muscle.

Use your mind to control stress. If you walk around and everything is stressful, you have a problem. You may respond to stress by making poorer lifestyle choices, such as not eating healthfully and not exercising enough.

Look at your nutrition -- in terms of quality, quantity, and frequency of eating. You should eat often.

Quality is all about eating whole foods, fruits, and vegetables, whole grains, lean protein.

Processed foods are bad. Anything that comes in a family-size bag, turn in the opposite direction and run.

Quantity is where a lot of people fall. The majority are baffled by what a serving size should look like. When eating out, and in doubt, eat half of it or less.

Be accountable for calories. You need a general idea of how many calories you need. An average woman, not an athlete, in her 40s or 50s, needs about 1,500 to 1,600 calories a day, on average, if she is exercising. A middle-aged man, average height and not an athlete but exercising, needs about 1,800 to 2,000.

Muscle, of course, refers to the need to exercise and, of course, to weight train.

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