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Metabolic health educator Marsha Shepherd Whitt discusses the article “Why ‘eat less, move more’ fails for midlife weight loss.” Marsha explains that weight loss struggles in midlife are often driven by physiology rather than a lack of discipline. As women move through perimenopause and menopause, biological changes alter how the body partitions fuel, regulates blood sugar, and responds to insulin. Marsha highlights how frequent glucose exposure and rising cortisol levels can push the body into a defensive conservation mode that protects fat stores at the expense of muscle and bone. Instead of forcing a deficit, she advocates for restoring metabolic stability by lowering chronic glucose exposure and preserving muscle mass. Discover how aligning with your biology can end the cycle of self-blame and finally unlock sustainable fat loss.

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Transcript

Kevin Pho: Hi. Welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Marsha Shepherd Whitt. She is a metabolic health educator. Today’s KevinMD article is “Why ‘eat less, move more’ fails for midlife weight loss.” Marsha, welcome to the show.

Marsha Shepherd Whitt: Thank you for inviting me, Dr. Pho.

Kevin Pho: All right, so you are a metabolic health educator. What led you to write this article in the first place?

Marsha Shepherd Whitt: Well, while researching for my book on menopause, I came across an interesting statistic. A full 75 percent of women who ask their doctors for help with menopause symptoms, which almost always includes fat gain, don’t get the help they need. Some are automatically prescribed hormone replacement, which has its place, but more often than not, they are told that it is just a normal part of aging or that they need to eat less and exercise more. Perimenopause and menopause alone create internal stress in the body. Typically, by the time a woman reaches that stage of life, she is already experiencing the cumulative effects of decades of stress. So when they are told to eat less and exercise more, that doesn’t change the physiology. So I followed the physiology instead of the narrative.

Kevin Pho: For those who aren’t familiar with physiology, or if it has been a while since they have learned it, just give us a snapshot view about the changes women go through in perimenopause and menopause that potentially may lead to weight gain.

Marsha Shepherd Whitt: Sure. What I have been noticing and what many clinicians see too is that a lot of women in midlife are doing exactly what they are told. They are eating less, exercising more, and trying to be disciplined. Instead of losing body fat, they feel worse. They are more tired, more hungry, and they lose strength. Sometimes their bone density declines and their fat mass either doesn’t change or actually increases. The usual explanation is willpower, aging, or fake hormones, but that doesn’t really explain the pattern.

What is actually happening is that the physiology of midlife is different. As estrogen and other growth and recovery signals decline, the body shifts into a more conservation-oriented state. It becomes more focused on preserving energy, maintaining blood glucose stability, and buffering stress. So fat tissue becomes a kind of safety buffer. Muscle and bone become harder to maintain, and recovery is slower.

When we introduce calorie restriction into that environment, the body doesn’t interpret it as a signal to burn fat. It interprets it as resources are uncertain, and the appropriate biological response to uncertainty is conservation, not release. So it conserves fat and becomes willing to sacrifice muscle and bone instead because those are metabolically expensive tissues to maintain. Exercise adds another layer. Exercise increases demand, which is good, but if recovery capacity is low and fuel regulation is unstable, the system experiences that demand as stress. So appetite increases, cortisol increases, and again, the system becomes more protective of fat mass as a buffer.

None of this means the system is broken. It is actually doing exactly what it has been designed to do under those conditions, which is to protect survival. So the clinical shift really isn’t about telling people to try harder. It is about changing the target. Instead of suppressing intake, we focus on restoring regulation through adequate protein, stable glucose, muscle and bone maintenance, sleep, and stress recovery. When the system feels safe again energetically and hormonally, fat loss often becomes possible, not because we forced it, but because the body no longer needs to defend it.

Kevin Pho: So it sounds like the traditional medical advice to eat less and move more, especially in perimenopause and menopause, may be doing more harm than good for these women.

Marsha Shepherd Whitt: That is exactly right. As women, we are programmed from the time we are teenagers that if you want to lose fat, you have got to reduce your calorie intake. So many of us went on crash diets eating 500 to 1,000 calories a day. That actually creates damage inside the mitochondria. That damage is cumulative over the years and it makes it more difficult for the body to release fat later.

Kevin Pho: You mentioned that you are writing a book on menopause and doing some research. For women in this age group, what are some things that they should be doing?

Marsha Shepherd Whitt: I would like to focus on four things: hunger, stress, light exposure, and sleep. We must eat the right kind of food that is actually nourishing our bodies, not junk food or a bunch of sugar. When we eat junk food or a bunch of sugar, it makes it very difficult for the body to do what it is designed to do and creates a release of cortisol because the body is in survival mode. Cortisol makes the body hold onto fat stores.

We also have to regulate our stress. The proper kind of food helps to regulate internal stress, but we also have to have a handle on external stress or namely our response to it. If we get light exposure outside during the day, especially in the mornings, that helps to regulate our circadian rhythm. This makes it possible for us to have adequate sleep. So if we can get those down, hunger, stress, light, and sleep, we are doing well.

Kevin Pho: When you talk about eating the right food, go into more detail in terms of what that diet would look like.

Marsha Shepherd Whitt: Sure. It needs to be nourishing protein and fat, preferably from animal sources for higher nutrient density and higher bioavailability. Once we do that, it calms the internal stress signals. The body is no longer questioning whether it is going to get another meal anytime soon. When we have protein and fat coming in on a regular basis, the body can relax.

Kevin Pho: In terms of lowering glucose exposure, you wrote in your article that this allows insulin levels to fall naturally. This can help with the potential weight gain during the perimenopausal phase.

Marsha Shepherd Whitt: Absolutely. Cortisol is the main driver of fat gain and the body holding onto fat.

Kevin Pho: Now, what other pieces of advice can you share or can primary care physicians like myself share for perimenopausal and menopausal women in the exam room?

Marsha Shepherd Whitt: Consider how much of what we call pathology is actually the body adapting to certain conditions. Consider how often the problem is not the body, but how the internal environment actually works and the expectations we are placing on it. When we realize that women are not noncompliant but are physiologically mismatched to the advice they are receiving, that reframing can be incredibly relieving for both sides. Women need help addressing four important issues: food, stress, light exposure, and sleep. Once those are done correctly, fat release becomes possible.

Kevin Pho: From your research for your book, why is this message not getting out? Why has it taken so long for this metabolic reframing to get through to mainstream medicine and mainstream health advisors?

Marsha Shepherd Whitt: Because medical professionals are not taught human nutrition beyond what it takes to help someone survive an acute accident or condition. They are not taught what actually nourishes the human body. I would hope that clinicians begin to delve further into human nutrition and learn what actually nourishes the body, not just the kind of food that parades as food, but real food that deeply nourishes the human body.

They are not taught that because the medical institution basically is funded by Big Pharma and Big Food. They have got to make a living. So doctors are taught to treat symptoms, not find and treat the root cause. They are taught to simply prescribe pills, and they have done their job as far as they have been taught. Now I know there are a lot of medical professionals out there who have a deep desire to really help their clients, and that starts with knowledge. Human nutrition is game one.

Kevin Pho: In addition to nutrition, light therapy, and sleep, I believe one of the other elements is exercise since muscle mass decreases as one ages. Talk more about the role of exercise and strength training as women go through the menopausal phase.

Marsha Shepherd Whitt: Sure. Exercise comes next after food. Food is your foundation, and exercise helps that along. Because estrogen and progesterone are declining, the body needs to feel safe. One of those ways to relieve external stress is through exercise. My husband and I do an intense strength training session twice a week. We go to Planet Fitness. It is inexpensive, and they have all the weight machines that we need. We take ourselves very quickly through an entire body workout in about 23 minutes, and that puts a lot of good stress on the body. When the muscles and bones are stressed, it tells them they have got a job to do, so they need to build.

Kevin Pho: How much exercise typically would you recommend?

Marsha Shepherd Whitt: I would recommend what Kevin and I do, which is high-intensity strength training twice a week, not high-intensity aerobics. Strength training is very important, especially as we get older.

Kevin Pho: Why that emphasis on strength training?

Marsha Shepherd Whitt: Because it puts a good stress on the body, on the muscles, and on the bones, and it tells them they have got to build. Aerobics doesn’t do that.

Kevin Pho: As you know, in the primary care setting, sometimes I only have 10 to 15 minutes with my patients, and we have to go through a myriad of checklists of things that we need to do in that 10 to 15 minutes. What are some of the strongest, high-impact pieces of advice that you could share with menopausal patients where I can distill some of the messages that we are talking about into short segments?

Marsha Shepherd Whitt: When they go into the gym to exercise, tell them to start with the largest muscle group, which is the legs. Then go to the back. So do an exercise like a leg press or a couple of leg machines, then do back pulldowns, then work the shoulders and chest, and then the arms. Moving from large to smaller groups allows them to use their time wisely and ensures the body uses its strength wisely during the workout. Those other factors such as food, stress, light exposure, and sleep help to build muscle mass and bone density.

Kevin Pho: For menopausal or perimenopausal women in the exam room, are there any specific questions they should be asking their clinicians?

Marsha Shepherd Whitt: I would suggest that women who are offered prescription drugs upfront ask if this is the first thing they should do. Almost always the answer is going to be no. Nutrition is number one. That is the foundation that you lay for everything going on in your body.

Kevin Pho: In terms of the medications typically offered, like hormone replacement therapy, what is your perspective on that?

Marsha Shepherd Whitt: My perspective on hormone replacement is that a local hormone replacement is preferable to systemic. When a person takes systemic hormones, I understand that 80 percent of that is cleared out by the liver. It takes a lot of hormone to actually get to where it needs to go in the body. Locally applied therapies, such as vaginal estrogen for instance, can do their job right there at the site, and it makes a big difference. I tend to stay away from anything systemic that can cause adverse reactions in other areas of the body.

Kevin Pho: You mentioned that you are researching for a book on perimenopause and menopause. Is there anything that is underreported or anything that surprised you during your research?

Marsha Shepherd Whitt: The fact that 75 percent of women walk out of their doctor’s office after having sought help for menopause symptoms is a big surprise to me. I mean, 75 percent leave empty-handed, not even with a prescription. It is a very big gray area for clinicians. The field is wide open for them to learn what really makes a difference for these women.

Kevin Pho: So you are saying that 75 percent of these women are not leaving with any advice to help with their symptoms?

Marsha Shepherd Whitt: That is right. Now these days a lot of them will be given a prescription for Ozempic, a GLP-1 agonist. The body makes its own GLP-1. We just have to give it the right tools to do so.

Kevin Pho: We are talking to Marsha Shepherd Whitt, metabolic health educator. Today’s KevinMD article is “Why ‘eat less, move more’ fails for midlife weight loss.” Marsha, let’s end with take-home messages that you want to leave with the KevinMD audience.

Marsha Shepherd Whitt: Focus less on suppressing intake and more on restoring regulation. Stabilize glucose through an adequate intake of protein and fat, preferably animal-based. Reduce carbohydrate consumption to place the body in the best possible position for muscle and bone maintenance and sleep. This reduces stress and enhances recovery. When the system feels safe, fat loss often follows.

Kevin Pho: Marsha, thank you so much for sharing your perspective and insight. Thanks again for coming on the show.

Marsha Shepherd Whitt: Thank you for having me. Have a good day.