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Weight Gain in Middle Age: The Problems

Ava Port, MD and Neda Frayha, MD
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When a listener wrote in wondering how she can best advise her female patients in their 40s who gain weight for seemingly no reason, the PC RAP team jumped all over this request. Endocrinologist and weight loss specialist Dr. Ava Port reviews why weight creep happens in aging women, as well as successful strategies for all our patients to achieve healthy weight loss.

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Stephen P. -

I had a pt return from gynecology having "discovered" her reason for weight gain-PCOS. I understand PCOS to be a result of weight gain with weight loss the most important treatment. Is PCOS in your differential as a cause of weight gain and if so and suspected do you check hormone levels? (Thanks for covering such a common question in practice!)

Neda F., MD -

Hi Stephen. Thanks for your comment! I asked Dr. Port for her thoughts, and here's her response:
"PCOS *is* often on my differential when considering differential causes of weight gain. It is a state of both androgen excess and insulin resistance, so I look for physical exam features such as acanthosis or hirsutism, and historical features, such as irregular menses or infertility to clue me in that direction. To screen for insulin resistance, we often use A1c, but very often in PCOS we see selective insulin resistance (ie the ovaries) but other tissues (ex: adipose, skin) are still perfectly responsive to insulin and hence the weight / fat gain and acanthosis that often accompanies the syndrome. I like to check fasting insulin and glucose levels in addition to A1c, as this is a better barometer of background hyperinsulinemia. I also check testosterone, FSH/LH, and DHEA to screen for hyperandrogenism and look at the gonadotropin ratio (LH:FSH > 3 is highly suspicious for PCOS). Patients where I am considering PCOS also typically warrant being screened for Cushing’s syndrome (with a 1 mg DST, 24 hr urine cortisol or midnight salivary cortisol x 2-3) and possibly congenital adrenal hyperplasia (17-OHP) which can often have overlapping features and virilization similar to PCOS." Hope this is helpful!

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Good Samaritans Full episode audio for MD edition 206:06 min - 97 MB - M4AHippo PC RAP August 2018 Written Summary 511 KB - PDF

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