5 Tips for Women Trying to Lose Weight for Pelvic Health (and during a Pandemic!)
Today I had the opportunity to talk about weight loss with a patient that has bladder leak. What does weight loss have to do with pelvic health? First — a personal story.
While I was pregnant earlier in the pandemic, I was mostly healthy but had the occasional pregnancy indulgences: a 3x2 at In and Out (yes, it’s exactly as it sounds, a burger with 3 patties/slices of cheese between 2 buns); 1/2 of a homemade, 3-tier yellow cake (I’d never made a tiered cake before); and chugging my “pregnancy cocktails” almost non-stop (a delightful mix of 1/2 carbonated water and 1/2 juice. On ice, of course). Now that baby is out, postpartum+breastfeeding+pandemic quarantine+holidays = lots of sweets for breakfast. I will admit, I ate an entire cherry pie over the course of a week for breakfast at one point during my maternity leave (that’s one cherry pie in one week, not a cherry pie per day, just to be clear). So I am not immune to the pitfalls of maintaining a healthy diet this past year, even as a physician who has a certification in fitness training. I know better.
One thing I did keep consistent in my pregnancy and (mostly) postpartum is I have kept moving. I fortunately had a healthy pregnancy and exercised until I went into labor. Starting around 4–6 weeks postpartum I started walking more, about 2–3 miles outside a few times a week while wearing my baby. I added some weight training, functional fitness, and postpartum pilates as the weeks went on. I fortunately have a supportive partner who would workout with me frequently, and I even continued to train friends and clients until my last month of pregnancy.
So back to my original question — what does weight loss have to do with pelvic health? We know that exercise has benefits for mental health. This benefit translates to women with bladder leak as well. In one study, an 8% weight loss among overweight and obese women cut down their bladder leaks by one-half. So, if you’re overweight around 200lbs, for example, losing 10–20 pounds could mean half as many leaking episodes. This is about the same benefit as many medications and procedures on the market for bladder leaks (in addition to all the other benefits of diet and exercise!).
5 Tips for Women Trying to Achieve Weight Loss in a Pandemic
- Keep track of what you’re eating (as well as your activity)
In this pandemic, the refrigerator has never been closer as many people are spending more time at home. Dieting can get complicated, but I think a good place to start is to have a true understanding of your current habits, such as with a food diary. Many of my patients express frustration that they think they’re eating well but have a hard time losing weight. Apps like My Fitness Pal and Lose It! are convenient food diaries for your phone. Before starting a diet, spend one week eating like normal, then record every single food or beverage that you put in your mouth. When you review the diary later, you can try tailoring a diet that works for you.
Where I notice a lot of women falling off when it comes to diet is with portion sizes, snacks and beverages, and nutrient density. If you take the time to look at recommended portion sizes, you’ll realize that the bag of chips you “only have once in a while” is actually 2 or maybe 3 portions, even though the one bag looks snack-sized. Many cereals are recommended as 1 cup of cereal with 1/2 cup skim milk. If you measure it out that looks more like the kid-sized portions from elementary school, not the full bowl you’ve been pouring every morning. Snacks and beverages are tricky because we often have them on the go or don’t pay attention while consuming them. Any beverage that is not water, black coffee or sugar-free tea probably has unnecessary sugars. But what about veggie juices? Or other beverages targeted at dieting? There are some good ones out there, but they are expensive, in my opinion, and it’s often better for your diet and wallet to just eat the actual vegetables. Nutrient density can get complex but to keep it simple — 250 calories from a donut are not equal to 250 calories from a serving of lean meat, or a cup of brown rice. The calories are only a measure of the energy in the food. But if that energy comes from protein or whole grains, your body processes (or metabolizes) the nutrients in that food differently, making you feel more full (or less), spiking your blood sugar differently, and ultimately, being stored differently (or possibly, helping you eliminate waste and unwanted fat).
The nice thing with Lose It! and My Fitness Pal is that the free versions help track calories, which is a good place to start for many people. The paid versions help you track macros (protein, fat, and carbs), which can get as complicated as you want to make it, but this helps tie into you having a better understanding of nutrient density. They also help track calorie expenditure, or the energy (loosely translated, fat) that you burn during common exercises. You may notice that the 30 mins of walking you’re doing may not burn as many calories as 15 minutes of a high intensity workout with weights, which brings me to my next point…
2. Get moving!
To maintain healthy weight, the recommendation is for 30mins of moderate exercise 5 times a week (150mins total), or 25mins of high intensity exercise 3 days a week (75 mins total). Pandemic mode and chilly winter temps have kept a lot of us indoors, so many of us have had to get creative with this one. Brisk walking, in my opinion, is the ideal exercise if you’re able to maintain a pace where you’re breathing hard for 20–30 mins a day. This may get you to a certain level of weight loss, but for many women, our bodies adapt and we eventually need to add more.
The benefits of HIIT, CrossFit, Orange Theory, or other similar workouts are challenging intensity and the variety in movements. Not everyone has access to such programs, but there are tons of workouts available on YouTube these days, and many local gyms have been creative with Zoom or other online workout classes.
3. Keep it simple…
I think many countries find American fitness culture entertaining. I say this based on my experience of my mom’s half of the family being from the Philippines, as well as having travelled over the years for international study and surgical missions. For the emphasis we put on creative workout schemes, we are the most obese country in the world.
What many other societies do right is that they avoid sedentary lifestyle. People live in more walkable cities or utilize more public transportation. Additionally, grocery stores or markets have finite amounts of food, with whole-food products that expire like normal (I’ve always been intrigued how packaged cookies can last for weeks when baked goods should go stale in a few days…). Food portions are packaged for normal adult consumption, and super-sized is not the norm.
At the end of the day, achieving a normal body weight comes down to calories in and calories out. That sounds simple, but the details are tricky. The reason I like patients to start with a food diary prior to starting a diet is because, unfortunately, most studies show that people have a hard time maintaining diets beyond 1–2 years. If you’re able to implement changes to food you normally eat, that may be more sustainable than swapping out your entire diet for unfamiliar foods. Food is such an important part of our culture, and no one diet fits all cultures. However, if someone can make healthier choices, like more whole grains, leaner meats, fresher fruits and vegetables, and better portion sizes, these kinds of changes can last a lifetime.
4. …But keep your exercise varied with different levels of intensity
Having a consistent time of day for workouts may help you get into a rhythm. But doing the same workout everyday may get you in a rut eventually. With activities like walking or running, it can get easy to start going through the motions without getting that same “burn” that you had when you started working out. This translates into the common story I hear: a woman may be following the recommended length of time to exercise, but starts to feel that she plateaus in her weight loss journey.
Trying a change in intensity could make a big difference. If you walked 30mins a day for a month, that’s awesome! Now consider making it a 15 min walk with a 15 min run, add strength training, or bodyweight movements like push-ups, squats or lunges. Consider intense workouts a few days a week, and then 1–2 active rest days like yoga/pilates or hiking. The variety will target different muscle groups, help keep you mentally engaged, and help keep you on track toward weight loss.
5. Be consistent…but be forgiving toward yourself
This past year has had unprecedented challenges. Many of us are trying to juggle work with childcare difficulties. Some of us experienced the loss of family, friends, a job, or just a general loss of our former way of life. I know I’m not the only one who opted for the comfort of HGTV over a quick workout while my baby was taking a nap. Sometimes it just seems so mentally draining to think of working out. On days like that, I think it’s even more important to have movement built into your regular activities. For those of us with kids, being active is a great way to help them transition to the next nap or bedtime.
Same with food — many of us are cooking more than ever. But sometimes I just can’t deal, and food delivery is what I need to get through the evening. I try to follow the 80/20 rule and make my healthy options what I do 80% of the time. Try to make the healthy option the easy or default option. Everything else is just us trying to get through the day — and that’s ok! But for those with chronic conditions, including bladder leak, hopefully these tips will help you take control of your bladder symptoms by improving your overall health.
