Weight management in the perimenopausal – menopausal women Dr Angela Kwong

Episode Title: Weight Management in Perimenopausal and Menopausal Women with Dr. Angela KwongEpisode Summary: Recorded live in Sydney at the Women's Health in Primary Care Conference organised by MyHealth Academy, this episode of the General Practice Clinical Sessions podcast features Dr. Angela Kwong, a GP and the RACGP NSW state lead for obesity management. Dr. Kwong explores the physiological drivers behind menopausal weight gain and advocates for a holistic, multidisciplinary approach to metabolic health that goes beyond simply prescribing weight-loss medications.Key Topics Covered:The Menopause and Metabolism Link: Estrogen levels drop like a "roller coaster" during menopause. Because estrogen receptors are located throughout the body—including the brain, pancreas, liver, and macrophages—these hormonal fluctuations can disrupt energy balance, trigger inflammation, and lead to insulin resistance. This often results in a change in body shape, characterized by the accumulation of visceral fat around the midsection (often described by patients as a "kangaroo pouch"), and can negatively alter lipid profiles.Treating the Foundation (Insulin Resistance): Dr. Kwong advises GPs to proactively order fasting insulin tests for perimenopausal women showing signs of metabolic changes, noting that a level of 10 or above indicates established insulin resistance. She emphasizes that treating this underlying insulin resistance (such as with Metformin) is the foundational step before introducing GLP-1 receptor agonists, which she considers the "cherry on the top".GLP-1 Prescribing & "Bi-weekly Dosing": To help patients manage gastrointestinal side effects like nausea and fatigue, Dr. Kwong utilizes a "bi-weekly dosing" strategy. By splitting a weekly GLP-1 dose in half (e.g., taking 2.5mg on Monday and 2.5mg on Thursday instead of 5mg at once), patients experience fewer medication peaks and a much smoother journey. She stresses the importance of finding the minimum effective dose for the individual's quality of life, rather than racing to the maximum prescribed dose.Sustainable Nutrition and Exercise: Weight management requires more than just eating less and moving more. Dr. Kwong highlights the importance of optimizing protein intake to prevent muscle loss (sarcopenia) during weight loss, alongside increasing fiber and addressing common deficiencies like Vitamin D. Furthermore, she encourages shifting away from a "punishing" exercise mindset to joint-friendly activities that support bone and muscle health without aggravating existing injuries.Real-World Case Study Discussed:A 56-year-old menopausal woman with a starting weight of 116 kg (BMI 48), severe insulin resistance (fasting insulin 19.8), Vitamin D deficiency, and hip pain worsened by her heavy gym routine.Management: She was treated with a foundational dose of Metformin, followed by a customized low-dose, bi-weekly GLP-1 regimen (3.75 mg Tirzepatide) to manage her nausea and fatigue. Her exercise was shifted to Pilates and home weights, and minor dietary tweaks were introduced to boost her protein intake.Outcomes: Over approximately five months, she safely achieved an 18.5% weight loss (dropping to 96.1 kg). More importantly for her quality of life, she lost 15 cm off her waist circumference (dropping three dress sizes), which profoundly improved her daily comfort and confidence.Continuing Professional Development (CPD): Australian general practitioners can obtain CPD points for listening to this episode through My Health Academy. Myhealth Academy Link: https://lms-academy.myhealth.net.au/login/index.php?tenant=MHAC01 To listen to more live conferences without interrupting your schedule, visit armchairmed.tv/podcasts.------------------------------------------------------------------------If you are a General Practitioner who gets invited to dozens of webinars a month. The General Practice Clinical Sessions Podcast is designed for you.Instead of giving up an evening with your family for a live webinar or your weekend for a conference, you can listen to it here whenever it's convenient, in half the time and while you are commuting, exercising or even walking the dog.It's the same education, without interrupting your life.GPs can also earn CPD hours.Earn Educational Activity (EA) CPD without sacrificing time with your family.Listen to your Clinical Sessions Podcasts on your commute or while you exercise. Then each wee