The MiDOViA Menopause Podcast
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The MiDOViA Menopause Podcast
Episode 038: GLP-1s: Myths, Truths, and Menopause
Weight gain during menopause frustrates countless women—but what if there was a science-backed solution that addressed the underlying hormonal shifts? Michelle Cardel, Chief Nutrition Officer at Weight Watchers, takes us on an eye-opening journey through the world of GLP-1 medications, debunking myths and revealing surprising truths along the way.
Originally developed for diabetes management, these medications have revolutionized weight management by targeting the biological drivers of hunger. "They mimic a natural hormone that helps regulate blood sugar, reduces appetite, and slows gastric emptying," explains Cardel. The result? A remarkable reduction in what researchers call "food noise"—that persistent, all-consuming focus on eating that many women experience during menopause.
Perhaps most surprising is the medication's impact beyond the scale. Weight Watchers research shows an astonishing 50% improvement in overall quality of life for GLP-1 users, affecting everything from self-esteem to sexual function. "Women report feeling more in control around food, with less urgency to snack or overeat," notes Cardell, making these medications particularly valuable during hormonal transitions.
Contrary to circulating fears, Cardel addresses bone health concerns head-on: "Research has shown GLP-1 medications might actually be beneficial for bone formation." However, she emphasizes the importance of resistance training, adequate protein, and a comprehensive approach. Her simple-to-remember 30-30-30 rule provides practical guidance: aim for 30 grams of protein per meal, 30 grams of fiber daily, and 30 minutes of physical activity.
The conversation shifts from viewing GLP-1s as a "shortcut" to recognizing them as legitimate treatment for a chronic condition. As Cardel powerfully states, "Just as we support treatment for other conditions like asthma or hypertension, using GLP-1s to support weight and metabolic health is a science-backed choice." For women navigating menopause, this perspective offers not just hope but permission to prioritize their health without shame or stigma.
Ready to transform your understanding of weight management during menopause? Listen now and discover if GLP-1 medications might be part of your midlife wellness journey.
Website: https://www.weightwatchers.com
Dr. Cardel is a nutrition scientist, registered dietitian, and Chief Nutrition Officer at WeightWatchers. She also serves as a faculty member at the University of Florida, where she co-directs the Center for Integrative Cardiovascular and Metabolic Diseases. At WeightWatchers, Dr. Cardel leads clinical trials, the program innovation team, and nutrition and food database. Her team shapes the organization’s nutrition strategy using the latest science, develops evidence-based programs, and the most cutting-edge science is integrated into member programs and content.
A Fellow of The Obesity Society, Dr. Cardel has authored over 125 publications in high-impact journals like JAMA, JAMA Pediatrics, AJCN, and Obesity. Her numerous accolades include the University of Alabama (UAB) Outstanding Woman Award, the Academy of Nutrition and Dietetics Excellence in Emerging Outcomes Research Award, UAB’s Young Alumni Rising Star Award, and The Obesity Society’s Practitioner of the Year Award for Excellence in Clinical Care and Management of Obesity.
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Welcome to the MiDOViA Menopause Podcast, your trusted source for information about menopause and midlife. Join us each episode, as we have great conversations with great people. Tune in and enjoy the show.
Kim Hart:Hey, welcome everybody. Today we are talking about GLP-1s the information, the myths and the truth. We hear people curious about this medication for menopause and other things all the time, so we brought our friend Michelle Cardel in. Michelle is the Chief Nutrition Officer for Weight Watchers and a very good friend of MiDOViA. So Michelle welcome.
April Haberman:Thank you, it's so great to be here with you, kim, and April.
Kim Hart:eah, we're excited. Welcome, thank you. It's so great to be here with you, kim and April yeah, we're excited. Before we get started, do you want to tell our audience a little bit about yourself, what you've been doing and how you got to where you are now?
Michelle Cardel:Sure. So I'm trained as a nutrition scientist and as a registered dietitian. I've been in the field for weight management for nearly 20 years, doing weight management and nutrition related research, and have been at Weight Watchers for four years now.
Kim Hart:That's great. All right, let's dive in.
April Haberman:This is a really hot topic. I know that our audience is really excited for this content. So, yeah, let's jump in. Kim, to your point, let's go.
Kim Hart:What exactly are GLP-1 medications, and so how do they help with weight loss? Like what are they?
Michelle Cardel:Yes, so GLP-1 medications were originally developed to manage type 2 diabetes, and GLP-1 medications are a class of drugs that mimic a natural hormone, glp-1, which helps to regulate blood sugar levels. It reduces your appetite, and it also slows down your gastric emptying, or how quickly your stomach empties. So the combination of all of these things leads to longer lasting feelings of fullness, which, of course, reduces your food intake and, over time, results in weight loss.
April Haberman:Makes sense intake and, over time, results in weight loss Makes sense. That being said, though, how are GLP-1s different from other weight loss medications or fad diets? Can you tell us the difference?
Michelle Cardel:Absolutely so. Glp-1s stand out from fad diets because they are not like a quick fix. Rather, they're an evidence-based tool for treating the chronic condition of obesity, and these medications actually address those biological drivers of excessive weight gain. They're also much more effective than earlier editions of weight management medications, which you know, I think is part of the reason why they've created such a buzz. And unlike fad diets that often promote, you know, rapid, unsustainable weight loss through like extreme restrictions, glp-1s actually support gradual, clinically proven weight loss with a foundation that's based in science. So the medications actually address both the physical as well as the hormonal aspects of hunger. So it makes this like a really powerful tool for long-term weight management, while under medical supervision, which is a really important part of this.
April Haberman:Yeah, and just to note though, right there before we jump into our next question, GLP-1s have been around for a while.
Michelle Cardel:Yes, so people often think these are new medications. While yes, so people often think these are new medications, this class of medications has actually been FDA approved since 2005. And then, on top of that, there was all the research that was done on the medications before they garnered FDA approval. So we have over 25 years of research on the GLP-1 class of medications and their safety and efficacy profiles.
Kim Hart:It's interesting and it's more widely being used now and it feels like there's stigma attached to it, like people don't want to say I'm on it, why, why?
Michelle Cardel:Mm-hmm. Yeah, it's something that our patients have really shared with us, that they're experiencing. So they're stigmatized for living in a larger body and then now that there's evidence-based medical intervention to treat their chronic condition and they're taking the medications, then they're shamed for that too. So, people are like you need to lose weight, but no, no, no, no, no, not like that. I really think it's attached to the pervasive weight bias and stigma in society, where we inaccurately conflate thinness with wellness and, almost like, with morality. In a sense, that's so weird.
Kim Hart:I mean, good for you for figuring out that this is what you need to do and we're going to judge you. That just that feels. Okay, sorry, let's get back to what it is.
April Haberman:Speaking of stigma, though, I mean women in menopause. We're going through menopause. We're experiencing hormonal changes. There's a lot of stigma that's associated with that, especially in the workplace, with the work that we do here at Medovia, but many women in midlife are experiencing the hormonal shifts, and what we hear often one of the biggest complaints, is weight gain, right, so can you help us to understand how the GLP-1 medications interact with the hormones and those hormone shifts?
Michelle Cardel:During midlife, as you two know, you know better than almost anyone, many women experience these hormonal changes, particularly that drop in estrogen, and this can slow metabolism. It can, you know, change your body composition to increase fat storage and it can make weight loss more challenging. And so the GLP-1 medications work by mimicking, you know, this hormone that our body already creates and helping us regulate that blood sugar which can become problematic post-menopause. It can help with the appetite and the digestion pieces which, all you know, can be affected from those hormonal shifts. And while the GLP-1s don't replace estrogen or directly alter any menopause-related hormones, glp-1s can help counteract some of that metabolic slowdown by, you know, improving things like insulin sensitivity, by reducing cravings, by promoting that feeling of fullness, and this makes them especially helpful for women navigating that weight gain during peri or postmenopause, you know, because what they were doing before might not feel as effective as it once did.
Michelle Cardel:But you know we're really interested at Weight Watchers around the efficacy of our programs for, you know, women in midlife, and we actually did some research, using one of our randomized controlled trials, looking at the effectiveness of the Weight Watchers Points program for women of menopausal age, and we saw it actually was highly effective for producing clinically significant weight loss. So in our study of, you know, over 300 people, we saw that the Weight Watchers program actually led to an average of nearly 7% body weight loss in a six month period, or 14 pounds after being on the program for six months, and I think this does highlight that the utilization of evidence-based comprehensive lifestyle modification programs Lake Weight Watchers can be really helpful for women in midlife who are seeking weight loss.
Kim Hart:Yeah, that's. I'm glad you guys have done the studies on it, cause that's interesting to get like real feedback, not just right Anecdotal. But I'm curious about the idea of appetite cravings, emotional eating. I know that there's the idea of food noise, quote unquote. Food noise sort of goes away and can you explain what, how and why that happens? And and like is this? You take it, it's a shot, right, you take a shot and all of a sudden you don't feel like you need to eat as much as you did before. Like I don't understand what's going on there.
Michelle Cardel:Isn't that incredible.
Kim Hart:Yeah.
Michelle Cardel:You know these GLP-1 medications work by mimicking that natural hormone that actually helps regulate hunger signals in the brain.
Michelle Cardel:So it's that conversation between your gut and your brain leading to that reduced appetite, the fewer cravings, that greater sense of fullness after eating. And so, you know, for women going through perimenopause and menopause, those hormonal fluctuations can intensify that emotional eating. It can disrupt their normal hunger cues. So this is where GLP-1s can be particularly impactful. So by steadying those signals, glp-1s can make it easier to distinguish between what is true hunger and what's a stress or hormone-driven craving. And women you know many women report feeling more in control around food, with less urgency to snack or overeat, making these JLP1s such a powerful tool. And you know we did do a study in collaboration with Dr Leslie Heinberg at the Cleveland Clinic in adults on these medications and we saw significant decreases in emotional eating as well as significant improvements in stress and overall quality of life. And so you know, these medications, for those who which it's medically appropriate, can be a powerful tool to help some address some of those less desirable symptoms that arise from from these menopause hormone changes. Yeah, interesting.
April Haberman:It is fascinating to me, it really is that arise from these menopause hormone changes. Yeah, it is fascinating to me, it really is, and I'm not taking GLP-1, but I'm just wondering if because I'm not, I'm wondering you made that comment about the brain and the gut communicating with one another, and I know for myself, late at night I can sit on the couch and I'm like gosh, those chips sound good or something salty, and those thoughts go through your mind. What you're saying then, if I understand, is that I wouldn't have those same thoughts, correct, because I wouldn't have that same craving or that emotional craving that I normally would have.
Michelle Cardel:Yes, exactly, and so you know. Kim mentioned this idea of food noise and how we define. Food noise is kind of this persistent, ever present, all consuming focus on food. That actually disrupts your day-to-day life and your quality of life, and so our team collaborated with Pennington Biomedical Research Center after we were hearing from patients about these decreases in food noise. As scientists, we hadn't really heard this until these medications came out, and we're like this is so interesting. We need to find a way to actually measure this, and so, in collaboration with Dr HM Dictus and Dr Corby Martin at Pennington, we actually developed the first scientifically validated way to assess food noise, and we're seeing in our patients significant decreases in food noise, even within a month of taking the GLP-1 medications.
April Haberman:Wow, that's incredible. That's incredible, and how much of a relief. That has to be right If it's a constant noise in your head to be able to think about other things in life it's not so all consuming anymore, yeah.
Michelle Cardel:And that's what we hear from the patients. They tell us like holy cow, I didn't even realize that there was this like persistent voice in my head, like I would be eating breakfast and thinking about what I was going to eat for lunch you know, at the same time, and when that goes away, there's a sense of relief and we saw an over 50% increase in quality of life in six months for patients on these medications, which I mean 50%.
Michelle Cardel:It's unbelievable. I mean they had improvements in their sex life and their self-esteem. In the distress that they felt in public, they felt better at work. I mean it's really having beneficial effects across a variety of components of their life.
April Haberman:So amazing.
Kim Hart:It is amazing, and I'm actually on GLP ones and I love it. I love it Lowered all of my metabolic numbers to normal. Yes, I've lost some weight, but I feel so good I can't even discuss how great I feel and how motivated it makes me to want to take better care of my body. I'm a huge fan. It's not easy, though, and so I want to talk about the bone health effects of it.
Kim Hart:Everyone's like you're going to lose your bone mass. You don't want to talk about the bone health effects of it. Like you know, everyone's like you're going to lose your bone mass. You don't want to do that. And so let's talk about that health concern and how concerned should people really be and what should they do to mitigate any issues that might happen in there, because we all know how important bone health is as you age.
Michelle Cardel:So, first off, I'm so happy for you, kim, that you found something that I can do for you, like it truly, almost like brings tears to my eyes because I can see, like in your face and in your emotion, like how, what a big impact it's had on your life and that that in and of itself is so incredible. But to your question around you know bone health and there's lots of other questions around, like muscle mass and other health concerns. So, you know, in the one to three years preceding and then the five to 10 years following menopause, women experience an annual you know 2% reduction in bone mass and similarly, women experience a reduction in muscle mass each year following menopause. But research has shown that GLP-1 medications might actually be beneficial for bone health by promoting bone formation, which is, you know, increasing your osteoblasts, which are your bone formers, and then reducing your bone resorption, so decreasing those osteoclasts that you know break down your bone and you know this is resulting in no significant impact on the bone fracture risk.
Michelle Cardel:So, on the other hand, research has shown that approximately 25 to 39% of total weight loss during GLP-1 treatment is muscle mass and this muscle mass loss is largely attributed to the quantity of weight loss during GLP-1 treatment is muscle mass, and this muscle mass loss is largely attributed to the quantity of weight loss.
Michelle Cardel:Anytime you lose weight, you're going to lose a proportion of fat and lean mass, and so, even though those numbers sound startling, they actually very much mirror what we see in other forms of rapid weight loss, like what happens after bariatric surgery or if you lose weight rapidly on a lifestyle program. So I think the key focus is to really prioritize resistance training which I know you all talk so much about, which you want to do at least two days per week, but more if you can and ensuring that you're eating a diet that's high in lean proteins, calcium and vitamin D, and you know having that you know, those four pillars of calcium, vitamin D, lean protein and resistance training can help attenuate a lot of both that bone loss, but also that muscle mass loss as well.
Kim Hart:That's very interesting to me that it's comparable to other weight loss programs, because I think there's been some scary media out there about now we're going to have an osteoporosis crisis, and what I'm hearing you say is, at any time you should pay attention to all those things you're talking about, right? Protein, vitamin D, weight-bearing exercise which, by the way, is my second more favorite thing that I'm doing to help my menopause, my first being my estrogen patch, which you'll have to take out of my dead hand. But I think it's really interesting that scary stuff out there is not scary.
Michelle Cardel:Yeah, and I do want to put the caveat there that a lot of folks are getting these medications without that medical supervision and intervention, and I think that's where the concern comes, where people are just being given these medications without guidance around nutrition, physical activity, how you know? How are they addressing their sleep issues, their stress management like without really taking this more holistic health view? And I think that is where there's potential for problems to arise and that's why it's so important to, if you're going to take these medications, to have a comprehensive lifestyle modification program, like the Weight Watchers GLP-1 program, to do alongside the medications.
Kim Hart:That's a good point and I've told April when I started taking this it's like it's not the easy way out. This is definitely not the easy way out. It is just as hard as any other diet or lifestyle change, but it is. If you could get help on some of those things, and I tried for a very long time with my cholesterol triglycerides to lower them. Nothing worked. This did I mean it's. It's fantastic.
April Haberman:I think that's a big misconception, kim. We hear we do hear that a lot. Oh, it's the easy way out, and I think there are a lot of other misconceptions with GLP-1s as well. Are there any in particular, Michelle, that you would like to share outside of that that aforementioned?
Michelle Cardel:Yeah, I think that focus on that they're a quick fix or that they're only for people with diabetes.
Michelle Cardel:Those are pervasive misconceptions when in reality these medications work by addressing those underlying biological factors like insulin resistance and appetite regulation challenges that many women face during perimenopause and postmenopause.
Michelle Cardel:But another common myth is that once you stop taking them, all of the weight is destined to come back, and we do see from the pharmaceutical company sponsored trials that within a year, about two thirds of the weight is regained when people stop taking them. However, you know, maintaining the weight loss is possible. The weight loss is possible. We do see in our Weight Watchers members who are on a GLP-1 and switched from our clinic membership to our behavioral membership that they not only maintain their weight but they actually continue to lose weight 13 weeks later. Many folks will need long-term treatment to manage their chronic condition, but these results highlight that, alongside long-term lifestyle changes, like Kim was referencing, glp-1s can be a powerful tool to almost reset your habits and improve your metabolic health. And it's important to note that the benefits of these medications aren't just limited to weight loss. We're also seeing improvements in cardiovascular disease risk, sleep apnea, kidney functioning and even improvements in addiction, like behaviors like alcohol consumption.
April Haberman:Yeah, I just I did see that recently as well. Can I ask you a question before we hop off of this particular topping question? Are there any long-term risks for someone to take GLP-1s long-term?
Michelle Cardel:So with any medication, there's going to be risk involved. But we also have to remember there's risk involved with living with obesity, with diabetes, with living with sleep apnea. So that's why it's such a personal, it's such a personal decision that needs to be made between a patient and their healthcare provider to see, like is this, is this medication, the right thing for you? But most patients, like what Kim is describing, had tried like all these other things before getting to a place where they even felt comfortable entertaining medication as as part of their treatment regime. Um, but once they try it and they they see the effects. Most of our patients? Um really want to stay on the medications, maybe not forever, but until they develop the healthy habits that they will sustain them over the longterm, whereas other patients are like you will take these medications out of my cold dead hands forever.
April Haberman:And what I'm hearing is it is very personal and it is important to work with your health care professional to make that determination, with risk benefit as with anything else, right, exactly.
Kim Hart:I've heard some people talk about micro dosing GLP ones. When and how would you do that? What are your thoughts on on that idea? Idea?
Michelle Cardel:Yeah, we're hearing more and more about that, particularly because of how expensive the medications are and how few insurance companies are covering it. And what we're hearing from folks is one way in which they're managing that is, rather than taking you know the shot once a week, particularly once they've reached you know their weight loss goal. Particularly once they've reached you know their weight loss goal, they are then using it as a maintenance strategy and extending the duration between the shots, and that keeps the costs down, et cetera. There's a little bit of research on this topic, but it's still very much in its infancy and we need a lot more research in order to really understand what would be an appropriate clinical protocol to help support patients doing this.
April Haberman:Yeah, that makes sense. I'm wondering we've talked about stopping the medication and, you know, will the weight gain come back, risks of regaining weight? And I'm hearing from you over and over again that lifestyle behavioral management is really important and we know that is important for, you know, not just weight loss, but we just talked about bone health and muscle mass and heart health, etc. What advice would you give to someone in their 40s or 50s who's going through menopause, that's considering GLP-1, outside of what we've already talked about, is there anything else that you would add?
Michelle Cardel:I think, considering GLP-1s as one tool in a broader holistic strategy. You know they can be effective for managing weight and diabetes and cardiovascular risk et cetera. But, like we've talked about focusing on that balanced diet, that regular physical activity, that restorative sleep, that stress management, you know, at the end of the day, it's all about that holistic health. And you know I think a lot of folks when they're, you know, in their twenties and maybe even their thirties, the focus is on thinness. But as you get older, you have this like switch in your brain where it's no longer about thinness and really maximizing health span and feeling good in your body and thinking about like mobility and functionality over the longterm.
Michelle Cardel:You know I'm I'm in perimenopause and, like you can, I love my estradiol patch and I love my progesterone. And you know my hot yoga classes and my resistance training and my weighted vest. You know these are all the things I do, not to think about a number on the scale, but really to think about. You know I want to be able to run around with what I hope to have. You know, future grandkids one day hiking. You know, with my husband who's from Alaska, I want to be able to keep hiking in Alaska you know well into our sixties, seventies and maybe even eighties. You know, that is what is motivating me at this point, and in talking with you all, I feel like you all have had similar experiences as well.
Kim Hart:We're big fans of the weighted vest We've got to walk together.
April Haberman:We should send each other some pictures. Yeah, I feel like sometimes I look crazy with my weighted vest and everything else here in Seattle, but but you know what the other thing is? I don't care, because it's not about how I look To your point, michelle, it's about my health and health span and being strong and healthy and around for a very long time doing the things that I love. Yeah, and I love that mindset shift as well.
Michelle Cardel:Yeah, it's very liberating, yeah, yeah, it's liberating, yeah it is 100% liberating.
Kim Hart:I've been telling everybody about my weighted vest. I mean I got a lot of things I'm pretty excited about right now, but you know, glp the media also does a really good job of scaring you about the side effects. What are the side effects that people might experience when they're on this medication?
Michelle Cardel:Well, the most common side effects are typically related to the digestive system. So many women will experience mild to moderate nausea, especially when starting or increasing their dose. Other possible side effects can include, you know, bloating, constipation, diarrhea. These symptoms usually improve over time as the body adjusts. Eating smaller, balanced meals, staying well hydrated, you know, really prioritizing lean protein, fruits and vegetables all of these things can help minimize the discomfort. Less commonly, some people might experience fatigue, headaches, heartburn. So it's really important to work closely with your healthcare provider to manage your side effects and, depending on the severity of the side effects, they may adjust the medication as needed to find that right balance for your body.
Kim Hart:And I like how you keep reinforcing, like work with your medical provider, because I think that's really, really key. But, as a nutritionist, when someone's in menopause on GLP-1s or not what's your recommendation on the amount of protein people should get?
Michelle Cardel:Depending on how much resistance training you're doing. Generally we would recommend between 1 and 1.5 grams per kilogram of body weight. So for kilograms, just take however many pounds you weigh and divide it by 2.2. So say you weigh 220 pounds, divide by 2.2, that's about 100 kilos. You want to aim for at least 30 grams of protein per meal, at least 30 grams of fiber daily and at least 30 minutes of physical activity per day. I love that.
April Haberman:I love that too. That is so easy. 30-30-30. Yeah, you can do that one. Not much to remember. We haven't heard that one before. Like hey got it. Yeah, I can remember that, kim. Oh man, this is such good information.
April Haberman:I know, I feel like we could keep talking about GLP ones, but we I'm going to recap because that's what I do Right, we keep hearing from you that it is important to work with your healthcare provider. It is important that you consider lifestyle behavior, nutrition, exercise, that you really look at this in a holistic banner, and also the perspective of healthspan versus just lifespan, that this isn't just a quote. I'm using air quotes here for our listeners. Weight loss, drug, right. So is there anything else, Michelle, that you really gold nuggets, that you really want to leave our audience, that we haven't talked about?
Michelle Cardel:Yeah, I think a lot of folks tend to see these medications as being like a crutch, and I just want to like be clear about that that GLP-1s are not a shortcut and certainly not something to feel guilty about. While some may worry that relying on the medication means they're using a crutch, I think it's just so important to reframe that thinking. Just as we support treatment for other chronic conditions like asthma, hypertension, you know, diabetes, using GLP-1s to support weight and metabolic health is a legitimate, like science-backed choice. And these medications you know we've talked about all of the benefits of them and I really believe that they can be part of a broader wellness approach and that GLP-1s can actually empower women to feel more in control, not less. That's great, that's a good point.
Kim Hart:So where can people find you and information about GLP-1s?
Michelle Cardel:People can find information about me on my socials, including Instagram and TikTok at drmichellecardell, and they can find more information about GLP-1s on our Weight Watchers page. If you Google Weight Watchers Clinic or Weight Watchers GLP-1, we have so many blogs and content articles that you know our science writers have written, our medical and science team have reviewed, so you can know and trust that the information that you're getting from there is science-backed, it's evidence-based and we'll give you that good information.
April Haberman:Excellent, so good. Okay, we now we're shifting from GLP ones, uh, and we asked this question of all of our guests. So what is the best piece of advice that you've ever received, michelle?
Michelle Cardel:The best piece of advice I've ever received. That is such a hard one received. That is such a hard one. I think it's to be unapologetic about who you are and what you need to, not just to not just, um, you know, get by, but to really thrive, you know, and that might be with your partner, that might be with your family. Setting boundaries you know with with the workplace, whatever that means for you, but really setting, you know, being comfortable, asking for what you want and and standing by it.
April Haberman:I love that. Not feeling guilty or shamed or anything. Right, this is what I need. I love that. Yeah, be bold. Well, it has been such a pleasure having you on. I really appreciate it. This is this is definitely a hot topic. I'm sure we've viewed a lot, but until we meet again, I'm sure we will All of our listeners. We meet again, I'm sure we will All of our listeners and Michelle go find joy in the journey. Thanks, Michelle.
Michelle Cardel:Thanks. Thank you, April, for all you're doing to bring light to such an important topic of menopause. We appreciate all the work that you're doing.
Kim Hart:Thank you, of course. Thank you, see you soon. Have a great day.
April Haberman:Thank you for listening to soon. Have a great day.
