Episode 247: The Menopause Metabolism Shift: How Foundayo Changes the Game

[00:00:00] Welcome back to the Back on Track Achieving Healthy Weight Loss, where I help you get on track and stay on track with your weight loss journey. I'm your host, Dr. Alicia Shelly. So let's get started.

[00:00:27] Hello, and welcome back to the Back on Track Achieving Healthy Weight Loss podcast. I'm your host, Dr. Alicia Shelly. Now, if you're a woman in your 40s or 50s, and you ever said, I haven't changed anything, but I'm gaining weight, or my body just does not respond the way it used to, this episode is for you.

[00:00:50] Because today we're talking about the big M, menopause, a stage of life that can completely change how your body regulates weight. And there's some new exciting research that was presented at the 2026 American Diabetes Association Scientific Conference. And I'm excited to share with you that new research with the oral GOP-1 medication called Fundeo, or ofroglipuron is the scientific name.

[00:01:19] So today we're going to discuss why menopause causes weight, why it's not simply a lack of willpower, and how GOP-1 medications may help, and what this new study found and what women should focus on during menopause. So let's jump in. So many people think that menopause is simply when your period stops. But medically, menopause is much more.

[00:01:45] It is a major hormonal transition where your ovaries are gradually producing less estrogen and progesterone. Now, menopause is when your cycle stops. However, many years before that happened, you were having a lot of fluctuation in your hormones. In fact, this particular period of time is called perimenopause.

[00:02:10] And these hormones influence estrogen and progesterone can influence more than just reproduction. They can affect your appetite, fat storage, muscle mass, insulin sensitivity, sleep, mood, energy, bone health, and even your heart health. And this transition starts to occur between the ages of 45 and 55. And you know what?

[00:02:38] A lot of women notice these symptoms even years before they actually stop their final menstrual period. And you're considered to be in menopause once you go one year, 12 months without a cycle. So a lot of my patients, they may go eight months without a cycle, and all of a sudden, they have one. And then they have to wait another 12 months. And then after that, maybe at the ninth month or the 10th month, it happens again.

[00:03:03] So you're not considered to be in menopause until you are one full year without a cycle. Now, the most common symptoms that we see during menopause, of course, your hot flashes, night sweats at night. You wake up in a pool of sweat. Mood changes where you just like all of a sudden you get angry at things. You get emotional at other stuff, crying. Like it's just these switches, these transitions.

[00:03:30] All of a sudden, something that your spouse does is just irritating you to the nine. It's these mood changes. It's poor sleep where you're waking up multiple times at night when you didn't do that before. Brain fog where it's just hard to find the words. Like, you know, it's right there at the tip. You know, you know what this word is, but it's just not there. Vaginal dryness, which can make sexual intercourse more painful. Joint aches, just achiness in your joint.

[00:03:59] People complain of like frozen shoulder, feeling fatigue and just wore out where you just don't understand why you're so tired. And then, of course, weight gain. And yes, weight gain is one of the biggest frustrations women tell me about. And here's the important thing. Menopause does not magically slow your metabolism overnight. Instead, multiple biological changes can happen simultaneously.

[00:04:28] And these changes are leading to why menopause causes weight gain. So the first thing that happens is your estrogen is declining. And estrogen is important in regulating your hunger, fullness, insulin sensitivity, and where the location fat is stored. Because up to this point, we are storing fat in our, maybe our thighs, in our legs, in our hips, in our buttocks area.

[00:04:56] But then once you hit menopause, you start to notice you get more body fat in your abdominal area. And I have a lot of people who are like, man, I just need to get rid of this thing that's in the middle of my midsection, this tire in my midsection. And that's because as estrogen starts to fall, abdominal fat starts to increase, insulin resistance increase.

[00:05:21] And insulin resistance is where basically the body does not respond to the insulin that is being produced. I like to describe it as this. When we think of digestion, when you eat something, your body breaks it down in the stomach and in the small intestine into sugar. That sugar is absorbed and taken into the bloodstream to be used by the muscles and the organs for energy. But it needs a hormone called insulin to bring it into the muscle to be used.

[00:05:50] However, it comes to a point, especially in menopause, where the body is not responding to the insulin. Like the insulin's there, the sugar's there, but the body's like, I don't know who you are. I don't want to do this. And so you have to produce even more insulin in order to bring that sugar into the muscle so the muscle can use it for energy. However, what happens is because you have to eat more and more insulin, it actually causes your body to store body fat.

[00:06:17] Also, the sugar that's in the bloodstream is increasing as well. And now we're setting you up for prediabetes and diabetes. I see a lot of women, especially post-menopausal, who are developing diabetes. And a lot of it sometimes can be due to a little portion of it can be due to menopause. You can't necessarily not remember genetics as diabetes runs in the family, but you definitely see a lot more of it just due to that menopause.

[00:06:45] And so let's talk a little bit more about muscle mass. What does muscle mass do in menopause? Beginning around age 40, women naturally lose their muscle. And since muscle burns more calories than fat, losing muscle means your resting metabolic rate actually gradually decreases because you don't need, you don't have as much muscle. So your body doesn't need to burn more calories because there's not enough muscle.

[00:07:10] And so if you think about it, if you start from when you were 20 and you ate the exact same amount of food, you exercise the same, your body will actually gain a pound every year because naturally you're losing muscle and your metabolic rate is gradually declining. Now let's look at how sleep is being affected by menopause. So the symptoms of menopause, like hot flashes and night sweats, actually interrupt your sleep.

[00:07:39] I mean, most women can tell you waking up in the middle of the night in a pool of sweat is not comfortable, at least. And when you're not getting a good night's rest, what happens is your body increases your hunger hormones like ghrelin and cravings for sugar. And so you tend to do a lot more emotional eating when you're getting poor sleep. Now, the next thing that happens during menopause is that sometimes your stress hormones can rise.

[00:08:07] So many women during menopause are simultaneously caring for their children, caring for their parents. They may have demanding careers and they may have relationships. And so all of these things are contributing to more stress. And when you have more stress, that leads to higher cortisol levels, which can increase abdominal fat storage, which leads to the extra body fat in the midsection.

[00:08:35] And then also the body changes during menopause. The appetite centers in the brain become harder to satisfy. This is one reason many women describe feeling hungry more often than they did 10 years earlier. So when women tell me, doctor, I'm doing everything right, I believe them. Because you know what? Biology changes. Our bodies are changing. They're transitioning. And sometimes it's more than just willpower.

[00:09:01] Now, let's talk about how GOP-1 medications help. Now, GOP-1 medications do not replace healthy habits. Not at all. They help restore some of the biological signals that become more difficult during menopause. They help by reducing hunger. So people naturally eat less because they feel satisfied sooner. Also, many people describe less food noise. So they spend less time thinking about food.

[00:09:29] They also help the body process glucose more efficiently. So they kind of bring down those insulin levels so that your body is working properly. And it can lead to less fat storage. Also, because it slows down your stomach emptying and digestion, the meals stay longer in the stomach. And it increases that fullness. So you feel full longer.

[00:09:55] Also, when you combine nutrition, exercise, behavioral changes, GOP-1s can help patients lose clinically meaningful amounts of weight. But I just want to be clear. GOP-1 medications do not treat menopause itself. They do not replace estrogen. But they could help counter many of the metabolic changes that occur during menopause.

[00:10:21] So if you think that you need to replace your estrogen, it is important that you see your menopause specialist, whether it's your OB-GYN, your primary care specialist, or a person who can help manage the hormones where you are. Now let's talk about the new Orphaglipuron menopause study. Now, this research was presented at the 2026 American Diabetes Association Scientific Sessions.

[00:10:48] The researchers performed a post hoc subgroup analysis of the phase three trials of ATTAIN-1 and ATTAIN-2. What that means is that each, you know, when you're putting out your medication, you have to have your primary study that looks at, you know, whether the medication works. So you usually have your treatment arm and then you have your placebo arm.

[00:11:13] And so in the ATTAIN-1 trial, it looked at individuals taking Orphaglipuron versus placebo, and they did not have diabetes. Whereas the ATTAIN-2 trial also looked at people who were taking Orphaglipuron versus people who have placebo, but they did have type 2 diabetes. So that's the difference between the two clinical studies.

[00:11:36] And then what they did after the studies is that they looked at the menopausal women in these different trials, and they were able to see what the results were. And I'll show that here in a second. And the question they were trying to answer was, does Orphaglipuron or does Fundeo work equally well before, during, or after menopause? So they had women in all these different phases, and they wanted to see, are they able to lose weight? Across more than 1,500 women in these two studies,

[00:12:06] meaningful weight loss occurred regardless of menopausal state. So I know some people feel like it's harder for them to lose weight, especially going during it and maybe after, but they showed that majority of the women actually lost weight, which is a good thing. So in the first trial, the ATTAIN-1, which is participants without diabetes, when they were at the highest dose of 17.2 milligrams, the perimenopausal population lost 12.8% of their weight loss for about 18, 28 pounds.

[00:12:36] Whereas the perimenopause, those who are going through it now, they lost between 14.4% of their weight loss, are about 30 pounds. And the people who were post-menopause lost 14.1% weight loss, are about 28 pounds. And this is actually quite significant because in the ATTAIN-1 trial, the average weight loss that was seen at the highest dose was 11.1%.

[00:13:01] So in this particular sub-hoc analysis, it shows that even if you're, you know, the average was 11.1, but these women saw higher weight loss. So between 12.8 and 14.4%, regardless of their stage of menopause. And then when they looked at that particular subset of women, about 51.5% of women lost at least 15% of their body weight. So that's half of the women there lost at least 15% of their body weight,

[00:13:30] which is quite significant. If you're looking to lose like 25, 30 pounds, then this definitely is a medication that can be of assistance. Now let's look at the ATTAIN-2 trial, which were basically participants with type 2 diabetes. So in the ATTAIN-2 trial, those participants with type 2 diabetes, these women also experienced significant weight loss despite having diabetes. Now when you have insulin resistance,

[00:13:59] it actually makes it harder for you to lose weight because your body wants to store, like I mentioned before. And so even at the highest dose of 17.2 milligrams, if you were in that pre-menopausal state, it was 11.3%. If you're in that peri, meaning you're going through it, menopause was 18, 8.9%. If you're post-menopause, you were 13.6%.

[00:14:25] And up to 44.2% of those participants achieved at least a 15% weight loss. So they were actually still, besides the perimenopausal population in the pre-menopause and post-menopause, they were still beating the average weight loss that was seen in the ATTAIN-1 trial. And so researchers also found significant reductions in waist circumference, suggesting improvements in abdominal fat. Right here in that midsection,

[00:14:55] and this abdominal fat has been linked to diabetes, heart disease, and metabolic syndrome. So it is important to do your best to kind of reduce that abdominal body fat. Now, before we get too excited, it is important to understand the strengths and limitations of this research. This was a post hoc subgroup analysis, meaning that the original trials were not specifically designed to compare menopausal groups. These findings were found after the fact, when they actually went through the data.

[00:15:25] And they are encouraging. But we should consider more exploratory studies. And we should just, you know, make sure there's more studies looking at menopause and GOP-1s. And the one thing I want to just say is that when we are in menopause, weight loss is not the only goal during menopause. The goal is not to simply lose weight, but the goal is to age healthy. And what does that look like? That's preserving muscle, protecting bone,

[00:15:55] lowering your cardiovascular risk, preventing diabetes, and improving quality of life. That means women should also focus on strength training two to three times a week in order to preserve muscle and protect your bone. Also, it's important to eat adequate amount of protein. And usually that's generally one to 1.2 grams of protein per kilogram per day, especially for many midlife or older adults.

[00:16:21] If you are actively exercising, then that amount should increase to 1.5 grams of kilograms per day. And it should be individualized based on your kidney function. So if you have kidney, chronic kidney disease, or especially in stage 3B and higher, definitely speak to your doctor on how much protein you should be getting. A good example of how much protein you should focus on, if you weigh 70 kilograms, which is equal to 154 pounds,

[00:16:51] then you would just multiply that 70 kilograms to 1.2 grams, which is equal to 84 grams of protein you should be eating. Now, if you weigh 250 pounds, that is equal to 113 kilograms of weight, which means you should be eating around 135 grams of protein. So it's important to kind of make sure you're getting your protein in because many people forget, and that's when they start feeling more tired. They start feeling a little bit run down.

[00:17:20] Also, it's important to make sure you're getting your calcium and vitamin D when appropriate, prioritizing your sleep, and managing your stress. GOP-1 medications are powerful tools, but they are only one piece of the puzzle. So here's what I want you to remember. Number one, menopause changes biology. Weight gain is common, but it's not simply a lack of willpower. GOP-1 medications help address some of the biological drivers of weight gain

[00:17:49] by reducing hunger, improving fullness, and improving insulin sensitivity. But remember, it's only one piece of the program. And then number three, the new ATTAIN analysis suggests that orfraglipuron or Fundeo produces meaningful weight loss before, during, and after menopause, and even in women with type 2 diabetes. And then lesson four is weight loss should always be paired with exercise, protein intake, sleep, and muscle preservation

[00:18:17] for the best long-term health. So thank you again for joining me for another episode of Back on Track Achieving Healthy Weight Loss. If you found today's episode helpful, please share it with a friend, especially someone going through menopause who may be wondering why her body feels so different. And remember, weight gain during menopause isn't a personal failure. It's biology. And biology can be treated and managed.

[00:18:43] And until next time, stay strong, stay committed, and stay consistent. And remember, we are stronger together.