Tag: Lifestyle Medicine

Menopause Treatment by Telemedicine: How It Works

On By Dr. Scott RennieIn Menopause & Women's HealthLeave a comment

For many women, menopause care has long been an afterthought in traditional medicine. The conversation often starts late, if it happens at all. Now, thanks to telemedicine, that’s beginning to change.

Over the last few years, virtual menopause clinics have emerged to fill a long-standing gap in women’s health. Clinics like Midi Health and Menopause RX connect women directly with clinicians trained in menopause care. According to the Centers for Disease Control and Prevention, about 42 percent of women now use telemedicine, and a growing number are using it specifically for midlife and menopausal health (Pevzner, 2025; CDC, 2025).

This shift matters. Research shows that most doctors receive little or no formal training in menopause management. A 2019 Mayo Clinic report found that only 7 percent of medical residents felt prepared to manage menopause (Mayo Clinic Proceedings, 2019). Women often report their symptoms being dismissed or overlooked. In a 2025 survey of 1,000 women aged 45 to 60, nearly 71 percent said their physician didn’t adequately prepare them for menopause or discuss treatment options (Pevzner, 2025).

That’s where telemedicine can help. Virtual menopause clinics provide timely access to clinicians who understand hormonal transitions and can offer evidence-based guidance. As Dr. Sherry Ross, an ob-gyn in California, explained in a Yahoo Health interview, these platforms solve many of the problems in the current healthcare system, particularly access and education (Pevzner, 2025).

Telehealth also reaches women in rural or underserved areas where menopause-certified specialists are scarce. The Menopause Society, formerly NAMS, highlights this benefit in its educational resources, noting that virtual platforms can deliver specialized care to women who might otherwise go without it (The Menopause Society, 2025). On my own panel, roughly 25 percent of women arrive already on hormone therapy started elsewhere; most others are still looking to start when they get to me. That tells me how far this shift has already gone outside primary care.

Virtual visits handle a fairly wide range of these symptoms: hot flashes, sleep disturbance, mood changes, low libido, and mild vaginal dryness lead the list, and each of these can often be addressed through careful history, lifestyle interventions, and evidence-based hormonal or non-hormonal therapies (Pevzner, 2025).

Of course, telehealth isn’t the right fit for everyone. Complex or potentially serious symptoms such as postmenopausal bleeding, abnormal discharge, breast changes, or pelvic pain still require in-person evaluation. As Dr. Robin Noble, a gynecologist in Maine, reminds clinicians, some conditions simply can’t be ruled out without a physical exam (Pevzner, 2025).

That balance is important. Telemedicine can’t rule out postmenopausal bleeding, abnormal discharge, or a breast change over video, and it shouldn’t try to. The best virtual programs integrate follow-up visits, communicate with the patient’s primary physician, and make sure screenings like mammograms and Pap smears stay on schedule (The Menopause Society, 2025).

When colleagues ask how to steer patients toward credible virtual options, I start with licensure: is the provider licensed and, ideally, certified by The Menopause Society (MSCP)? From there, check that the clinic’s data security is HIPAA-compliant, and don’t sign on until there’s a real process for ongoing monitoring and coordination of care (The Menopause Society, 2025).

Here’s where I push back on the marketing a little. Platforms like to say virtual care “closes the gap,” but a same-day video visit doesn’t fix a residency curriculum that gave menopause a few hours of teaching total. It gets a patient to someone who knows the topic faster. It doesn’t fix why so few primary care doctors learned it in the first place.

Some version of this comes up constantly: a woman held off on raising her symptoms because she didn’t want to waste the doctor’s time. Then she gets to someone who takes the question seriously, and what she finds is reassurance and a plan. That’s the kind of access we should all want for our patients: timely, informed, and respectful of their experience.

Menopause care is finally catching up with the rest of modern medicine, and telemedicine is a big part of why.

Scott Rennie, D.O.

References

Pevzner, H. (2025, July 30). Your complete guide to getting menopause help online. Yahoo Health. https://www.yahoo.com/lifestyle/menopause-telehealth-guide

Centers for Disease Control and Prevention (CDC). (2025). Telemedicine utilization data.

Mayo Clinic Proceedings. (2019). Menopause education in residency training.

The Menopause Society (formerly NAMS). (2025). Professional resources and video library.

Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

How Much Exercise Do You Need to Lose Weight?

On By Dr. Scott RennieIn Weight Loss & Metabolic HealthLeave a comment

Patients ask me all the time how much exercise really matters for weight loss. The honest answer is that it depends on what they are trying to do. Losing weight quickly, keeping it off, and staying healthy are three different goals, and exercise performs very differently against each one.

On one point the research is not ambiguous. Exercise on its own rarely produces large weight loss. Most trials show modest changes, roughly half a kilogram to three kilograms, and that is in people putting in 180 to 270 minutes a week (Jakicic et al., 2019). Below 150 minutes, most people do not lose much at all. I see the same thing on my schedule. Patients who start walking three times a week often feel noticeably better while the scale barely moves, and that gap is worth naming out loud before they get discouraged by it.

None of which makes exercise optional. It is among the best tools we have for preventing regain. Long-term data show that people sustaining higher volumes, often north of 250 minutes a week, are considerably more likely to hold onto a 10 percent loss (Jakicic et al., 2014). That is where the real return sits.

Paired with dietary change, the numbers improve. Adding exercise to calorie restriction increases short-term loss by about 20 to 25 percent over diet alone (Wing et al., 1998; Goodpaster et al., 2010). I had a patient who was cutting calories carefully and getting almost nothing for it until she added regular cycling. With both together she lost roughly twice as much and held it considerably longer.

Type and volume both matter. For general health, 150 minutes of moderate activity a week is the baseline. For meaningful weight loss, 250 to 300 minutes is closer to what is needed. For maintenance, somewhere in the 200 to 300 range seems to work. None of this requires a gym. Walking, yard work, and even light activity like standing or slow walking accumulate, and a 2021 doctoral dissertation found that increasing light-intensity activity independently predicted weight loss at both 6 and 12 months (Jackson, 2021).

Practically, I tell patients to start from where they actually are. Adding steps, breaking up long stretches of sitting, and picking something they do not dread produces more consistency than any prescribed routine they will abandon in a month. Thirty to sixty minutes on most days works whether it comes in one block or four. And if weight loss is the goal, it has to be paired with dietary change; exercise alone will disappoint them.

Exercise is not a shortcut to weight loss, and patients who come in expecting it to be will be let down. What it does do is keep lost weight off, improve metabolic health, and protect function as people age. Move more, sit less, keep going.

Scott Rennie, D.O.

References

Jakicic JM et al. Physical Activity and the Prevention of Weight Gain in Adults: A Systematic Review. Med Sci Sports Exerc. 2019;51(6):1262-1269.

Jakicic JM et al. Obesity. 2014;22:2284-2292.

Goodpaster BH et al. JAMA. 2010;304(16):1795-1802.

Wing RR et al. Am J Clin Nutr. 1998;67(3):551-558.

Physical Activity Guidelines Advisory Committee. 2018 Scientific Report.

Jackson R. Doctoral dissertation, 2021.

Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Does Fasting Slow Aging? What the Science Says

On By Dr. Scott RennieIn Longevity & Healthy AgingLeave a comment

Aging cannot be stopped. The pace of it may be influenced by what and when we eat, and that idea is old rather than new. Since the 1930s, animal studies have shown that cutting calories without causing malnutrition extends lifespan. Rodents held at a 30 percent reduction lived longer with less cancer and less heart disease.

The proposed mechanisms are lower oxidative stress, better mitochondrial function, and less inflammation. Less fuel in, less metabolic wear.

Then you move from mice to people and it gets complicated.

The CALERIE trials brought calorie restriction into human research. CALERIE II found that cutting roughly 15 percent of calories for two years improved blood pressure, cholesterol, and markers of oxidative stress, and those benefits appeared without major weight loss (Kraus et al., 2019). The obstacle is adherence. Sustained restriction is hard on mood, on social life, and on nutritional balance, and most people will not hold it.

Which is how fasting patterns entered the conversation. Intermittent fasting covers several approaches. Some people fast on alternate days. Others follow 5:2, eating normally five days a week and restricting on two. Time-restricted feeding, which confines eating to an 8 to 10 hour window, has drawn the most recent attention.

Alternate-day fasting does produce fat and weight loss, but hunger is a serious barrier and dropout rates run high. Modified versions have not clearly outperformed standard calorie restriction (Trepanowski et al., 2017).

Time-restricted feeding looks more workable. Sutton and colleagues tested an early schedule with all meals between 7 a.m. and 3 p.m. Participants did not lose weight, but insulin sensitivity, blood pressure, and oxidative stress markers all improved, and they reported less hunger through the evening (Sutton et al., 2018). Other short-term work points the same direction, particularly on appetite control and metabolic flexibility (Hatori et al., 2012; Varady et al., 2022).

What does that mean in practice? Calorie restriction has the strongest animal data and some genuinely promising human results, and almost nobody sustains it. Alternate-day fasting rarely survives contact with real life. Time-restricted feeding is the one most patients can actually keep, and even moving to a 10 hour window and dropping late-night meals is a defensible starting point.

When I talk this through with patients, I usually suggest starting at a 12 hour window and tightening it only if they tolerate the change well. What goes in the window still matters more than the window does, and nutrient density should not get lost in the enthusiasm about timing.

Fasting is one tool among several, and which one fits depends on the person, their health, and what they can hold onto for longer than a month.

Scott Rennie, D.O.

References

Ravussin E, Redman LM et al. 2015.

Kraus WE et al. Lancet Diabetes Endocrinol. 2019.

Sutton EF et al. Cell Metab. 2018.

Trepanowski JF et al. JAMA Intern Med. 2017.

Heilbronn LK et al. 2005.

Spadaro PA et al. 2022.

Hatori M et al. Cell Metab. 2012.

Varady KA et al. 2022.

Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Does Chronic Stress Cause Weight Gain? A Doctor Explains

On By Dr. Scott RennieIn Weight Loss & Metabolic HealthLeave a comment

Obesity gets described as a balance of diet and exercise, and stress plays a far larger role in it than most people are told. I have seen patients who eat well and stay active and still lose ground the moment their stress rises. Research from Dr. Rajita Sinha at Yale explains a good deal of why. Chronic stress produces measurable biological change, well past anything you would call a mood.

Stress acts on the brain circuits governing emotion, motivation, and self-control. Those circuits overlap with the ones handling food reward and craving, particularly for calorie-dense processed food (Sinha et al., 2022). Cortisol climbs under chronic stress. Ghrelin rises with it while leptin falls. What you end up with is a body primed to eat more, in an environment where high-calorie food is always within reach.

Calling that emotional eating undersells it. In Sinha’s lab work, people exposed to stress through guided imagery ate more snack food afterward, and participants who were already overweight were the most affected. Their cravings and calorie intake tracked with measured increases in cortisol and ghrelin. The stress reached past how they felt and changed how their brains and bodies handled food.

The pandemic ran this experiment at national scale. Nearly half of U.S. adults gained weight over that period, with worse effects among people who already had higher BMIs (Khubchandani et al., 2022). Children were not spared; CDC data showed the rate of BMI increase doubling against pre-pandemic years (Lange et al., 2021). The predictors of gain were emotional distress, having children at home, and how long it had been since someone last weighed themselves.

Work outside the pandemic points the same way. In one community study, people with higher baseline cortisol and greater insulin resistance were more likely to gain weight over the following six months (Chao et al., 2017). Those markers did more than correlate with obesity. They predicted it.

That has pushed researchers past the eat-less-move-more framing toward treatments aimed at the stress itself. Mindfulness-based stress reduction lowers food cravings, perceived stress, and blood pressure in people with obesity (Tuit et al., 2011). There is even evidence in parenting: a small study of low-income mothers found mindful parenting reduced parental stress and was associated with healthier BMI outcomes in their children (Jastreboff et al., 2018).

Medical and surgical treatment still matter, and the evidence suggests they perform best alongside strategies that reduce stress reactivity and support executive function. Stress management belongs in the treatment plan rather than tacked onto the end of it.

I have seen patients who feel defeated because they are certain the weight they gained under stress was a personal failure. The science says otherwise. Stress reshapes brain pathways, moves hormone levels, and changes eating behavior in ways we can measure. None of that makes change impossible. It does mean compassion is not optional in this conversation, and that treating stress as part of the disease moves the discussion off blame and onto something we can actually act on.

Scott Rennie, D.O.

References

Sinha R. Chronic Stress and Obesity. Yale School of Medicine, Columbia Obesity ABOM Virtual Course, 2022.

Chao A et al. High Cortisol and Insulin Resistance Predict Weight Gain. Obesity. 2017.

Khubchandani J et al. Depression and Anxiety Predict Weight Gain During the COVID-19 Pandemic. Diabetes & Metabolic Syndrome. 2022.

Lange SJ et al. Body Mass Index Increase in Children During COVID-19. MMWR Morb Mortal Wkly Rep. 2021.

Tuit K et al. Mindfulness and Stress Reduction in Obesity. Appetite. 2011.

Jastreboff AM et al. Mindful Parenting and Childhood Obesity Prevention. Journal of Pediatrics. 2018.

Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

How Does Aging Change Your Metabolism? What Research Shows

On By Dr. Scott RennieIn Weight Loss & Metabolic HealthLeave a comment

Obesity, diabetes, cardiovascular disease, and frailty get treated as though they were the price of getting older. Work from researchers like Luigi Fontana points somewhere else. Decades of metabolic strain do most of this damage, and diet, activity, and the choices stacked on top of them shape how much strain accumulates.

The scale is hard to ignore. Chronic disease accounts for close to 90% of U.S. healthcare spending, most of it aimed at managing complications rather than preventing them (Martin et al., Health Affairs, 2021). Life expectancy in this country fell by more than two years between 2019 and 2021. Obesity now affects 40.3% of adults aged 20 and older, with 9.7% in the severe range (1). Excess adiposity drives hypertension, diabetes, fatty liver disease, and several cancers.

The biology is familiar. Oxidative stress, inflammation, and insulin resistance sit underneath most of these conditions (Fontana & Partridge, Cell, 2015). Abdominal fat is active tissue rather than storage. It fuels insulin resistance and chronic inflammation, and it also activates bone marrow. In the PESA cohort of 745 apparently healthy adults imaged with FDG-PET, bone marrow activation tracked with every component of metabolic syndrome, and the activated group carried metabolic syndrome at 22.2% versus 6.7% (Devesa et al., Eur Heart J, 2022). Obesity changes the terrain of the body long before symptoms show up.

Calorie restriction without malnutrition is the clearest intervention we have. The animal data are strong. In rhesus monkeys, long-term restriction slowed age-related brain atrophy (Colman et al., Science, 2009), preserved muscle and function (Colman et al., J Gerontol, 2008), and lowered frailty and chronic disease burden (Yamada et al., J Gerontol, 2018).

This literature gets oversold, and the primate data are where it happens. The 2017 joint reanalysis of the two big studies found a survival benefit in the Wisconsin animals and no significant survival effect in the National Institute on Aging cohort (Mattison et al., Nat Commun, 2017). Health measures improved in both. Lifespan did not reliably follow. That is a more honest summary than the one usually quoted.

Human data are thinner but point the same direction. CALERIE tested roughly a 25% calorie reduction over two years and found improvements in blood pressure, cholesterol, glucose, inflammatory markers, heart rate variability, and insulin sensitivity (Meydani et al., Aging, 2016; Stein et al., Aging Cell, 2012; Weiss et al., Am J Clin Nutr, 2006). Even the more realistic reduction people actually achieved, closer to 12%, produced meaningful metabolic change (Kraus et al., Lancet Diabetes Endocrinol, 2019).

Calories are one variable. Nutrient quality and timing matter too. Studies in mice suggest high-protein diets may shorten lifespan, while restricting methionine or branched-chain amino acids improves metabolic health and longevity markers (Solon-Biet et al., Cell Metab, 2014). A trial in men with prostate cancer found that a single month of protein restriction lowered fat mass, cholesterol, and insulin (Fontana et al., Cell Rep, 2016). Protein source appears to matter as well, with plant-based sources holding an advantage over animal-based ones.

Timing has drawn its own attention. Intermittent fasting, whether through time-restricted eating or alternate-day fasting, extends lifespan in animal studies and protects against age-related disease including diabetes and cancer (Mattson et al., PNAS, 2014). Human studies suggest benefits on body fat, insulin sensitivity, and metabolic markers (Tosti et al., Aging Biology, 2022).

The gut microbiome adds a layer underneath all of it. Diet shapes microbial diversity and function, which in turn shapes inflammation, immunity, and metabolism (Thorburn et al., Immunity, 2014; Griffin et al., Cell Host Microbe, 2017). Fiber, protein type, and eating pattern all shift that balance. Nutrition never acts alone. It works through microbial partners.

What Fontana and others argue is that the real challenge lies less in treating diseases once they appear and more in holding metabolic integrity across a lifespan. That means healthcare built around prevention rather than reaction. Whole-food, plant-predominant eating. Fewer excess calories. Less reliance on protein-heavy patterns. Fasting strategies where they fit the patient. Attention to gut and immune health.

Aging isn’t a disease. Metabolic dysfunction is. Treat it early and seriously, through diet, lifestyle, and the interventions that have evidence behind them, and the curve bends toward years worth having.

Scott Rennie, D.O.

References:

1. National Center for Health Statistics. Prevalence of Overweight, Obesity, and Severe Obesity Among Adults Age 20 and Older: United States, 1960–1962 Through August 2021–August 2023. https://www.cdc.gov/nchs/data/hestat/obesity-adult-17-18/obesity-adult.htm

2. Martin AB, et al. Health Affairs. 2021.

3. Fontana L, Partridge L. Promoting health and longevity through diet: from model organisms to humans. Cell. 2015;161(1):106-118. https://pubmed.ncbi.nlm.nih.gov/25815989/

4. Fontana L, Kennedy BK, Longo VD, Seals D, Melov S. Medical research: treat ageing. Nature. 2014;511(7510):405-407. https://pubmed.ncbi.nlm.nih.gov/25056047/

5. Devesa A, et al. Bone marrow activation in response to metabolic syndrome and early atherosclerosis. Eur Heart J. 2022;43(19):1809-1828. https://pubmed.ncbi.nlm.nih.gov/35567559/

6. Colman RJ, et al. Science. 2009;325(5937):201-204.

7. Colman RJ, et al. J Gerontol A Biol Sci Med Sci. 2008;63(6):556-559.

8. Yamada Y, et al. J Gerontol A Biol Sci Med Sci. 2018;73(3):273-278.

9. Mattison JA, et al. Caloric restriction improves health and survival of rhesus monkeys. Nat Commun. 2017;8:14063. https://pubmed.ncbi.nlm.nih.gov/28094793/

10. Weiss EP, et al. Am J Clin Nutr. 2006;84(5):1033-1042.

11. Meydani SN, et al. Aging (Albany NY). 2016;8(7):1416-1431.

12. Stein PK, et al. Aging Cell. 2012;11(4):644-650.

13. Kraus WE, et al. Lancet Diabetes Endocrinol. 2019;7(9):673-683.

14. Solon-Biet SM, et al. Cell Metab. 2014;19(3):418-430.

15. Fontana L, et al. Cell Rep. 2016;16(2):520-530.

16. Mattson MP, et al. Proc Natl Acad Sci USA. 2014;111(47):16647-16653.

17. Tosti V, et al. Aging Biology. 2022.

18. Thorburn AN, et al. Immunity. 2014;40(6):833-842.

19. Griffin NW, et al. Cell Host Microbe. 2017;21(1):84-96.

Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.