It's November, which means sugar cookies, gumdrops dancing in my head, comfort foods, eggnog, pumpkin pie, and all the other delicious things that seem to magically appear between now and January 1. I can practically smell the sticky buns already!
Of course, along with all the yummy holiday traditions come the familiar internal conversations:
Should I eat that?
Do I really need another cookie?
Am I going to regret this tomorrow?
Why does everything taste better when it's cold outside?
Then add family gatherings, complicated relationships, packed schedules, financial stress, and the emotional gymnastics that sometimes accompany the holidays. It's no wonder our bodies can feel like they're working overtime. Throw in midlife hormonal changes, disrupted sleep, shifting metabolism, increased anxiety, and changes in body composition, and suddenly that holiday tension feels like more than just a second helping of pie.
But what if we approached our bodies with a little less judgment and a lot more curiosity?
For this edition of The Midlife Collective, I am excited to introduce you to Dr. Lara Felker, DNP, AGNP-PC, primary care provider and nurse practitioner, and the founder of Mercer Weight Loss & Wellness.
I first met Lara with her six-week-old baby in tow. Her third! She is one of those genuinely kind souls with an adventurous entrepreneurial heart and a desire to help others that is impossible to miss. Her passion for empowering women to understand their bodies and make informed health decisions is loud and strong.
Lara brings an impressive clinical background to her work. She spent five years as an intensive care nurse in the medical-surgical transplant ICU at the University of Washington Medical Center before returning to UW to earn her Doctor of Nursing Practice degree. For the past eight years, she has worked as a primary care nurse practitioner, focusing on preventative care, chronic disease prevention, and helping people improve their everyday quality of life.
What I appreciate about Lara's approach is her emphasis on treating the whole person. She believes healthcare should be built around evidence-based medicine, individualized treatment, and compassionate care, not simply a number on the scale or a list of symptoms. She also values the long-term relationships that allow a provider to understand the person behind the health concerns.
And when she isn't caring for patients, you might find her on the water. Lara is an avid sailor who recently spent the summer sailing around the San Juan and Gulf Islands with her husband and three young daughters, ages four, two, and a newborn who was just eight days old at the time! She used to race sailboats before motherhood changed the itinerary a bit.
I think we can all agree that takes a certain kind of adventurous spirit!
Let's Talk About It: GLP-1s, HRT, and Midlife Bodies
Michelle: Midlife can bring changes in weight, body composition, appetite, metabolism, and where we store fat. What is actually happening in our bodies, and where do HRT and GLP-1 medications fit into the picture?
Lara: As estrogen and progesterone decline during perimenopause and menopause, several things begin to shift, even when our diet and exercise habits haven't changed. Fat distribution often moves from the hips and thighs toward the abdomen, muscle mass can decline more quickly, and insulin sensitivity can worsen.
Sleep is another big piece of the puzzle. Night sweats and hot flashes can disrupt sleep, which then affects mood, appetite regulation, and the hormones that influence hunger. It's a domino effect!
HRT (Hormone Replacement Therapy, also called Menopausal Hormone Therapy - MHT) and GLP-1 medications serve very different purposes.
HRT replaces hormones the body is no longer producing at the same levels. It can help with hot flashes, night sweats, sleep disruption, vaginal and urinary symptoms, and bone health. For some women, it can also improve mood symptoms associated with hormonal changes.
GLP-1 medications work differently. They influence appetite, fullness, and blood sugar regulation through signaling between the gut and brain. They are used to treat conditions such as obesity and type 2 diabetes and may be appropriate for women experiencing increased metabolic risk in midlife.
The important distinction is that GLP-1 medications do not replace estrogen or address menopausal symptoms such as hot flashes, sleep disruption, or vaginal changes. These are different tools for different needs.
And perhaps most importantly, none of these midlife changes means you've failed at diet or exercise. Much of what is happening is normal biology.
Michelle: Women are receiving so many messages about weight right now: lose it, maintain it, accept it, treat it, don't talk about it! How do we acknowledge legitimate health concerns without reinforcing the idea that a smaller body is automatically a healthier body?
Lara: I think we have to distinguish between treating a health concern and trying to fix something that has been made to feel unacceptable by cultural expectations. There is a difference between using a medication to address a defined health issue and using it primarily because your body doesn't look the way you think it should. The cultural and social media noise around midlife weight gain is incredibly loud and often shaming. We need to be careful not to let those messages drive our healthcare decisions.
A smaller body is not automatically a healthier body. The focus should be on overall health, metabolic markers, quality of life, and longevity rather than simply a number on the scale.
Michelle: Is there a right way to start GLP-1s or HRT? If a woman is considering either, where should she begin?
Lara: Start by asking yourself what you are actually trying to address.
What is happening with my health right now?
How am I feeling?
What am I hoping to improve?
How do I want to feel in the future?
Both HRT and GLP-1 medications require medical oversight from a credible healthcare provider who takes the time to understand your health history and develop an individualized treatment plan. This should never be a "set it and forget it" approach. You need a provider who follows up, monitors your progress, adjusts treatment when necessary, and considers your health as a whole. Be cautious of providers who advertise medications as miracle solutions, guarantee specific amounts of weight loss, or make sweeping promises.
I also encourage women to look beyond providers whose primary focus is aesthetics. These medications require clinical knowledge and experience to prescribe and manage safely. GLP-1 medications have been around for decades, and I have been prescribing them for patients with diabetes for the past eight years. They are not new, but their popularity in the weight-loss space certainly is.
Michelle: Body positivity has helped women challenge the idea that thinness equals beauty, worth, or health. But what if you don't love everything about your body? What if you want to change something for health, comfort, or simply personal preference? Can we accept our bodies and still want something different?
Lara: This is a hard question! I think it really comes down to balance and recognizing that our goals change as we age.
As women get older, the true path to longevity is taking care of the body as a whole rather than chasing the ideal body that is constantly being sold to us on social media. It's important to use available treatments and tools to help us reach meaningful health goals. But we need to be cautious of providers who focus simply on making women skinny.
I think we can acknowledge that we don't love every change that comes with aging while still respecting our bodies and making thoughtful decisions about our health.
Michelle: Before deciding that we need to change our bodies, what questions should we ask ourselves?
Lara: I would go back to the questions we started with.
What is happening with my health right now?
What am I hoping to treat or manage?
How am I feeling?
What are my goals?
What do I want my health to look like in the future?
Think about your overall health, your expectations, and your quality of life. Find a qualified provider who will take the time to understand you and help create a treatment plan that is specific to your needs.
Ultimately, it's about taking care of your body as a whole, not chasing someone else's idea of what your body should look like.
I asked Lara what she hopes women take away from this conversation. Her answer is one I think deserves to be highlighted:
"If you remember one thing about weight loss and menopause care, I hope it is to find someone who listens, who is available, and who provides evidence-based care."
I love that. Because finding the right provider is about more than getting a prescription. It's about having someone who listens to your concerns, understands your health history, answers your questions, and walks alongside you as your needs change.
As we head into the holiday season, I hope we can give ourselves a little breathing room. Enjoy the cookies. Eat the pie. Notice when stress is getting the best of you. Pay attention to what your body is communicating rather than immediately criticizing what you see in the mirror.
And if you're curious about HRT, GLP-1 medications, or other ways to support your health in midlife, get informed. Ask questions. Find a provider who listens. Make decisions based on your health and your values, not the latest trend or someone else's expectations.
You don't have to earn your holiday treats, and you don't have to apologize for wanting to feel good in your body.
Perhaps the real midlife goal isn't getting our old bodies back. It's learning how to care for the bodies we're living in now.
