I want to start by stating that I’m against diets and diet culture. I’m against the objectification of women and the devotion to thinness so common in many cultures. It deeply saddens me the amount of emotional damage that the pursuit of unrealistic standards of body size can cause in women, sometimes for many years of their lives.
Many of my clients have come from this place of struggle. When working with them, my primary mission is to gently liberate them from the years of negative self-talk and frustration that inevitably come with chronic dieting and/or food restriction. The approach then is to focus less on parameters like the weight on a scale or body fat composition and more on health and wellbeing.
As a warning, this article may trigger some emotional responses in those who struggle with emotional eating. So please do not read it. Contact me to discuss your issues personally instead.
This article intends to cover what happens to the female body around the menopause transition based on scientific evidence, why it is important to learn about the risks involved with this particular change, and suggestions on how to deal with it.
Gaining weight around your belly in midlife
Moving away from the “aesthetics” side of gaining belly fat, the most common type during menopause, there are indeed serious health concerns associated with intra-abdominal or visceral fat. Around midlife and beyond, there’s a higher risk for developing conditions such as type 2 diabetes, heart disease, and cancer due to aging. Gaining weight in the abdominal area can add an extra risk factor for developing these conditions and others, such as increased inflammation in the body, the risk for non-alcoholic fatty liver disease, stroke, arthritis, and metabolic syndrome. Higher body fat serves as insulation and can also aggravate hot flashes, which are common during menopause. I will come back to more of the consequences of weight gain in midlife later.
Research shows that, on average, women gain about 1.5 pounds per year in their 40’s and 50’s.
Approximately two-thirds of women ages 40 and 60 are overweight in the U.S., and almost half are categorized as obese based on their BMI, or body mass index.
Even naturally thin women may start seeing some belly roll that didn’t exist before.
Why is weight gain more common around menopause time?
It’s hard to blame weight gain on the changes coming from either aging or menopause. It likely happens due to both.
One of the reasons that can explain weight gain during this time has to do with changes in metabolism. Metabolism is the mechanism that our bodies burn calories. The average metabolism at rest for a 40-yr-old woman who’s 5.7 and weighs 140lbs is around 1400 calories per day.
There’s evidence that metabolism starts to slow down (or decrease) after the age of 40.
Although a recent (2021) study published in the respected journal Science found that people may not change their metabolism much between the ages of 20 and 60, we can’t deny that muscle mass decreases significantly in women over 40 years of age.
This decrease in muscles can decrease metabolism since muscles require a greater amount of energy to be used as fuel than any other organ in the body except the brain.
Approaching menopause causes the hormone estradiol (a type of estrogen) to fluctuate and eventually decrease to extremely low levels once menopause begins. Since estradiol is anabolic (helps build muscle), a decrease of it can be a factor for decreasing muscle mass further, along with aging.
A classic study examining physical and psycho-social changes during the menopausal transition is the Study of Women’s Health Across the Nation (SWAN). This long-term, longitudinal study followed over 3,000 ethnically diverse women for over eighteen years, starting approximately nine years prior to menopause (perimenopausal years) through ten years after a woman’s last menstrual period.
Some highlight results concerning body composition:
According to body composition assessments, around two years before the last period, the rate for body fat gain doubled, and muscle mass or lean tissue started to decline.
The above trend continued for approximately two years after the last menstrual period, after which the rate decreased by half but continued with a steady progression.
The SWAN data confirm with other bodies of evidence that perimenopausal women go through a more rapid increase in body fat and a redistribution of fat to the abdominal area, which results in a shift from a gynoid (“pear” shape) to an android (“apple” shape). Other radiology testing studies have found that postmenopausal women have more intra-abdominal or visceral fat (deep belly fat) than premenopausal women.
Are all women in perimenopause or menopause at risk for weight gain?
The answer is no. Many women go through menopause without gaining any weight; some might even lose weight, but most likely because of a loss in muscle mass.
Factors that may affect weight gain can be:
AGE – age by itself increases the chance of gaining weight
GENETICS – If obesity runs in the family, the genes can be passed down the line. This does not mean that you’re doomed. Lifestyle habits can have a great impact on the expression of those genes.
RACE & ETHNICITY – In both men and women, obesity in the U.S is highest in black and brown people, followed by Hispanic, then white. Asians have lower rates of obesity, but within this group, ethnic groups such as Filipino have higher rates, while Japanese have lower rates.
SOCIO-CULTURAL – Within this category, there are many factors: economic, availability of healthy foods, cultures that prioritize food in gatherings, safety, marital status, etc.
SEDENTARY LIFESTYLE – Lack of physical activity, long hours of screen time, sedentary job.
EATING BEHAVIORS – Eating high amounts of processed foods high in sugar and fat can increase daily calories to the point that’s it’s hard to burn.
LACK OF SLEEP – Studies have shown that insomnia or lack of sleep can increase a person’s weight, probably by changes in hormones that control hunger and circadian rhythm.
STRESS – When stressed, the release of cortisol, a defense hormone, will decrease metabolism to shift to a “survival mode,” triggering fat storage, among other things.
PSYCHOLOGICAL -Trauma or some childhood experiences can manifest on disordered eating behaviors, including bingeing. Depression can also trigger emotional eating.
Stress eating during the menopause transition
Perimenopause and menopause can be a period of extreme changes in a woman’s life. These changes are not only physical but psychological as well.
Depression is higher during this phase of life. It can be associated with various factors or circumstances: hormonal changes, aging parents, “empty nest syndrome,” teenager kids, financial fears around retirement, higher responsibilities at work, divorce.
Adding low self-esteem due to weight gain and aging can be a real low point during this complicated time.
Studies have found that women in midlife have a higher probability of turning to stress eating to cope with their emotions.
One study reviewed the role of depression and stress eating in the menopause transition and found the following:
Environmental stress is associated with lower estrogen levels.
Hormone imbalances happen not only from the biological expression of perimenopause itself but from psychological factors, which can induce coping responses such as stress or emotional eating.
Postmenopausal women are more likely to experience an increase in appetite due to stress or depression than premenopausal women.
According to this study, there may be a connection between hormone fluctuation and stress response, accounting for weight gain.
The important lesson here is that women during this time need to learn non-food strategies for stress management.
How to achieve sustainable weight loss during the menopause transition?
Let’s start with what NOT to do: Don’t follow any restrictive diets. Restricting foods or calories in excess can add stressors to your body. Your metabolism may decrease, your mood swings may get worse, your quality of life may plummet. It’s not worth it, especially at this phase of life, when you’re probably dealing with lots of other things.
I’m sorry to say, but there’s no shortcut.
I want to invite you not to think of how “hard” and “long” this process will be. Instead, it is an opportunity to take care of yourself and your body, nourish it with healthy foods, and allow you to have your favorite treats.
Learn about moderation, about listening to your body’s cues, get in tune with yourself.
Suppose you take the focus away from hitting a number on a scale or fitting on a specific size of clothes and shift towards more significant benefits such as your wellbeing, your energy level, your sleep quality, your improved physical strength or how your body “feels” better instead of “looks” better. In that case, there’s a chance you will change for the better in more than one way.
Here are some specific tips to improve your nutrition and to help manage your weight:
Eat breakfast – although some women skip this important meal to save calories, many studies have shown that people tend to compensate for those calories later in the day. Eating breakfast can decrease morning cortisol (stress hormone) and increase the action of insulin for muscle building. It's a win-win situation for perimenopausal and menopausal women
Add 20-30g of proteins in the main three meals and around 10 -20g of protein to snacks. Good sources of protein are lean meats (beef, chicken, turkey, pork), fish and seafood (tuna, cod, shrimp, salmon, scallops, etc), dairy (yogurt, cottage cheese, cheese, etc), eggs, plant proteins (beans, peas, soy, tempeh, quinoa, lentils, chickpeas, nuts, seeds) and supplements (collagen, whey or vegan protein powder).
It may help to use a calorie tracker. The caution comes with setting the calories in terms of not reducing them too much. 300 caloric deficit per day from your total energy expenditure should be enough for a gradual weight loss. Be sure to add any physical activity to the daily expenditure total.
Eat enough fruits and vegetables. They have antioxidants that fight inflammation, lots of fiber, and micronutrients that are great for skin, bone, digestive, and overall health. Aim to have 1 ½ to 2 cups of fruits and 2 to 2 1/2 cups of colorful vegetables when you can.
Move. Exercise and be active. Include strength training exercises at least 2x /week to build those muscles. It’s not about exercising to burn calories, it’s about incorporating the activities that will benefit your muscles and bones.
Don’t go crazy on the weekends. Enjoy foods and drinks you love in moderation; no need to overindulge. If you allow yourself to treat yourself occasionally, there won’t be such a lure to those foods. There are no forbidden or bad foods.
Remember that managing weight during menopause transition should not have a deadline or be too stressful. It’s ok to set short-time goals with small signs of progress other than weight that add up with time.
And although it can be concerning to gain weight in midlife, don’t let it worry you too much. Just decide to do something about it. Imagine if your doctor recommended strength exercise to protect your knee – you would simply try to incorporate that into your life, correct? Same thing with nutrition: try incorporating it into your reality, there’s no need for a drastic change.
Slow and steady is what will get you there!