Tales from our Women's Health Hub
“Despite exercising myself to death and watching every morsel, why am I gaining weight after 40?”
Many women who come to see us for a Women’s Health Check have a raised BMI. It’s not an easy subject for anyone to discuss, but the conversation must be had, not least because there are many ways in which we can help support women with their weight loss and, in turn, help them with so many health benefits.
Women who put on weight year on year become quite frightened and distressed. They can feel lost and helpless. It has a huge impact on their self-esteem and confidence and they feel sad that they can’t wear certain dress styles, or get into a particular pair of old jeans they have always loved .
They talk about having two wardrobes, their “fat wardrobe” and their “thin wardrobe” and how they feel that getting into their old clothes is a hopeless goal. However, we all know deep down how unhealthy it is to be overweight and this further compounds the worry around weight gain.
Lots of women who have come to see us have been in cycles of dieting, intense exercise, and meticulous calorie counting—only to see the number on the scale creeping up after 40. It’s a very familiar story.
The impact of perimenopause and menopause on weight
The weight gain that happens in midlife, especially during perimenopause and menopause, is a well-documented phenomenon that affects millions of women worldwide.
Weight gain is one of the most common side effects of perimenopause and menopause, affecting at least 50% of women. Evidence from the SWAN study and The Healthy Women’s study suggests that on average, women gain approximately 1.5kg per year during the perimenopause transition, resulting in an average weight gain of 10kg by the time menopause is reached. Most of this weight accumulates around the abdomen and upper body. As oestrogen levels reduce, visceral fat increases from 5-8% total body weight to 10-15% total body weight. Concurrently, metabolic rate slows as lean muscle mass reduces.
The role of hormonal changes and fat redistribution
One of the primary culprits behind midlife weight gain is hormonal fluctuation. Oestrogen plays a significant role in regulating fat distribution in women. Before menopause, women tend to store fat in the hips and thighs, but as oestrogen levels decline during perimenopause and menopause, fat storage shifts to the abdomen. This results in increased visceral fat—the dangerous fat that surrounds internal organs.
Visceral fat isn’t just a cosmetic concern; it’s metabolically active and has been linked to an increased risk of heart disease, diabetes, and other chronic conditions. This change in fat distribution means that even if your weight remains the same, you may notice a thickening of your midsection and a loss of definition in areas where you previously carried less fat.
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Metabolism slows down with age
Another key factor in midlife weight gain is a slowing metabolism. Metabolism is the process by which your body converts food into energy, and as we age, this process naturally becomes less efficient. Research shows that resting metabolic rate (RMR) declines by about 2-3% per decade after 30, meaning your body burns fewer calories at rest than it once did.
In addition, the body’s ability to utilise carbohydrates efficiently decreases, leading to higher insulin resistance. This makes it easier to store fat, especially around the midsection. Even if you eat the same number of calories as you did in your 30s, your body may now be storing more of them as fat instead of burning them for energy.
Decreased muscle mass and lower energy levels
Muscle mass naturally declines with age—a process known as sarcopenia. Since muscle tissue is metabolically active and burns more calories than fat tissue, losing muscle means burning fewer calories overall. This makes weight maintenance and loss more challenging.
Compounding this issue is the fact that energy levels tend to decline with age, making it harder to maintain an intense exercise routine. Perimenopausal and menopausal women often experience fatigue due to hormonal changes, poor sleep, and stress, all of which make it more difficult to engage in high-intensity workouts or long exercise sessions.
Less muscle mass and reduced energy—means that workouts that once helped maintain weight in your 30s may no longer be sufficient in your 40s and beyond.
Medical conditions that contribute to midlife weight gain
While ageing and hormonal changes play a significant role, it’s important to rule out underlying medical conditions that could be contributing to weight gain. Some of the most common include:
Thyroid Dysfunction (Hypothyroidism)
The thyroid gland regulates metabolism, and an underactive thyroid can slow down metabolism, leading to unexplained weight gain, fatigue, and sluggishness.
Insulin Resistance and Type 2 Diabetes
Midlife weight gain, especially in the abdominal area, is often linked to insulin resistance, a precursor to Type 2 diabetes. Insulin resistance makes it harder for your body to regulate blood sugar, leading to fat accumulation.
Adrenal Fatigue and Chronic Stress
Chronic stress increases cortisol levels, which can promote fat storage around the midsection. Women in midlife often experience higher stress due to work, family, and caregiving responsibilities, exacerbating weight gain.
Sleep Disorders (Sleep Aponea, Insomnia)
Poor sleep quality is linked to weight gain, as sleep deprivation disrupts hunger hormones (ghrelin and leptin), leading to increased appetite and cravings for high-calorie foods.
If you’re struggling with unexplained weight gain despite a healthy lifestyle, consulting a healthcare provider to check for these conditions is crucial.
Medical interventions: Wegovy and Mounjaro
Recently, weight loss medications such as Wegovy and Mounjaro have gained attention in the media for managing midlife weight gain. These injection medications work by mimicking the hormone GLP-1, which helps regulate appetite by increasing feelings of fullness and reducing cravings, they can support weight loss. Some women lose up to 20% of their body weight.
Wegovy and Mounjaro can be effective when combined with lifestyle changes such as a balanced diet and regular exercise. They are prescription only medications and require a detailed medical history taking and prescribing by experts in the field of weight management.
What can you do to manage midlife weight gain?
While weight gain in midlife may seem inevitable, there are strategies to help manage it effectively:
1. Strength training to preserve muscle mass
Since muscle mass naturally declines with age, incorporating resistance training into your routine is essential. Strength training helps build and maintain muscle, which boosts metabolism and increases calorie burn even at rest. Aim for at least two to three strength-training sessions per week focusing on major muscle groups.
2. Adjusting nutrition to support metabolism
What worked for weight management in your 20s and 30s may not work in your 40s and beyond. Some dietary adjustments include:
- Prioritising Protein: Protein helps preserve muscle mass and promotes satiety, making it a key macronutrient for midlife weight management.
- Balancing Carbohydrates: Instead of cutting carbs completely, focus on complex carbohydrates like whole grains, vegetables, and legumes to help manage blood sugar levels.
- Healthy Fats: Incorporate healthy fats like avocados, nuts, seeds, and olive oil to support hormone health and provide sustained energy.
- Reducing Processed Foods and Sugar: Processed foods and refined sugars can exacerbate insulin resistance and contribute to fat storage around the abdomen.
3. Managing stress and prioritising sleep
Since cortisol (the stress hormone) contributes to weight gain, stress management is essential. Incorporate relaxation techniques such as:
- Yoga and meditation
- Deep breathing exercises
- Leisure walks in nature
Adequate sleep is equally crucial, as poor sleep disrupts metabolism and increases hunger hormones.
Summary
Midlife weight gain is influenced by hormonal shifts, metabolic slowdown, fat redistribution, and potential medical conditions. Understanding these changes and adapting your approach to diet, exercise, stress management, and medical care can make a significant difference. With the right adjustments, including possible medical interventions, it is possible to navigate this phase feeling strong, healthy, and confident. We offer tailored advice and guidance to help women live healthier and happier lives.
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Take charge of your wellbeing and book an appointment with one of our GP and Women's Health Specialists at The McIndoe Centre.
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