Managing Midlife Weight Gain: Strategies & Solutions

One of the most frustrating shifts for many menopausal women is weight gain, especially around the midsection. If you’ve noticed the scale creeping up despite your best efforts, you’re not alone. Understanding why this happens and what you can do about it is key to maintaining your health and well-being during menopause and beyond.

Why Does Weight Gain Happen in Midlife?

Although aging is the main reason for midlife weight gain, menopause plays a role in changing how and where our bodies store fat. As estrogen levels decline, fat tends to accumulate more in the abdomen rather than the hips and thighs. This shift increases the risk of health concerns like heart disease and type 2 diabetes. Excess weight—especially abdominal fat—can worsen menopause symptoms like hot flashes and night sweats, impact sexual health, and contribute to joint pain, sleep apnea, and even cognitive decline.

How Can You Manage Weight Gain in Menopause?

The good news? You don’t have to accept weight gain as inevitable. A multi-faceted approach that includes lifestyle changes and, if necessary, medical treatments can help.

1. Nutrition Matters

Your metabolism naturally slows as you age, so your dietary needs shift. Focus on nutrient-dense foods:

Lean proteins (chicken, fish, tofu)
High-fiber foods (vegetables, whole grains, legumes)
Healthy fats (avocados, nuts, olive oil)
Reducing processed foods and added sugars to prevent blood sugar spikes

2. Exercise Smarter, Not Harder

A combination of strength training and cardio is key. Strength training preserves muscle, which helps keep your metabolism active, while activities like walking, swimming, and cycling improve heart health. Don’t forget flexibility and balance exercises like yoga or Pilates to support overall mobility and prevent injury.

3. Behavioral Shifts Make a Difference

Small, sustainable lifestyle changes can lead to lasting results:

Prioritizing sleep (7-9 hours per night) to regulate hunger hormones
Managing stress through meditation, deep breathing, or hobbies
Tracking food and activity to increase awareness of habits

What About Medications?

For some women, lifestyle changes alone may not be enough to achieve and maintain a healthy weight. Several FDA-approved medications are available to help manage weight, particularly for those with a higher BMI or related health conditions.

FDA-Approved Medications for Weight Loss

Tirzepatide (Zepbound, Mounjaro) – A dual glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) receptor agonist (RA) offers significant weight loss (up to 21% in 16 months). Taken as a weekly injection.
Semaglutide (Wegovy, Ozempic) – A glucagon-like peptide-1 receptor agonist (GLP-1 RA) that slows digestion, reduces appetite, and improves insulin sensitivity. Weekly injections can lead to an average weight loss of 15% over 16 months. FDA-approved to reduce risk for cardiovascular disease (CVD). Should not be used by women with a personal or family history of medullary thyroid cancer or multiple endocrine neoplasia syndrome type 2.
Oral Semaglutide (Rybelsus) – The first FDA-approved oral GLP-1 receptor agonist. Taken as a daily tablet, it works similarly to its injectable counterparts by slowing digestion, reducing appetite, and improving blood sugar regulation. Although only approved for treating type 2 diabetes, it has shown promising weight-loss benefits.
Phentermine/Topiramate (Qsymia) – A combination of an appetite suppressant and a medication that affects neurotransmitters. Can result in average weight loss of 9-11% over 12 months. Taken as a daily oral tablet. Should not be used by women with CVD, untreated hyperthyroidism, uncontrolled hypertension, monoamino oxidase (MAO) inhibitor use, or closed-angle glaucoma.
Naltrexone/Bupropion (Contrave) – Works by affecting the brain’s reward system to reduce cravings and appetite. Typically results in 5-6% weight loss over 12 months. Not recommended for women using opiates or MAO inhibitors.
Orlistat (Alli, Xenical) – A fat absorption inhibitor that blocks dietary fat intake. Can be taken orally and lead to weight loss of 5-6% in 12 months.

Is Medication Right for You?

Weight-loss medications are typically recommended for women with:

A BMI of 30 or higher
A BMI of 27 or higher with obesity-related health conditions

Because these medications require long-term use to maintain weight loss, it’s important to discuss with your doctor whether they align with your health goals and lifestyle. Additionally, certain medications may be better suited for specific health conditions:

Heart Disease? Semaglutide is FDA-approved to reduce cardiovascular risk.
Diabetes or Prediabetes? Tirzepatide or semaglutide have effects
that extend beyond weight loss because they help prevent the progression from prediabetes to diabetes, improve diabetes control, and metabolic dysfunction-associated liver disease.
Struggling with cravings? Naltrexone/Bupropion may be the best fit.
Prefer an oral option? Oral semaglutide (Rybelsus), Phentermine/Topiramate, or Naltrexone/Bupropion are taken as pills.
Cost a factor? Phentermine/topiramate ER is the most cost-effective antiobesity medication, with a monthly cost of $100 USD.

Final Thoughts

Midlife weight gain can feel discouraging, but you are not powerless. By focusing on nutrition, exercise, and lifestyle habits—and considering medical options if needed—you can take control of your weight and overall health.

Menopause is a new phase of life, and while changes come with it, they don’t have to define you. Stay informed, be proactive, and take the steps that make you feel your best. Your health is worth it!