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Menopausal Weight Gain - The Hottest Topic of 2023

As the last post of 2023, I'm reposting the top viewed post of 2023. Anyone want to guess the topic? Yep, you got it. Menopausal weight gain!


"Debunking Myths of Menopausal Weight Gain" was most the most popular post of 2023, but all posts about weight gain drew a crowd - here and here. Articles regarding the use of weight loss drugs, fad diets, and alcohol also were popular. You can find tips on how to alter your eating habits during menopause (check out this post) and learn about nutrition and hydration considerations during menopause here, here, and here.


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Many of my menopausal patients list weight gain as one of their most bothersome symptoms. And with good cause. Not only does increased weight put you at higher risk for serious disease, but also it impacts your confidence, sense of self, and mood. In good news, menopause does not cause weight gain per se. In bad news, there's no good way to counteract the real culprit.


Women have a tendency to gain weight with age, independent of menopausal status. Studies show that women gain about 1.5 pounds per year during their 50s and 60s. Although 1.5 pounds doesn't seem that big of a deal, it's not difficult math to understand that those pounds could add up to an additional 30 pounds in 20 years. Some of the weight gain can be blamed directly on decreased estrogen and progesterone (i.e., menopause). Decreased estrogen causes women to feel more hungry, process carbohydrates and proteins poorly, use muscle protein (instead of fat) as fuel, decrease muscle mass, and store more fat, but numerous studies have confirmed that there is little net effect on weight caused by menopause. Consistent with those findings, menopause hormone therapy (MHT) does not appear to limit or reduce weight gain.


There also are other indirect factors that influence weight that are in play for women in this age range: higher incidence of mood disorders like depression and anxiety can lead to additional food intake; sleep disturbance from night sweats can cause fatigue that limits the frequency and/or intensity of workouts; decreased muscle mass as a consequence of aging burns fewer calories; and an overall decrease in physical activity in women as they age can further decrease muscle mass.


Instead of an increase in weight, menopause has been shown to cause a redistribution of fat from the hips and thighs of women to their midsection. Your pants really did get tighter in the waist. But your pants would be tighter even if you weighed exactly the same as when you were 30 or 40. In fact, the fat redistribution does not appear to be different for menopausal women regardless of their weight, body fat, or physical activity level. In a recent study, visceral fat deposits in menopausal women were shown to increase to 15% to 20% of total body fat, compared with 5% to 8% in premenopausal women. Premenopausal women (5-7 years before their final menstrual period) did not experience an increase in visceral fat until the menopause transition (3 years before to 1.5 years after their final menstrual period), but their overall body fat and waist and hip girth did increase.


Although there are obvious pyschosocial issues associated with a radical change in body shape (from pear to apple), the increase in visceral fat is most alarming since it is linked to a higher incidence of serious health conditions, like stroke, heart disease, type 2 diabetes, Alzheimer’s, dementia, high blood pressure, breast, endometrial, and colorectal cancer, and high cholesterol. Unfortunately, scientists have not found anything that will stop or reverse this redistribution. No matter what any social media influencer tells you, there are no exercises, foods, diets, or supplements that target visceral fat. However, a separate study found that "not only do women who enter midlife with a higher level of physical activity and maintain that level weigh less to begin with and gain less weight over time, but women who increase their level of activity in midlife, regardless of where they start from, also gain less weight." Experts recommend that women do the things that are proven to reduce body fat in general - eat better, exercise more, reduce stress, limit alcohol, don't smoke, and get adequate sleep.


In summary, women gain weight steadily from their 30s through their 60s, but the weight gain is not caused by menopause. Instead, menopause prompts a redistribution of fat from the hips and thighs (gynoid fat) and the fat you can grab around your waist (android fat) to so-called visceral fat deep within your abdomen surrounding your organs. This increase in visceral fat has significant health ramifications since visceral fat has been linked to cancers, metabolic diseases, cardiovascular diseases, and progressive brain disorders. Although experts are not certain how to reduce visceral fat specifically, they do recommend that women exercise regularly and focus on making healthy lifestyle choices as a way to reduce overall body fat.


Perhaps the worst news of this blog post is that you can't really change the fact that your body shape changes during menopause. The good news is that it's not your fault...it's your physiology. If you can make healthier choices, you should do that. But if you're already doing all the things you should be doing, I encourage you to embrace the new you. If nothing else, it's a good excuse to buy new clothes and get that new bike that you've been eyeing since "your doctor told you to exercise more." We're in this together.


Happy New Year from Purely Menopause!




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