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Midlife Weight Gain—Sound Familiar? You’re Not Alone

by JoAnn Pinkerton | Jan 23, 2018

We're pleased to have a guest post from Dr. Stephanie Faubion.

Faubion, Stephanie

Stephanie S Faubion, MD, FACP, NCMP, IF
NAMS Board Member

Why is it that midlife women struggle so much with weight? Weight gain is a problem for many women, despite maintaining the same diet and exercise routines that they’ve had for years. Even if the number on the scale doesn’t change, women complain of a shift in fat to the midsection after menopause. Sound familiar? You’re not alone!

The reality is that weight gain during midlife is common, and about two-thirds of women ages 40 to 59 and nearly three-quarters of women older than 60 are overweight (body mass index [BMI] greater than 25 kg/m2). On average, midlife women gain 1.5 pounds (0.7 kg) per year. Although this may not sound like much, it adds up over time. Is this important? Most definitely! Obesity, and specifically abdominal obesity, increases the risk of chronic medical conditions in postmenopausal women, including diabetes, hypertension, hyperlipidemia, certain cancers (including breast and uterine cancers), and heart disease, the number-one killer of women. Women who are obese may also experience more severe hot flashes. In addition, there is an emotional burden related to weight gain in midlife that can affect a woman’s self-image, relationship with her partner, and even her sexual function.

The reasons why this happens are several and probably relate more to aging than to menopause and the loss of the ovarian hormone estrogen. Lean body mass decreases with age in men and women as a result of changes in hormones but also because of changes in lifestyle (more sitting, less physical activity). Because we lose muscle mass with age, we burn fewer calories at rest and also when we exercise. Couple these changes with moving less, and you have a recipe for weight gain. This explains why you may gain weight with the same diet and exercise routine that previously worked for you.

As for the contribution of menopause, the loss of estrogen leads to a shift of fat to the midsection, but women around menopause may have a few other factors that play a role. During the menopause transition, night sweats, sleep disturbance, and problems with mood are common and may affect a woman’s ability to adhere to a healthy diet and regular exercise program. Whether you are just trying to stay awake or combat a low mood, the candy bar (instead of an apple or a bag of carrots) may seem like a great energy booster. Similarly, an exercise class may be more daunting if all you want to do is head to the couch after a long day. Certain medications (including antidepressants, which are commonly prescribed to midlife women) can also promote weight gain.

It’s important for midlife women to understand that the rules change in terms of what it will take not only to avoid weight gain but also to lose weight as we get older. Diligent attention to lifestyle choices, particularly diet and exercise, is important, as is setting reasonable and achievable weight-loss goals.

Contrary to popular belief, exercise alone will not lead to substantial weight loss. Cutting calories is necessary for weight loss, but increasing exercise will help sustain weight loss, prevent weight gain, and lead to favorable changes in body composition (decreased abdominal fat and preservation of muscle mass). The general recommendation is 30 minutes of moderate-intensity exercise most days per week. In terms of the type of diet, none has proven superior to any other in terms of weight loss. The diet that will work the best is one that cuts calories and that you can stick to, keeping in mind that drastic changes in diet are probably not sustainable.

Although estrogen used for management of menopause symptoms is not a weight-loss drug, it improves body composition by reducing abdominal fat. Weight-loss medications may be an option for women with a BMI greater than 30 kg/m2 or greater than 27 kg/m2 with weight-related complications (such as hypertension or diabetes). Bariatric surgery may be an option for women with a BMI greater than 40 kg/m2 or greater than 35 kg/m2 with weight-related complications.

Weight gain is a common, frustrating problem for midlife women and can lead to overweight and obesity and increased risk for chronic medical conditions. Understanding the factors that lead to weight gain and changes in body composition, as well as the importance of lifestyle modification in combating or even preventing these changes, can help women maintain their weight and their health as they age.


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We strive to bring you the most recent and interesting information about various aspect of menopause and midlife health. We accept no advertising for our website. We want you to have accurate, unbiased, evidence-based information. 

JoAnn V. Pinkerton, MD, NCMP
Executive Director


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