Menopause has a bad reputation, and for many women, the leading reason for this is that women in their 50s gain an average of 1.5 pounds each year, much of it in the form of stubborn belly fat.
“Menopause is associated with increased abdominal weight gain, increased visceral fat (fat dispersed around the organs), and decreased muscle mass,” Jolene Brighton, PhD, a Florida-based naturopathic endocrinologist and author of Is This Normal?, told Fortune. “While aging is generally thought to be behind the increased distributed central fat, the decline in estrogen is strongly associated with this change in body composition.”
According to Brighton, weight gain can be caused by a variety of factors, including changes in testosterone levels, lack of sleep, and muscle wasting.
These changes “can cause a spike in cortisol, insulin, and more,” Dr. Karen Tang, a Philadelphia-based gynecologist with 460,000 followers on TikTok, tells Fortune. Both can lead to weight gain and increased appetite issues, but cortisol in particular has been linked to increased abdominal fat storage.
“It also increases your risk of things like insulin resistance and diabetes, which can contribute to fat storage,” she says.
What’s more, Tan, who is also Centrum’s menopause spokesperson, explains that these big changes can lead to hormone-related symptoms of bloating, such as water weight, but she says that the most troubling thing is the extra visceral fat that “you can’t eat.”
In particular, Brighton adds, “higher trunk fat distribution has been associated with increased risk of diabetes, cardiovascular disease, high blood pressure and metabolic syndrome.”
What to do about the excess belly fat gained during menopause?
Tan says it’s important to first see a doctor who can investigate medical reasons for your weight gain, from thyroid issues to diabetes.
But once those have been ruled out, you need to start looking at ways to change your exercise and eating habits.
“You may need to change up your exercise routine,” says Brighton, especially if you notice that your previous exercise routines no longer have as much effect on your body.
Focusing on building muscle mass should be a priority, she advises. “Additionally, find ways to increase your activity levels throughout the day by going for a walk, taking up a new hobby that gets you moving, or being mindful of the time you’re sitting,” she says. For patients who work at a desk, Brighton suggests they consider wearing a weighted vest and working out on a treadmill.
“Try something like tennis or pickleball,” she adds. “These provide the benefits of physical activity and community, and are closely linked to longevity.”
Tan recommends strength training at least twice a week, as it has been shown to help maintain bone density and prevent osteoporosis.
She also suggests trying shorter, high-intensity interval exercises rather than long-distance walking, for example, but always balance this with other menopausal symptoms, such as joint pain. “Sometimes it’s about finding something sustainable that you enjoy without exacerbating other symptoms,” says Tan.
You may need to change the way you eat.
Even if you’ve eaten the same diet your whole life, your body now processes food differently, which explains the seemingly inexplicable weight gain, says Tan. “Your muscles respond differently, and you have less muscle mass than before, which changes your metabolism,” he says. “To combat these changes, you need to take them into account when thinking about how to eat and exercise,” he says.
Tan says there’s evidence that cutting back on excess sugar, salt and processed foods and embracing a Mediterranean, plant-based diet can help with menopausal symptoms. “And we want people to eat healthy foods that nourish their bodies, rather than just starving themselves,” she says.
Brighton suggests increasing your protein and fiber intake and limiting alcohol and added sugars to less than 25 grams per day, and if you’re not sure where to start, “working with a registered dietitian or certified nutritionist who specializes in menopausal women can help you get started,” she adds.
Additionally, Brighton recommends talking to your doctor about whether menopausal hormone therapy is appropriate to help limit central weight gain, build muscle mass, and support your training efforts.
The good news in all of this, says Tan, is that while the metabolic and belly fat changes may feel severe during the perimenopause-to-premenopause transition, which lasts an average of 10 years, there’s evidence that they eventually level out. “So it’s not really a snowball effect,” she says, “but it’s a very difficult few years as people try to find a new normal.”
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