Midlife Weight Gain: The Latest from NAMS 2022 – Everyday Health

At this year’s meeting, menopause experts discussed recent data on age-related weight change, belly fat accumulation, and what women can do about it.
Whoever coined the phrase “Don’t mess with success,” had probably never gone through the transition to menopause. Seemingly overnight, a diet and exercise routine that’s helped you maintain a healthy weight for most of your adult life isn’t working the way it once did.
“Weight gain in midlife often surprises women,” says Stephanie S. Faubion, MD, the medical director of the North American Menopause Society (NAMS). While the age at which women reach menopause varies, many start to experience the years-long transition — and the symptoms that come with it — in their forties.
“I commonly have women come into my office saying, ‘I haven’t changed anything, and I’m gaining weight.’ My response is, ‘Exactly. If you haven’t changed anything, you will gain weight in midlife. The rules of your body have changed.’ It’s very frustrating for women, but it’s predictable,” says Dr. Faubion, who is the director of the Office of Women’s Health at the Mayo Clinic in Jacksonville, Florida.
In this stage of your life, you have to be more diligent than ever in your attention to your lifestyle, says Ekta Kapoor, MBBS, a researcher and physician at the Menopause and Women’s Sexual Health Clinic at Mayo Clinic in Rochester, Minnesota.
Without extra effort at healthier eating and regular physical activity, weight gain is inevitable, she says.
A leading researcher in menopause and weight, Dr. Kapoor presented on the effects of age and menopause as well as weight management strategies at this year’s annual meeting of the North American Menopause Society (NAMS) held October 12–15, 2022, in Atlanta.
“It is imperative that women enter menopause with this knowledge and familiarity with practical tips to prevent and manage weight gain,” she says.
Women in their fifties gain an average of about 1.5 pounds a year, says Dr. Kapoor.
The increase is gradual, but women tend to find it unsettling; weight gain is a common complaint of midlife women, and it can bother them more than vasomotor symptoms such as hot flashes and night sweats, says Kapoor.
Hormones aren’t really to blame for the weight gain in menopause, says Faubion. “In general, both men and women gain weight in midlife,” she says. For starters, a decrease in muscle mass means that the body burns fewer calories, both during activities and at rest, says Kapoor.
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Midlife can also be a time where subtle but real decreases in physical activity take place, she notes. People may spend less time engaging in moderate to high intensity exercise.
Changes in lifestyle, such as attending more social events, can mean consuming more calories, says Faubion.
The result? A “positive energy balance” (having more calories than the body burns), which leads to increased fat and weight gain, says Kapoor.
The loss of estrogen that happens during menopause can cause women to accumulate fat in their belly area, says Kapoor. Even women who don’t gain weight overall may still see an increase in belly fat, she adds.
Nearly two out of three women in the United States between the ages of 40 and 65 are classified as obese, and among women over 65, it’s almost 74 percent, according to the National Health and Nutrition Examination Survey (NHANES).
Overweight and obesity is determined by body mass index (BMI), which is a person’s weight in kilograms divided by the square of their height in meters. Normal weight is 18.5 to 24.9; 25–29.9 is considered overweight, and 30 and above is considered obese.
Overweight or obesity increases a woman's risk of cardiometabolic conditions such as type 2 diabetes, hypertension, dyslipidemia, and coronary artery disease. Obesity also increases the risk of cancer in women, including breast and endometrial cancer, says Kapoor.
Extra fat in the midsection can also increase the risk for some chronic diseases, she says. Deeper belly fat, the visceral fat that accumulates around abdominal organs such as the pancreas, liver, and the small and large intestines, is active metabolic tissue and releases hormones and free fatty acids that have been linked to heart disease, diabetes, and hypertension, says Kapoor.
Although hormone therapy (HT) should not be used solely for weight management in midlife women, it may be one of many tools women can use to achieve a healthy weight, says Kapoor. For starters, it can improve body composition by redistributing the visceral fat to lower body fat deposits, she says.
Hormone therapy may indirectly help weight management strategies by reducing the burden of menopause symptoms (such as night sweats and other symptoms that interfere with sleep) and facilitating the adoption of a healthier lifestyle, says Kapoor.
Even women who aren’t candidates for hormone therapy or who do not wish to use it should pay close attention to managing menopause symptoms with nonhormone strategies, says Kapoor. Sleep disturbance and mood disorders are particularly crucial to mitigate given their adverse impact on midlife women’s weight, she says.
Some medications that menopausal women may be taking, including antidepressants, may contribute to weight gain, says Faubion. Talk with your doctor about your options if this is a concern.
“The most important intervention is to watch our overall caloric intake, and keep reducing it as we get older,” says Kapoor. Calorie restriction is necessary in order to match the reductions in the energy expenditure, which declines with age, she says.
Physical activity or exercise itself does not result in any substantial weight loss, says Kapoor.
“Though exercise is less effective than dietary interventions for weight loss initially, it plays a crucial role in weight maintenance after diet-induced weight loss and has multiple other health benefits,” she says. Kapoor recommends that women get 150 to 200 minutes of exercise a week.
Be ready for the changes that menopause will bring, says Kapoor. “Anticipate a slowing in metabolic rate in midlife that requires a reduction in caloric intake” she says.
Women who approach menopause at a normal weight are more likely to maintain it during the menopause transition, and in the following years, says Kapoor.
Medications for weight loss can be considered in clinically appropriate situations, for patients who meet the prescription thresholds, says Kapoor. Bariatric surgery is also a consideration for women with weight-related comorbidities, she says.
If trying to squeeze into skinny jeans is making you miserable, it could be time to let that go. “As long as a woman maintains a healthy body weight, she doesn’t have to remain a size 2,” says Faubion. “It’s probably unrealistic to believe that we will weigh the same as we did in high school when we go through menopause.”
A healthy weight is just that — healthy — and that’s the goal. “Weight loss of as little as 3 percent can provide significant health benefits, including improved cholesterol and lower risk of diabetes,” says Kapoor. For a 160-pound woman, that would translate to a weight loss of about 5 pounds.
A weight loss of 5 to 10 percent of body weight (provided that the woman needs to lose that amount to fall within the healthy BMI range) can have added health benefits, including improved blood pressure and less chronic pain, she says.
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