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Body Changes & Weight Gain

Body changes at midlife are normal and staying healthy should be the goal.

What do we mean by “body changes”?

  1. Change in body composition: loss of lean muscle mass and concurrent increase in fat mass
  2. Accrual of fat to the midsection and waist area instead of hips and thighs
  3. Weight gain (most research links gain to aging and not perimenopause per se)
The weight gain has been a disaster. I’ve always struggled with weight, but this is different. I’m always hungry. And I know I’m not making good choices, but it’s really been hard.

WLB Community Member

 

Theories about midlife weight gain & body changes

Body changes at midlife are a reality for most of us and the reasons why things change are not fully understood. Our goal is to share a range of theories and data to illustrate the wide range of factors that might lead to these body changes during midlife. As you’ll see some of these are at odds.

Theory 1: The changing hormones of the menopausal transition are to blame, namely a decline in estrogen.

  • Estrogen doesn’t decline for most of us until after the final menstrual period yet weight gain can begin before.

  • Some research supports that it’s aging and not hormonal changes that lead to weight gain.

  • Other research documents that a decline in estrogen leads to decreased energy expenditure (EE), which can contribute to fat gain.

Theory 2: It’s more about a change in body shape than weight gain.

  • Research does document a change in where we store fat. The medical term is central adiposity which means “middle” — it’s the increased size of our waistlines.

Theory 3: The loss of muscle mass as we age leads to a change in metabolism.

  • We lose lean muscle as we age. Muscle mass decreases approximately 3–8% per decade after the age of 30 and this rate of decline is even higher after the age of 60. Less lean muscle changes our resting metabolic rate.

  • However, a recent study (2021) determined that metabolism does not change until our 60s (more on this below).

Theory 4: Sleep disruption leads to weight gain.

  • For many of us, the weight gain begins before menopause when estrogen is still around. Yet, sleep disruption begins earlier. Our disrupted sleep page (link) offers ideas on how to get better sleep.

  • There is interesting research on short sleep and weight gain which we share below.

Hormonal contributors to midlife body changes

There are many hormones involved in the processes that lead to body changes. See the two papers we share in “featured resources”.

Chronic stress, common at midlife, causes a rise in cortisol, a hormone known as the “stress hormone”. Cortisol can impair metabolism. High cortisol makes us burn muscle and build fat.

Remedies to address body changes

PHYSICAL ACTIVITY

In a 3-year study, higher levels of sports/exercise and daily routine activity were associated with lower weight and waist circumference.

Read More

Greater levels of participation in both sports/exercise and daily routine activity over time were also associated with lower risk of substantial weight gain.

Furthermore, when within-woman changes in weight and waist circumference were examined in relation to categorical change in activity, women who increased their activity had the least amount of gain, while those who decreased their activity had the most. (Sternfeld, 2004 SWAN)

MAINTAIN LEAN MUSCLE MASS

Maintaining lean muscle mass can be achieved with a combination of resistance training plus a balance of protein, carbohydrates, and fat.

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Resistance training is building muscle by working against a force or weight. That force can be your own “body weight” as in push-ups or squats. Or the force can be lifting weights or other heavy objects or using resistance bands.

Getting enough protein is necessary. The Mayo Clinic shares these guidelines: 1–1.2 grams per kilogram or 75–90 grams per day for a 75-kilogram person. If you exercise regularly increase it to 1.1–1.5 grams per kilogram. And if you lift weights, increase again to 1.2–1.7 grams per kilogram.

Carbohydrates and fat are often vilified but they shouldn’t be. They are both necessary to build and maintain lean muscle mass. The Mediterranean diet (way of eating) is a good guide here.

MENOPAUSAL HORMONE THERAPY

MHT is not indicated for weight management or weight loss, however, women taking MHT for VMS symptoms (hot flashes & night sweats) noted favorable effects on body composition. The Menopause Society Hormone Therapy Position Statement

WEIGHT LOSS MEDICATIONS & BARIATRIC SURGERY

There are many new weight loss drugs aimed at those with type 2 diabetes and obesity: Ozempic, Wgovvy, Mounjaro, and Retatrutide.

Bariatric surgery is an option for obesity and includes a few types of procedures: gastric bypass and sleeve gastrectomy among others. More here.

FEATURED RESOURCES

A research paper that gives a window into the complexity of body changes at midlife.

A paper that examines the changes in satiety and hunger hormones between stages of reproductive aging.

Let’s dig into the research

SLEEP & WEIGHT GAIN

In a study with 68,000+ women, those who got less than 5 hours of sleep a night, gained more weight than those who slept 7+ hours a night.

HUNGER & SATIETY HORMONES: GHRELIN & LEPTIN

A very small study (only 15 people) had each person undergo three different sleep patterns

  1. Sleep for 7 hours
  2. ‘Late-night sleep loss’: sleep for 4 hours early in the night and then stay awake
  3. ‘Early-night sleep loss’: stay awake and then fall sleep at 3am

When sleep was restricted in the second half of the night vs. restriction in the first half of the night, it led an effect on ghrelin (the hunger hormone), hunger, appetite, and the desire to eat.

Another study found relationships between ghrelin and leptin and FSH and other hormones that change on the path to menopause.

ANXIETY, DEPRESSION & QUALITY OF LIFE

This study was conducted with 336 women ages 35–47 years over a 4-year time frame. The researchers aimed to answer what factors are related to clinically significant weight gain. (Freeman, POAS)

They identified these factors related to weight gain (predictors of gaining ≥10 lb):

  • anxiety
  • depression
  • quality of life measures
They found that the following factors were not related to weight gain:
  • hormone levels (included were estradiol (E2), follicle-stimulating hormone (FSH), luteinizing hormone (LH), dehydroepiandrosterone sulfate (DHEAS), and testosterone)
  • smoking
  • alcohol
  • food intake
  • self-reported measures of physical activity
QUESTIONING BMI
Top 3 Reasons to Rethink the BMI

BMI doesn’t take into account the relative amounts of body fat to lean muscle. A piece from NPR gives 10 reasons to rethink the value of BMI as a metric and here are the top 3:

  • The person who dreamed up the BMI said explicitly that it could not and should not be used to indicate the level of fatness in an individual.

  • It is scientifically nonsensical.

  • It is physiologically wrong.

For more details, and the remaining reasons you can read the full article: Top 10 Reasons Why The BMI Is Bogus

Read the Article
DATA REVIEW

The data are inconclusive

The data about weight gain and body composition is inconsistent and the theories about what contributes to body changes are often contradictory.

No Association with Weight Gain

A 3-year analysis in 3064 racially/ethnically diverse women, ages 42-52 found that change in menopausal status (i.e. going from premenopausal to the early menopause transition) was not associated with weight gain or significantly associated with increases in waist circumference.
The Study of Women’s Health Across the Nation

Weight Gain & Loss (3 Yrs)

In another 3-year study with 485 women, 42 to 50 years women gained an average of 2.25 +/- 4.19 kg (4.96 +/- 9.23 lbs)
  • 20% gained 4.5 kg (9.9 lbs)
  • 3% lost 4.5 kg (9.9 lbs)
Wing RR, et al. Weight gain at the time of menopause. Arch Intern Med. 1991 Jan; 151(1):97-102.

Average Weight Gain (10 Yrs)

The Australian Longitudinal Study on Women’s Health reported an average weight gain of 6.3 kg (13.8lbs) over 10 years
Australian Longitudinal Study on Women’s Health

Increased Body Fat

Visceral adipose tissue increases more rapidly during the menopause transition, before and after the Final Menstrual Period (FMP)
Visceral fat is belly fat found deep within your abdominal cavity. It surrounds important organs, including your stomach, liver and intestines.
5 YEARS  → 2 YEARS BEFORE FMP
2.3% Increase
in Visceral Adipose Tissue
2 YEARS BEFORE FMP → FMP
7.3% Increase
in Visceral Adipose Tissue
FMP  → 5 YEARS AFTER
4.5% Increase
in Visceral Adipose Tissue
The Study of Women’s Health Across the Nation

Body Weight Change (Per Yr)

% change in body weight per year (from 8 years to 1 year before the FMP): .3%
% change in body weight per year (1 year before the FMP to 3 years after): .4%
Actual weight change per year (1 year before the FMP to 3 years after): .25kg/year (.55 lbs/year)
The Study of Women’s Health Across the Nation (n= 1246 women)

REFERENCES

  1. Greendale GA, Sternfeld B, Huang M, Han W, Karvonen-Gutierrez C, Ruppert K, Cauley JA, Finkelstein JS, Jiang SF, Karlamangla AS. Changes in body composition and weight during the menopause transition. JCI Insight. 2019 Mar 7;4(5):e124865. doi: 10.1172/jci.insight.124865. PMID: 30843880; PMCID: PMC6483504.
  2. Mary D Sammel, Jeane Ann Grisso, Ellen W Freeman, Lori Hollander, Li Liu, Shinlan Liu, Deborah B Nelson, Michelle Battistini, Weight gain among women in the late reproductive years, Family Practice, Volume 20, Issue 4, August 2003, Pages 401–409, https://doi.org/10.1093/fampra/cmg411
  3. Pontzer H, Yamada Y, Sagayama H, Ainslie PN, Andersen LF, Anderson LJ, Arab L, Baddou I, Bedu-Addo K, Blaak EE, Blanc S, Bonomi AG, Bouten CVC, Bovet P, Buchowski MS, Butte NF, Camps SG, Close GL, Cooper JA, Cooper R, Das SK, Dugas LR, Ekelund U, Entringer S, Forrester T, Fudge BW, Goris AH, Gurven M, Hambly C, El Hamdouchi A, Hoos MB, Hu S, Joonas N, Joosen AM, Katzmarzyk P, Kempen KP, Kimura M, Kraus WE, Kushner RF, Lambert EV, Leonard WR, Lessan N, Martin C, Medin AC, Meijer EP, Morehen JC, Morton JP, Neuhouser ML, Nicklas TA, Ojiambo RM, Pietiläinen KH, Pitsiladis YP, Plange-Rhule J, Plasqui G, Prentice RL, Rabinovich RA, Racette SB, Raichlen DA, Ravussin E, Reynolds RM, Roberts SB, Schuit AJ, Sjödin AM, Stice E, Urlacher SS, Valenti G, Van Etten LM, Van Mil EA, Wells JCK, Wilson G, Wood BM, Yanovski J, Yoshida T, Zhang X, Murphy-Alford AJ, Loechl C, Luke AH, Rood J, Schoeller DA, Westerterp KR, Wong WW, Speakman JR; IAEA DLW Database Consortium. Daily energy expenditure through the human life course. Science. 2021 Aug 13;373(6556):808-812. doi: 10.1126/science.abe5017. PMID: 34385400; PMCID: PMC8370708.
  4. Patel, SR, Malhotra, A, White, DP, et al. Association between reduced sleep and weight gain in women. Am J Epidemiol. 2006; 164: 947-954
  5. Kapoor E, Collazo-Clavell ML, Faubion SS. Weight Gain in Women at Midlife: A Concise Review of the Pathophysiology and Strategies for Management. Mayo Clin Proc. 2017 Oct;92(10):1552-1558. doi: 10.1016/j.mayocp.2017.08.004. PMID: 28982486.
  6. Wing R.R., Matthews K.A., Kuller L.H., Meilahn E.N., Plantinga P.L. Weight gain at the time of menopause. Arch. Intern. Med. 1991;151:97–102. doi: 10.1001/archinte.1991.00400010111016.)
  7. Adamson, L.; Brown, W.; Byles, J.; Chojenta, C.; Dobson, A.; Fitzgerald, D.; Hockey, R.; Loxton, D.; Powers, J.; Spallek, M. Women’s Weight: Findings from the Australian Longitudinal Study on Women’s Health; Department of Health and Ageing, Australian Government: Canberra, Australia, 2007.
  8. Gavin KM, Kohrt WM, Klemm DJ, Melanson EL. Modulation of Energy Expenditure by Estrogens and Exercise in Women. Exerc Sport Sci Rev. 2018 Oct;46(4):232-239. doi: 10.1249/JES.0000000000000160. PMID: 30001272; PMCID: PMC6138559.
  9. Sowers MR, Wildman RP, Mancuso P, Eyvazzadeh AD, Karvonen-Gutierrez CA, Rillamas-Sun E, Jannausch ML. Change in adipocytokines and ghrelin with menopause. Maturitas. 2008 Feb 20;59(2):149-57. doi: 10.1016/j.maturitas.2007.12.006. Epub 2008 Feb 14. PMID: 18280066; PMCID: PMC2311418.