Dr K Weight Loss Clinic
For Women Over 40
76 Harley Street, London
Are you frustrated with menopause weight gain?
Is your weight going up and you don’t know what to do about it?
Have you gained more weight around your belly, even though that has never been a problem before?
Do all the things that used to help you to lose weight, not work at all now?
If you answered yes to any of those questions then this is the guide for you.
Most people make the mistake of thinking that what works for a 25-year-old to lose weight will also work for a 50-year-old. But as you will see in this guide, it’s not like that at all.
So it’s time to understand more about menopause weight gain and most importantly, what you can do about it.
I’m a medical doctor and at my weight loss clinic I only see women over 40. The average age of my clients is 53. Most of my clients are peri-menopausal or post-menopausal and so I have a lot of experience with helping women to lose weight during this phase of life.
I put this guide together to give some much-needed help and information about this important topic.
Going through menopause is generally associated with gaining weight.
In a study of women aged between 42 and 50, the average weight gain over 3 years was about 5 pounds. 20% of women gained 9 pounds or more (1).
So menopause weight gain is common. But for many women it also feels unavoidable. I want to show you that it’s not (more on that later) but first let’s understand a bit more about weight gain around menopause and what causes it.
Let’s quickly review what menopause is.
Menopause happens when a woman stops ovulating and her monthly period (menstruation) stops.
With natural menopause, the levels of oestrogen gradually decrease over time (but with lots of fluctuations).
Menopause can also happen because of surgery (when the ovaries are removed). In this case, the oestrogen levels drop immediately and the menstrual periods stop abruptly (2).
The time before menopause is called perimenopause and usually lasts 4-5 years. During this time, periods can be lighter or heavier, as well as more irregular. This is also the time you might experience hot flashes and night sweats.
For most women, perimenopause starts around the age of 45-47.
Technically you haven’t been through menopause until you have had 12 months without a period.
If we consider that menopause usually takes place between the ages of 45- 55, we can see that if there is an average weight gain of about 1- 1.5 pounds a year, then during this time, women can gain 10-15 pounds during this time (3).
Obviously this can be quite disturbing on many levels, but it also has health implications.
One of the main things you’ll notice about weight gained during menopause is where it goes. Before menopause, women tend to gain weight around their hips and thighs.
However with menopause, the falls in estrogen levels mean that the characteristic of menopause weight gain is putting weight on in the belly (4,5).
This is often referred to as a transition from a “pear” body shape to an “apple” one.
On a practical level, the “menopause belly” means that your belts need moving up a notch, and trousers or jeans that may have fitted well in the past become gradually tighter around the waist.
In terms of health, having more weight around the abdomen increases the risk of heart disease and type 2 diabetes (6).
In my clinic, weight gain at menopause affects two distinct groups of women.
These women will describe having been on “every single diet out there”. Often their weight problems started in their teens or early twenties.
If you are in this group, you may have found that in the past you were able to lose weight quickly with diets and exercise, but your main problem was maintaining the weight loss.
But after 40, a new problem arises. The diets no longer work. Even ones that worked in the past don’t work anymore. Losing every pound becomes a struggle.
If you’re in this situation, you may still be searching for that magic diet that will provide the solution. Or you may be starting to resign yourself to a future where your weight continues to increase and you are powerless to stop it.
Some women have never had to worry about their weight until they reached their forties. They have always been quite slim and able to eat freely without worry. But again, after forty, things change.
Sometimes this weight gain can be very gradual, a pound a year. For others it can be quite rapid, over a few months.
If you’re in this group, you will be ill-prepared for this since you will have had very little experience with dealing with weight gain.
When I see clients in this situation, they tend to be more distressed than the serial dieters, because this entire experience is so new to them.
We’ve talked about how menopause and the falling levels of oestrogen cause fat deposition in the belly rather than in the hips thighs and buttocks.
But contrary to popular belief menopause itself doesn’t trigger the actual weight gain. It just leads to the weight being gained being deposited in a different place.
Let’s imagine a scenario (based on an actual research study)(7) concerning menopause weight gain.
If you took a group of women in their forties and followed them up for five years, what would you expect to happen to their weight?
You would expect them to gain weight. Between 1- 1.5 pounds a year. And in this study the average weight gain was 4.5 pounds (so just under 1 pound a year).
But if you thought that the weight gain was directly related to menopause, you might expect the women who had gone through menopause to gain more weight than women who hadn’t. But this wasn’t the case.
Regardless of whether they had or hadn’t gone through menopause, the weight gain was similar across both groups.
What this shows is that there are other reasons why women gain weight in their forties.
So that raises the question, what are the actual causes of weight gain for women going through menopause?
As we age, our metabolisms slow. This is true of men as well as women.
What factors affect your metabolic rate?
Your natural body composition affects your metabolic rate. Men tend to be more muscular and have lower body fat than women, so their metabolic rate is higher.
As people age, the amount of muscle tends to decrease and fat makes up more of their weight, so their metabolism slows down. Their metabolism also tends to slow down for other reasons, independent of muscle mass as people get older (it’s not clear what the reason for this is). (8,9)
What is the practical implication of this?
It means you require fewer calories as you get older.
In fact, a woman in her fifties may require 400 fewer calories a day than a woman in her twenties (10). This means over time, even if your diet remains unchanged, you may still gain weight.
And when you think about it, 400 calories is a lot of calories. For some people it’s a whole meal. So if you’re in your fifties that’s a meal’s worth of calories that you have to cut back on, and that’s just if you want to stay at the same weight.
With men, who tend to notice “middle-aged spread”, they can use more exercise to offset this weight gain. Again, this is because they have more muscle mass than women. For women however, using exercise to counteract weight gain doesn’t work as well (or at all).
Over time, it’s so easy for bad habits to find their way into our lives. Even a small change in calorie intake can add up to significant weight gain over a longer period of time.
We have to remember that even if you only gain 1 pound every 3 months, this translates into 4 pounds a year, and 20 pounds in 5 years. Small differences add up over time.
It’s worth mentioning that for some women, they are able to maintain their weight quite well during their normal schedule, but tend to gain weight when they go on vacation or during the holidays. A couple of pounds gained on each occasion, can add up over time.
Any change in life circumstances can cause changes to your eating. Divorces, children moving out of home, family tragedies, can all create stress-related changes in your eating.
As people get older there is a tendency to be less physically active, which can contribute to increasing weight. (this doesn’t mean that being more physically active can lead to weight loss but it can help you to maintain your weight).
Medical conditions causing weight gain are thankfully quite rare. The main one that women need to be aware of is an underactive thyroid. This should be checked with your family doctor, with a blood test.
Medications can also contribute to weight gain. The most common examples are steroids which are prescribed for a large number of different conditions.
There is no evidence that HRT causes weight gain (11).
So in summary:
Weight gain during menopause is more related to lifestyle factors than hormonal changes. The contributor to this from a menopause point of view is that because of the fall in oestrogen levels, women going through menopause tend to accumulate fat around their belly.
But the question I asked earlier in the guide was whether menopause weight gain is inevitable?
It’s definitely not. But following the standard advice will not work. What do I mean? Read on…
What’s the standard advice anyone hears when they say they want to lose weight?
“Join a gym and go on a diet.”
But for women with weight gain at menopause, this advice doesn’t work.
And so, I have met hundreds of women, who have been sweating it out at the gym, and starving themselves on different diets and feel so frustrated and disillusioned that it hasn’t been working.
Exercise is VERY good for you. But for women, it’s not enough on its own to help you lose weight.
I hear from many clients who are in their fifties, stories like this:
“They said that if I stuck to this exercise program, the weight would just melt off”
If you’re in your fifties and someone tells you an exercise program is the solution to your weight problem, they are misleading you.
There are plenty of research studies that show for women exercise on it’s own does not lead to weight loss (12,13,14).
To lose weight, you need to reduce the amount of calories you take in.
Let me say again, this doesn’t mean don’t exercise. Exercise has so many positive benefits. And it helps you to maintain weight. All I’m saying is, exercise alone is not enough to lose weight (15).
When I talk about diets not working, I am talking about the short-term focused, drastic regimes that most people try when they want to lose weight.
Any diet in which you are drastically cutting back what you eat, and feel deprived, is by its nature a short-term effort. The vast majority of people will not be able to tolerate this approach for very long. It leads to a build up of pressure, increased cravings and hunger, and eventually failure of the diet a few weeks later.
As soon as you come off a diet, you return to your old lifestyle and the weight starts piling back on. This is how yo-yo dieting happens.
Furthermore for women over 40, an effect of lowered metabolism is that diets don’t work as quickly as they used to.
You could spend a lot of time trying to search for the magic diet that changes your life, but it’s going to be a futile search. It doesn’t exist.
The concept of a two week diet being your savior is a fantasy.
Before I talk more about a lifestyle-focused approach to losing weight, for completeness I should mention a couple of other treatment options for weight loss.
If your BMI is over 40 (calculate your BMI here) or your BMI is over 35 and you have other significant health problems like Type 2 Diabetes or hypertension, then weight loss surgery can be an option.
Bariatric surgery should only really be used as a “last resort to treat people who are dangerously obese” (16).
Bariatric surgery is a big decision and not one to be taken lightly. Most guidelines suggest that before jumping to surgery, you should try an exhaust all non-surgical options beforehand (i.e. try and make eating and exercise lifestyle changes). This is because weight loss surgery carries a risk of complications and requires a drastic change in lifestyle afterwards.
Medications can be prescribed when BMI is greater than 30, or greater than 27, with other significant health problems. Again, medication on its own is not recommended. It should be prescribed with a lifestyle change program.
Only one medication is considered safe (at the time of writing), which is Orlistat (17).
Orlistat works by blocking the action of a protein used to digest fat. The undigested fat is not absorbed into your body and is passed out with your faeces (stools).
Orlistat will stop around one-third of the fat from the food you eat from being digested. This will help you avoid gaining weight, but it will not necessarily cause you to lose weight.
The best way to lose weight is:
1. Eat fewer calories.
2. Get regular exercise (helps maintain weight and health (but not enough on its own to lose weight)).
3. Make the above two changes part of your lifestyle.
Lots of people talk about lifestyle change, but you hear very little about how to actually make it happen, even though it’s so important.
For women over 40, quick fixes don’t work and from the point of view of achieving lifestyle change that’s a good thing. Sure it means that you can’t drop a dress size in time for your vacation next week but it also means that you have to focus on long-term weight loss. This is a VERY good thing.
Losing weight without changing your habits can only ever be a short-term success. What’s the point of losing weight if you’re only going to gain it back a few weeks later? It’s only when you change your habits, that you creating lasting change.
So, how do you approach this? It’s all about thinking long-term.
As you can imagine, this is a huge topic, and it’s difficult to do it justice in one article.
What I’m going to do is give you 18 steps that encompass the lifestyle change approach that I use.
Two things to remember before reading this:
1. This isn’t a quick fix. It’s about creating a lasting change
2. There’s no magic to this approach. It’s based on common sense, but applied in a way that maximizes the chances of success
It might be your goal to lose 30 pounds, but that goal is too big and intimidating. Even decent amounts of progress will feel insignificant compared to your goal. Go for a smaller goal to begin with, and then once you reach it, set another goal.
Losing weight is pointless unless you can keep the weight off. Thinking only of weight loss is an immature way of approaching weight loss. You want to be slim for the rest of your life, not just for the next vacation. If you don’t realize this, you’ll be doomed to yo-yo dieting.
The best way to create pressure and unpleasantness around losing weight is to set a deadline. Especially an unrealistic one. Sometimes weight loss takes longer than you thought it would. That doesn’t mean you’ve failed. But if you have a deadline, it can certainly feel that way. Don’t set deadlines.
Replacing your existing way of life with a totally different one is setting yourself up for failure. It’s too much of change, and as soon as life gets in the way, you’ll lose the plot. Instead use your existing diet as the template and make small changes.
Don’t do things that you don’t think you’ll be able to stick with for longer than a few weeks. Always think, I’m creating a way of life, so I must be happy doing this for the rest of my life.
With my clients, this is the one non-negotiable aspect of my program. People who keep food diaries lose more weight than people who don’t.
Keeping a food diary makes you more aware of your eating, your food decisions and can influence your behavior positively.
You may have heard lots of different arguments for whether you should weigh yourself every day, or avoid the scales as much as possible. Coming from someone who used to be against weighing, here’s my case for why you should weigh yourself every day. (the short answer is that it helps keep you on track and once you’ve lost weight, it’s your early warning system).
Many women who come and see me have lost all confidence in their ability to lose weight. This partly relates to a history of failed attempts. But it also stems from making plans and not being able to follow through. This is because the plans that were made were not realistic and difficult to stick to. Part of my job requires building confidence again, by getting a track record of progress under your belt. Read more about it here.
Slowing down your eating is a great way to “have your cake and eat it” (metaphorically speaking). When you slow down your eating, you not only eat less, but it’s been shown that you’ll enjoy your meals more.
As mentioned, while exercise doesn’t contribute much to weight loss, it’s important for weight maintenance and also for general health. The important thing to remember is that exercise isn’t just about going to the gym. Introducing more walking into your life is an easy way to be more active.
Why eat something that is filled with calories if it’s mediocre? So many people eat things that they are indifferent to, when they should be focusing only on things that they really love.
It’s very difficult to resist food that’s in front of you… for anyone. Develop the habit of removing all tempting food from your surroundings. Make eating a snack, something that you do deliberately, and not just “because it was there”.
Some women are either on a strict regime or cutting loose eating excessively. Find the middle road. Like Goldilocks, go for the balance that is “just right”
Do you like chocolate? If so, when you eat chocolate, do you take the time to enjoy it, or wolf it down quickly and with loads of guilt? Savour foods you love. Enjoy them. They’re not the enemy.
For all ages, but especially after 50, plateaus are a part of weight loss. Don’t be surprised if your weight doesn’t budge for a week or two. Just make sure that you’re still doing all the right things. It can be very frustrating, but it’s just something you need to accept.
You will have days when things go wrong, and you eat more than you had planned. The bad response is to get frustrated, angry with yourself and give up. The good response is to draw a line under the situation and keep going.
You are not going to have to live a miserable life, just to maintain your weight. Instead you need to learn how to enjoy yourself, and still manage your weight. Work out how to It is possible.
Make small changes to your eating and keep going. Persistence is the key. Most people give up too soon or go hunting for another “diet”. Don’t make that mistake.
Gaining weight around the time of menopause is very common. It is due to a combination of different factors.
To lose weight and keep it off, you will need more than the usual solutions for weight loss. You need to change your lifestyle. This requires a long-term approach and small changes mixed with patience and persistence.
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http://www.cnpp.usda.gov/publications/usdafoodpatterns/estimatedcalorieneedsperdaytable.pdf (Accessed: 28 April 2014).
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16. NHS: Weight Loss Surgery http://www.nhs.uk/Conditions/weight-loss-surgery/Pages/Introduction.aspx (Accessed 28 April 2014)
17. NHS: Treating Obesity http://www.nhs.uk/conditions/obesity/pages/treatment.aspx (Accessed 28 April 2014)