Are midlife women doomed to gain weight?

Weight gain is a common complaint of midlife women, with more than two-thirds of midlife US women being over the ideal weight threshold. Aging-related metabolic changes promote weight gain in both sexes, but women face additional challenges because of menopause.

It is a simple fact of life—the human body’s metabolic rate drops with age because of a loss of muscle mass and reduced activity in the brown adipose tissue. Sleep disturbances and mood disorders, possibly related to the menopause transition, can additionally interfere with the adoption of healthy lifestyles, further promoting weight gain.

The loss of ovarian hormones after menopause leads to altered body composition, with reduction in lean body mass and an increase in visceral fat mass. In addition, menopause-related alterations in the gut microbiome can promote midlife weight gain.

All this added weight can worsen hot flashes while increasing 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.

Despite the rise in fad diets and over-the-counter supplements claiming to burn fat, the most important intervention for weight loss and maintenance remains calorie restriction. Although physical activity is less effective than dietary interventions for weight loss initially, it plays a crucial role in weight maintenance after the initial diet-induced weight loss and has multiple other health benefits.

Medications for weight loss are available, but there are concerns relating to costs, interaction with other medications, adverse events, and possible long-term toxicity. Bariatric surgery may be a highly effective option in extreme cases, but ultimately, sustained behavior modification is necessary to maintain results over the long term.

Although hormone therapy should not be used for weight management in midlife women, when used for the management of bothersome menopause symptoms, it can improve body composition by redistributing the visceral fat to the lower body fat depots.

Dr. Ekta Kapoor from the Mayo Clinic’s Center for Women’s Health will discuss midlife weight gain at the NAMS Annual Meeting, highlighting the latest thinking about why midlife women gain weight and how they can fight back.

“In the absence of active efforts at healthier eating and regular physical activity, weight gain is an inevitable occurrence in midlife women. It is imperative that women enter menopause with this knowledge and the familiarity with practical tips to prevent and manage weight gain,” says Dr. Kapoor.

“Without a doubt, women face an uphill battle against weight gain as they age and transition through menopause, but that does not mean there aren’t ways to help them combat the issue. This presentation promises to provide some valuable insights that health care professionals can leverage when providing weight management advice to their menopause patients,” says Dr. Faubion, NAMS medical director.