Menopause should be a reason to bust out the bubbly and celebrate the end of periods, period pain, leaking, mood swings and for any women living with daughters or other women, shark week. However, most women will report that menopause has been the cause of unwanted fat that has besieged their bodies. It’s not fair that menopause can deliver a coup de grace of kilos after all we’ve been through. But is menopause really to blame for our middle-aged expansion?
What do we know? We know women tend to gain weight around menopause. Also, we know most Australians don’t meet the exercise recommendations. Plus, we lose muscle as we age, and we don’t make a compensatory reduction in our diets. These four factors are the perfect storm for weight gain. Let’s examine these points in detail.
Firstly, between 45 and 55, women gain an average of half a kilo a year and a total of 2.3 kg during perimenopause. Unfortunately, the decline in oestrogen tends to shift fat from our hips, butts and thighs to our waistlines. The hormonal changes that accompany menopause are associated with increases in total body fat and abdominal fat, even in lean women but not necessarily weight gain.
Dr Mia Schaumberg is a Senior Lecturer in Physiology at the University of the Sunshine Coast. She says that without the protective effect of oestrogen after menopause, more fat, that is, adipose tissue, is deposited around the waist. The problem with adipose tissue is that it produces adipokines, molecules that are associated with chronic inflammation.
“The adipose tissue also produces oestrogen throughout menopause, but the pathway is changed because it is not the ovaries producing the oestrogen,” says Dr Schaumberg. “After menopause, the adipokines and chronic inflammation can lead to cardiovascular disease, osteoporosis and dementia in later life.”
Can we simply lose our bellies?
Unfortunately, not, says Dr Schaumberg. “There just isn’t the evidence that we can spot reduce weight. You need to target healthy habits with a combination of diet and exercise.”
So, menopause might leave us with a bigger belly but why do so many women believe menopause causes weight gain? Now to our second point, that we are a sedentary population.
In 2017-18, over half of Australian adults did not meet the recommended levels of physical activity. Data shows we become less active as we age. And if you think things can’t get worse, women are less physically active than men overall. Also, in 2017-18, 75% of men were overweight or obese compared to 60% of women. If menopause were to blame for our weight gain, this would show in the over 45 age group.
So, menopause might leave us with a bigger belly but why do so many women believe menopause causes weight gain? Now to our second point, that we are a sedentary population.
In 2017-18, over half of Australian adults did not meet the recommended levels of physical activity. Data shows we become less active as we age. And if you think things can’t get worse, women are less physically active than men overall. Also, in 2017-18, 75% of men were overweight or obese compared to 60% of women. If menopause were to blame for our weight gain, this would show in the over 45 age group.
Finally, and this is the hardest bit of information to digest, ageing and lifestyle are the likely culprits behind those extra kilos, for both men and women.
Dr Schaumberg says, “We are ageing chronologically, but during the process of menopause, those changes are faster.”
The problem for women is that it is hard to separate the influence of ageing and lifestyle on weight and menopause because the ageing and menopause occur around the same time.
As a child, Karen Horvath used to tease her mid-forties mother about her growing mid-section. But Karen wasn’t laughing when she experienced menopause at 42 and her flat stomach turned into a bulge by her mid-forties.
“By the time my mid-section had blown out, I was at a computer for most of the working day.”
Karen says at the time she started menopause, she was working at a bank and moving throughout the day. “I was on my feet all day. At lunch time I’d take a walk to get lunch and fresh air. When I got home, I’d walk the dog.”
She then relocated cities with a promotion, but this new role meant she was sitting at a computer for more than eight hours a day. Karen began a gym program and targeted her abs.
“All the activity just maintained the status quo,” she says. “There was no issue with my legs getting bigger, but it was the area between my hips and solar plexus.”
Relocating again two years later for another promotion meant Karen was spending even longer hours at a computer. Karen says, “By this time, my backside started widening. I was about 48, 49.”
Karen’s experience follows the trend of increasing waistline following menopause along with age-related weight gain. So, let’s unpack why we tend to gain weight as we age.
There are physiological and lifestyle reasons.
Physiologically, we can blame sarcopenia, age-related muscle loss that is also associated with an increase in fat mass. From our 30s, we lose approximately 5% of our muscle mass per decade and then more after 60. Lean muscles burn more energy so with less lean muscle as we age, we burn less energy.
Dr Schaumberg explains we can mitigate muscle loss through resistance training, exercises designed to build muscle and muscular strength using weights or body weight. With more muscle, we can burn more energy.
“Never underestimate the value of resistance training. It maintains our muscle mass and can delay or prevent sarcopenia to a point,” she says. “There will be age-related losses of muscle but then we can see people gain muscle even in later life. We cannot reverse all age processes, but we can slow them down.”
There is even some good news.
“When we build muscle through resistance training and high intensity interval training or HIIT, we also improve our basal metabolic rate, and this can assist with weight management.”
Your basal metabolic rate is the rate at which your body burns energy at rest for basic functions like breathing, keeping warm, digesting food and posture.
Dr Schaumberg says that resistance training and HIIT improves the metabolic activity of muscle, so the muscle then uses more energy, that is, calories, even if you are not exercising. Aerobic exercise like running, cycling and swimming doesn’t confer such noticeable benefits.
The physical activity guidelines recommend two days of resistance training also known as muscle strengthening activities. Latest figures report that after age 35, less than 40% of adults met the guidelines and the figures dropped with age. Worse, women were less likely to do muscle strengthening activities than men.
Feel a bit pressured into joining a gym? Don’t. There is a caveat here. You need to enjoy the activity you do. If you love aerobic exercise, keep doing it. Just add some hills or some sprints to get your heart rate up intermittently and work your muscles. Maybe throw in some planks and push up variations you can manage.
However, Dr Schaumberg has the best advice. She recommends exercising with friends. “Social connectedness is important. Exercising in groups is a great way to share experiences and motivate each other,” she says.
Physiology done, what about our lifestyle?
Kate Di Prima is an Accredited Practising Dietitian and Spokesperson for Dietitians Australia. She explains how lifestyle changes underpin our apparent menopausal weight gain using the analogy of declining engine size as we age.
“We go from a V8 engine in our 20s, down to a V6 and get to 4 cylinders and less in our 60s. Since smaller engines need less fuel, so we need less food as we age. “
She says, “In our 50s and 60s we’ve done the childbearing, mothering, we are at the end of our careers and enjoy a few glasses of nice wine, some crackers and cheese with friends but we keep eating the same as we did in our 40s. The deficit between input and output gets bigger and the weight gain increases.”
Once you start to gain weight, Kate says, it’s harder to lose it because there is less muscle mass.
Kate’s message when it comes to diets is “Down, not out.” She says cut down on carbs but don’t cut them out. This message is neatly illustrated by the Eat for Health Adult Brochure, an easy-to-follow evidence-based dietary guide.
She says, “Between the ages of 19 and 50, adults are advised to eat six serves of carbohydrates per day as wholegrains or high fibre. From 51 years, that drops to 4 serves.”
“That is a very clear-cut message,” says Kate, “that we need to cut down on carbohydrates, not cut them out.”
Interestingly, the last national nutrition survey found only 5.5% of Australian adults had an adequate usual daily intake of fruit and vegetables. It’s not surprising we are gaining weight if we aren’t meeting our fruit and vegetable recommendations and are substituting these food groups with additional carbohydrates and discretionary foods.
Kate advises her clients, “Without change, there will be no change.” Part of changing your diet is eating less and that can involve experiencing the sensation of hunger. Kate says many people have concerns around being hungry.
“There is no fear of hunger. There are lots of fears, but not a fear of hunger and there needs to be.”
“I say, ‘You have got to live with feeling hungry.’ It’s hunger. Hunger is not a national emergency. You need to retrain your body and your stomach and mind to say, ‘That’s all I need.’ We’ve lost the concept of what we need versus what we want.”
“When we are at work and feel tired at two in the afternoon, we don’t fall under our desks. We know we must stay till five, so we just push through. It’s the same with hunger.”
Kate’s advice for women in the mid-age group is to visit a dietitian and get reliable advice around correct portion size and the correct proportions of the food groups to ensure you are meeting your nutritional requirements.
If you’ve hit the menopausal milestone, it’s definitely worth celebrating, even if you’ve gained weight. Get together with friends and get active, regularly. Celebrate the next phase of your long and healthy life but maybe stick to one small glass of bubbly.