Weight Gain During the Menopause

Why do many women gain body fat during mid-life – is it simple aging or is menopause the cause?

For many years there has been some disagreement in the scientific literature as to what is the main cause of weight gain in menopausal women. Some researchers suggest that weight/fat gain is primarily due to aging, while menopause has little to no effect. Other researchers think that the progressive decline of estrogen levels during the menopause transition (aka perimenopause) is responsible for increased body fat levels with an observed increased amount of visceral fat (fat around the organs). Until recently we just didn’t know for sure, however, new studies are coming out that clearly demonstrate the issue.

A large longitudinal study called the Study of Women’s Health Across the Nation (SWAN) examines women’s health during their middle years, focusing on the effects of menopause. The study was launched in 1996 and initially enrolled 3,302 women across the United States. The women were tracked for 13-15 years, where they were required to note their menstrual cycles and receive a DEXA scan (a device that can measure body fat vs lean muscle mass) every year. The researchers primary goal was to determine whether the menopause transition influences body composition (fat mass vs lean muscle mass) and body weight.

Here is what they discovered:

During pre-menopause the women’s lean muscle mass stayed the same, however, there was a slight increase in body weight and fat mass (Greendale et al., 2019). During the menopause transition their fat mass spiked very high while their amount of lean muscle mass dropped, all the while their body weight increasing (Greendale et al., 2019). Eventually, after the menopause transition everything levels off (Greendale et al., 2019).

Bill Campbell (2024)

This important study links that during the menopause transition there are definite unfavourable alterations in body composition, which abruptly worsen at the onset of perimenopause.

It’s important to note that this data was collected in women who were not exercising nor eating a high protein diet. There are many studies that demonstrate the importance of consistent resistance training: whether Pilates on the equipment, using the loads of the springs, or performing challenging body weight exercises (known as calisthenics), or weight lifting with dumbbells and barbells. Resistance training is not only amazing for increasing lean muscle mass, but being stronger enables us to stay injury free and enjoy life with energy and vitality.

New studies are also showing that as we age we need to eat more protein, especially during the menopause transition when women experience an extreme loss of lean muscle. Higher percent protein diets work together with physical activity to stabilize lean muscle mass and bone mineral density and help prevent weight gain in postmenopausal women (Simpson et al., 2023). In a recent 12-week randomized control trial middle-aged women who ate a high protein diet of 25% of total calorie intake (vs the standard recommendation of 15%) significantly improved their body composition: increased lean muscle mass, reduced fat mass, reduced body fat percentage and lower waist circumference (Haghighat et al., 2020). For example, if a woman eats 2000 calories a day, she needs to ingest 125 grams of quality protein. It seems like a lot, but 33g at each meal, and a protein shake at snack time easily reaches your daily protein goal.

These above studies are so promising, we now know that during the menopause transition the bodies of women do change. And while this transition is a struggle, there are simple steps we can take:

• choose your favourite way to strengthen your body (Classical Pilates, of course!)

• prioritize protein during every meal, trying to eat 25% of your total daily intake (roughly 125g)

Resources

Bill Campbell’s Body by Science: https://www.billcampbellphd.com/

Greendale, G. A., Sternfeld, B., Huang, M., Han, W., Karvonen-Gutierrez, C., Ruppert, K., Cauley, J. A., Finkelstein, J. S., Jiang, S.-F., & Karlamangla, A. S. (2019). Changes in body composition and weight during the menopause transition. JCI Insight, 4(5), e124865. https://doi.org/10.1172/jci.insight.124865

 Haghighat, N., Ashtary-Larky, D., Bagheri, R., Mahmoodi, M., Rajaei, M., Alipour, M., Kooti, W., Aghamohammdi, V., & Wong, A. (2020). The effect of 12 weeks of euenergetic high-protein diet in regulating appetite and body composition of women with normal-weight obesity: A randomised controlled trial. British Journal of Nutrition, 124(10), 1044–1051. https://doi.org/10.1017/S0007114520002019

 Simpson SJ, Raubenheimer D, Black KI, Conigrave AD. Weight gain during the menopause transition: Evidence for a mechanism dependent on protein leverage. BJOG. 2023 Jan;130(1):4-10. doi: 10.1111/1471-0528.17290. Epub 2022 Sep 25. PMID: 36073244; PMCID: PMC10952331.