I’m a Dietitian and I Gained Weight with Menopause

Knowledge doesn’t always win out. Here’s what happened.

After 30-plus years in the nutrition field, I thought I knew enough to avoid menopausal weight gain. Armed with experience, I would outsmart the dreaded midlife muffin top. While I was convinced that I was thoroughly prepared to dodge the extra pounds, things didn’t go my way, and I’m pretty sure I know why.

My Menopause  

My perimenopause – the transition to menopause that can last from four to 10 years - started around age 48. That’s when my periods became unpredictable, which is a sign of declining estrogen levels and shifts in other sex hormones.  A year or two into perimenopause, my mother’s health began what would be a steady decline. For the next three years, I helped run her household, as well as my own, which included three teenagers. I also managed her medical care and my busy career.

On the whole, I ate and exercised about the same, but unlike most women going through the menopause transition, I actually lost weight. At least at first.

Weight Control is Elementary

Many women hit 50 only to be shocked by a higher number on the scale. While extra pounds – which mostly settle around your middle – seem like they come out of left field, the truth is that gradual weight gain typically starts in your 40s.

A long-term study published in the Journal of Clinical Investigation in 2019 found women gained between one and one-and-a-half pounds per year in their 40’s and 50’s. Body composition changes, too.  A 2022 Menopause study found that when perimenopausal women gained weight, it was more fat rather than muscle as compared to premenopausal women.

You can gain fat all over your body, but there is something about menopause that promotes visceral fat accumulation.  Visceral fat – also known as belly fat - is different than the fat on your thighs and buttocks, called subcutaneous fat.  It’s found under the abdominal wall and surrounds the internal organs. Although you can’t pinch or poke visceral fat, it’s why your clothes don’t fit as well as they once did.

In the flurry of midlife, it’s easy to put on an extra pound or so without noticing. Problem is, by the time you realize what’s going on, you could easily be five to 10 pounds heavier - without changing your eating or exercise routines.

How the Body Burns Calories

On the surface, weight control is simple math. Eat as many calories as you burn to maintain your weight. Eat fewer calories than you burn to lose weight. Eat more calories than you burn, and you will gain weight. How you actually burn calories, especially in midlife, is a bit more complex.

The body’s basal metabolic rate (BMR) is the energy (measured in calories) required to support all the functions that sustain you, such as maintaining your heart beat, building and repairing cells and tissues, and keeping normal blood glucose levels within a normal range. Basal metabolic rate accounts for the majority of the calories the body expends and the number of calories you burn is primarily influenced by how much fat-free mass you have. Your organs, bones, connective tissue, and muscle tissue are all considered fat-free mass.

Basal metabolic rate slows with age, largely due to the loss of skeletal muscle mass, which accounts for 30% to 40% of total body mass. Declining estrogen levels and changes in progesterone and testosterone during the menopause transition contribute to reduced muscle health and strength. In addition, visceral fat further complicates matters because it produces pro-inflammatory compounds that promote muscle breakdown.  A 2023 study in The Journal of Clinical Endocrinology & Metabolism found that visceral fat gain was inversely related to lower muscle mass over a six-year period.

It’s critical to hang on to the muscle mass you’ve got and possibly make even more, but not because doing so will send your BMR into overdrive. Muscle burns more calories than fat, but it’s unlikely that most midlife women will see a huge difference by adding a few pounds of muscle. However, every little bit counts in terms of calorie burn, and muscle is useful in many other ways.

Eating adequate protein and doing resistance training at least twice weekly is a must for maintaining and making muscle. The authors of the Menopause study I mentioned earlier concluded that perimenopause presents an important opportunity for muscle. That’s because they found that the closer women got to menopause, which occurs on average around age 51 in the U.S., the more difficult it becomes to make muscle.

Movement of any kind burns calories. Exercise, defined as planned activity, such as a yoga class, a brisk 30-minute walk, or singles tennis, is one way to expend energy.  Non-exercise activity thermogenesis (NEAT) is another way. Burning calories doing anything that’s not sleeping, eating, or exercise is NEAT. Walking a few extra blocks to work, taking the stairs instead of the elevator, raking leaves, cleaning the house, getting out of your car to get your coffee instead of using the drive-thru, and every other incidental move you make are examples of NEAT, which can amount to hundreds of calories burned every day.

My Weight Went the Other Way

Given that the odds were stacked against me, why did I escape weight gain, at least during the first few years of perimenopause? I credit NEAT.

When my mother was alive and there was so much to do, I was in motion most of the day. I ran her errands and mine, cleaned her house and my own, and took her to a lot of appointments, which was more physical than it sounds because she couldn’t walk on her own for about a year at the end. Plus, I was so busy that I had little time for mindless snacking, which is one of my downfalls and likely added hundreds of calories to my diet every day before perimenopause.

After my mother died, and my life settled down a bit, my weight began creeping up. By the time menopause happened, I had gained nearly 10 pounds (a few of those pounds were the weight I lost initially).  That was a wake-up call for me – I was no different from every other woman struggling with weight gain during the menopause transition.

After taking a hard look at my eating and exercise routines, I didn’t drastically overhaul my diet and exercise routines so much as tweaked them. I managed to lose about five of the 10 pounds. I’d like to lose all of them, but I refuse to cut out my favorite foods or feel hungry in the pursuit of weight loss. 

Here’s what I do now to better control my weight. Some of this may work for you.

Pump up the protein: I eat about 100 grams of protein daily, which is the right amount for me (protein needs are based on body weight). Adequate protein intake is paramount for supporting muscle mass, it promotes eating satisfaction, and it gives you a slight calorie-burning edge. That’s because protein has a greater “thermic effect of food,” (TEF) than carbohydrate or fat. Digestion and absorption of the nutrients in food requires the body to use energy, and protein takes more energy to break down. 

Frontload my calories: I was in the habit of eating a smaller breakfast and most of my calories came at dinner.  Now I eat an oatmeal/fruit concoction with about 600 calories in the morning and I’m less hungry throughout the day.  It’s probably a good idea to evenly distribute calories across three meals, as there is mounting evidence that saving most of your calories for later in the day may contribute to weight gain. In a 2022 Cell randomized controlled crossover trial, those who ate dinner at 9 PM reduced their total calorie burn during the day.

Focus on fiber. Fiber helps slow the passage of food through the digestive system so that you feel fuller for longer. I think fiber is one of the reasons I’m satisfied until lunch: my breakfast of oats, chia seeds, and dried fruit has about half the fiber I need for the day. A 2023 observational study published in the British Medical Journal found that a 10-gram increase in dietary fiber was associated with nearly two pounds less weight gain over a four-year period.  In a 2019 study in The Journal of Nutrition, there was a relationship between fiber intake and weight loss; people who ate about 25 grams of fiber daily shed the most pounds. Experts suggest about 30 grams of fiber daily, which means most Americans need to double their current fiber intake.

Strength train two to three times weekly. In my younger days, cardio was top priority and I’d half-heartedly worked out with weights. Once I hit my 50’s, and I came to understand that both types of exercise work better together, I began to value them equally. As I mentioned earlier, resistance exercise, which includes using bands, weights, or your own body weight, promotes muscle mass preservation, which positively affects your overall calorie-burning rate.  

Weight Control is Personal

I’ve been a registered dietitian (RD) for decades, but I didn’t fully understand to what extent midlife and menopause affected the body until my own perimenopause began.  There are a lot of myths about how to control your weight, but you don’t need extreme diets and expensive supplements. However, you probably need to work smarter rather than harder during this stage of life. That’s the crux of The Menopause Diet Plan, A Natural Guide to Hormones, Health and Happiness, which I wrote with my friend and fellow dietitian Hillary Wright.

There is no single best way to eat or exercise to control your weight during the menopause transition and afterwards.  What works for me may not work for you, and vice versa. I’d love to hear about your experiences with midlife weight changes in the comments!