Menopause, Belly Fat, and Your Health
Why your waistline is expanding and what it means to your wellbeing.
Declining estrogen is one of the reasons for a larger waistline in midlife, or any time that menopause occurs for that matter. I wrote about my own weight gain during perimenopause, most of which went to my midsection.
It’s unclear why, but lower estrogen levels favor fat deposition around the midsection. In one study of 380 women published in the Journal of Endocrinology and Metabolism, researchers found that women gained fat in their abdomens at a faster pace during the few years before and the one year after the final menstrual period.
The extra padding around your middle, and mine, is likely a combination of subcutaneous fat, located between the skin and abdominal wall, and visceral fat, found behind the abdominal wall and invisible to the naked eye. Subcutaneous fat and visceral fat may congregate in the same general area, but they influence your health in different ways.
Body Fat is Metabolically Active
Body fat – technically adipose tissue - is more than stored calories called upon for energy when you haven’t eaten for a while. Adipose tissue is considered an endocrine organ because it makes and releases hormones. Fat communicates with the rest of the body to regulate metabolism. Most body fat is the subcutaneous kind. Though visceral fat makes up a relatively small fraction of total body fat, it’s the most troublesome type.
Visceral fat triggers inflammation throughout the body. Visceral fat is situated in the vicinity of the portal vein, the vessel that ferries blood from the intestinal tract to the liver. It’s possible that the liver may be exposed to the inflammatory compounds visceral fat produces, resulting in a greater risk for several conditions such as type 2 diabetes, cardiovascular disease, and certain types of cancer, including breast and colorectal cancers.
Visceral fat also contributes to muscle tissue breakdown. A study in The Journal of Clinical Endocrinology and Metabolism found that visceral fat gain was inversely related to lower muscle mass over a six-year period – the more visceral fat, the lower a person’s muscle mass. Low muscle mass can lead to insulin resistance. Insulin resistance is linked to type 2 diabetes, high blood pressure, cardiovascular disease, and nonalcoholic fatty liver disease.
It’s important to note that where you carry most of your body fat matters regardless of your menopausal status. A Journal of the American Heart Association study that followed more than 500,000 adults ages 40 to 69 for seven years found that women were particularly prone to the effects of a larger waist. In the study, women who carried fat in their abdomens were up to 20% more likely to have a heart attack than women who had a more even distribution of fat throughout their bodies.
How to Measure Visceral Fat
You can’t tell by looking how much visceral fat you’ve got on board, and you won’t know just by weighing yourself, either. It’s possible to pinpoint visceral fat with imaging techniques such as DXA, CT, or MRI, but these methods are expensive and impractical. Measuring your waist circumference is quick, inexpensive, and provides a good enough idea of where you stand.
A waist measurement of less than 35 inches (90 cm) in women is best, but it’s not the only piece of information necessary to determine if you’re at risk. Waist circumference is often used in conjunction with Body Mass Index (BMI), which you can easily calculate here. It’s possible to have a high concentration of visceral fat and a BMI that falls within the healthy weight range, which is why health professionals use both measurements.
How to Lose Visceral Fat
I’ve seen many influencers peddling the idea that you can’t shed belly fat because it’s “resistant” for reasons only they know. Such claims are not based on scientific research and they’re often used to sell expensive programs or supplements that “magically” bust belly fat.
In truth, visceral fat is actually easier to lose than subcutaneous fat because it’s more sensitive to being broken down by the body. That said, “easy” is a relative term when it comes to weight loss. It’s not always easy, but it is possible to shed pounds in midlife.
A 2023 British Journal of Sports Medicine pooled the results of 36 randomized controlled trials (considered the gold standard of research and able to determine a cause and effect relationship) and found that cutting calories and regular exercise helped people lose visceral fat. Exercise appeared to have a stronger effect on visceral fat reduction than calorie restriction.
Exercise may be particularly helpful because it encourages visceral fat loss while simultaneously helping to maintain muscle mass. One meta-analysis found that high intensity interval training (HIIT) programs significantly decreased total and abdominal fat, but more so in premenopausal women than in post-menopausal women. It’s not possible to spot-reduce visceral fat by doing strengthening your abdominal muscles, although you may be able to achieve a flatter-looking stomach. Don’t expect miracles, though. As you age, skin and muscles are not as taut as they once were because of declining collagen levels.
As I mentioned earlier, I gained most of my menopausal pounds in my belly. I’ve lost about half of what I put on overall, but it’s unlikely that I will lose more than that, given that I’m unwilling to eat less or to exercise more than I already do. But I am always looking for ways to tweak my eating and exercise routines in ways that I enjoy and can live with on a long term basis.
In addition to regular aerobic and strength training exercise, here are some strategies that can help manage visceral fat.
Pump up the protein: A randomized controlled trial published in Nature found that a higher protein intake plus mild calorie restriction helped people lose belly fat. When you cut back on calories, it’s important to eat enough protein to minimize the loss of muscle tissue. At least two sessions of strength training weekly plus adequate protein helps preserve and build muscle mass.
Search for soluble fiber: Soluble fiber, found in oatmeal, oat cereals, barley, beans, nuts, lentils, peas, apples, blueberries, oranges, Brussel sprouts, and sweet potatoes, may offer a leg up on visceral fat. In a study published in Obesity, people who ate 10 grams more soluble fiber and increased moderate physical activity (30 minutes of exercise two to four times weekly) experienced significantly less accumulation of abdominal fat over the course of five years. Plant foods also contain anti-inflammatory compounds that help counteract the potential effects of visceral fat.
Switch to whole grains: Whole grains may provide an edge for overall weight control, according to findings from a study in the American Journal of Clinical Nutrition. In the study, postmenopausal women who swapped refined grains (such as white bread, white rice, and pretzels) for 100% whole grains absorbed fewer calories from the food they ate and burned more calories. Overall, the net losses amounted to about 100 calories a day compared to the group that ate refined grains.
Manage stress: Chronic stress exposes cells to cortisol and adrenaline on a constant basis. Adrenaline increases heart rate and elevates blood pressure while cortisol amplifies blood glucose levels. Research suggests that hormonal changes caused by ongoing stress contribute to the accumulation of visceral fat and muscle mass loss. Do your best to pinpoint what is causing constant stress in your life and to relieve it as much as possible.
Have you gained visceral fat? Leave a comment or question!
Thank you Katie. I'm glad to be helpful.
I weigh less than I have in 25 years (thanks to intermittent fasting, the only thing that has worked for me though I’ve never been one for fad diets) and yet the thicker middle is new. I was kicked into menopause slightly early due to breast cancer treatment (chemo, radiation, anastrozole). I also have Hashimoto’s. I really appreciate the nutritional guidance you provide.