I'm 45 years old and perimenopausal – why am I putting on weight?
Living well throughout perimenopause (and beyond) is key for dealing with the many symptoms – including menopause weight gain.
Weight gain is common in menopause for various reasons – but eating a healthy, balanced diet (with plenty of fruits, vegetables, fibre and prebiotics) can help.
Here GP and women’s health expert Dr Philippa Kaye answers all your questions about menopause weight gain....
Why am I putting on weight?
Weight gain and loss is complicated, involving hundreds of genes alongside your environment, medications you may take, stress, sleep, and more.
During perimenopause, a lot of people gain weight or find it harder to lose weight than previously. So what’s going on?
The average adult gains 0.45–0.7kg (l–1.5lb) each year, from early adulthood to middle age. This is thought to be due to the natural loss of muscle mass as we age.
Muscles naturally burn more calories (compared with fat cells) simply by existing, so the more muscle, the more energy you use, even if you aren’t moving. So if you have less muscle and eat the same number of calories, you can gain weight over time.
Causes of weight gain
Around the perimenopause, there is a loss of lean muscle mass and a gain of fat mass. Oestrogen has a role in where fat is deposited in the body; as levels fall, more is deposited around the tummy (visceral fat), hips, and bottom, and less in other areas. The body also tries to obtain another form of oestrogen – oestrone, made by adipose (fatty) tissue.
Insomnia and fatigue can affect some gut hormones involved in sleep, which also affect your appetite, controlling hunger and satiety (when you are full).
Depression, anxiety, and stress can change food choices.
Falling testosterone levels can lead to loss of muscle mass and weight gain.
Increased joint pain can make exercise less appealing.
There is no evidence that HRT leads to weight gain. In fact, using HRT to improve symptoms (such as insomnia or anxiety) may lead to healthier choices.
How to monitor your weight
These three methods may be helpful to monitor your weight over time. All have flaws, none can be used in isolation, and they don’t give an exact score related to your health, for example.
But, they may help identify weight gain and whether it is associated with more health risks. Here we focus on weight gain, but being underweight can also be related to health issues.
What to do
BODY MASS INDEX
Divide your weight in kilos by your height in metres squared (kg/m2). Use the total to assess whether you fall into the categories of underweight, healthy weight, overweight or obese.
WAIST CIRCUMFERENCE
Measure around your waist, just above your tummy button. A waist measurement over a certain threshold is associated with an increased cardiovascular risk.
WAIST-TO-HEIGHT RATIO
Measure both your height and your waist using inches or cm (but not a mixture). Divide your waist measurement by your height measurement.
Understanding your results
Being overweight is defined as a BMI above 25 and obesity as above 30 for white women. For women with a Black African, African Caribbean, or Asian background, overweight is a BMI over 23 and obesity a BMI over 27.5.
Examples of possible increased risk:
» Over 88cm (35in) for white women.
» Over 99cm (39in) for women of an African American background.
» Over 85cm (33in) for those of a Korean background.
A ratio of 0.5 or more (meaning that your waist is more than half your height) can mean that you have an increased heart health risk.
What helps to manage weight gain in menopause?
Eating healthily and exercising help to maintain muscle mass and minimise weight gain for everyone, whatever their body weight. Medical and surgical treatments for obesity are also available.
This is an edited extract from The Science of Menopause by Dr Philippa Kaye, out 10 October (DK, £16.99)
More menopause content
6 foods to include in your diet as you enter the perimenopause
Is eating a plant-based diet is the missing link to helping you manage your menopause?
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