Help! What Can I Do About Weight Gain in Perimenopause?

Welcome to No Sweat, Jenny’s monthly advice column, where an expert will answer all your burning perimenopause questions (submit your questions here). Kara McIver, MS RDN, is a registered dietitian nutritionist who is passionate about reducing the risk of chronic conditions through easy-to-accomplish nutrition and lifestyle changes.

During perimenopause, it can be helpful to see a dietitian, in addition to a physician, because much of what is recommended to manage the symptoms of this hormonal shift are nutrition and lifestyle changes. A registered dietician is better equipped, and simply has more time, to explain why a tweak to your diet, exercise routine, or sleep schedule can make a difference, and how to actually incorporate these changes into your life. Kara works with clients one-on-one through telehealth; you can find her online at TJPnutrition.com or @thejudyproject_, where she shares practical nutrition tips and advocates against fear-mongering and misinformation in the health and wellness industry. 

Dear Jenny,

I’ve always been pear-shaped. When I gain weight, it goes straight to my ass, which I never minded so much. And if I wanted to lose weight, I’ve felt lucky that it was fairly easy to drop a few pounds through diet and exercise. Now that I’m approaching 50, however, the small waist I’ve been vain about is getting thicker, while my hips and booty seem to be deflating. Not only that, the diet and exercise tweaks I’ve relied on in the past aren’t working anymore and the number on my scale keeps going up.

What’s going on and what can I do about it? 

—Mel, 47

Dear Mel,

Weight gain in perimenopause is common, and can be incredibly frustrating. What’s more, women experiencing it are the target of an onslaught of marketing for products that may or may not be helpful. (Honestly, mostly not.)

At any age, weight gain results from eating more calories than you expend. If you’ve heard the phrase “calories in, calories out,” that’s what I’m talking about here. However, during midlife, hormonal and lifestyle factors also play a huge role.

“Calories in” simply refers to the amount of energy you consume in a day: the food you eat, the drinks you drink, and even the bites, licks, and tastes (or BLTs) that seem incidental. For many women in midlife, those BLTs add more calories to your intake than you may realize. A fun-sized piece of candy from your coworker’s desk, an extra pump of sweetener in your coffee, finishing up the last bites from your kids’ meals, those nibbles while you’re cooking dinner—they all add up.

“Calories out” refers to how much energy you expend daily. Things get a bit more complicated here, especially as we age. To understand this better, let’s look at the four main components of your metabolism:

• The amount of energy your body expends to stay alive and awake. Your Basal Metabolic Rate (BMR) comprises the vast majority of your daily energy expenditure, powering your brain, organs, immune system, etc., when you’re simply existing.
• The amount of energy your body expends to break down your food. Digestion takes a bit of work. Different types of foods burn more energy than others, but breaking down any food burns more calories than not breaking down food at all (because you didn’t eat). Also, so-called “negative energy foods” are a myth. There aren’t any.
• The amount of energy your body expends to do non-exercise activity (also known as NEAT). This is all the movement you do in a day that is not specific to a workout session—fidgeting included. 
• The amount of energy your body expends during exercise. You can increase the number of calories you burn while working out by upping the intensity or duration of your workout. Ultimately, however, this is a small percentage of your day, and a small percentage of how many calories you expend overall.

If you eat fewer calories than you expend, you are in a caloric deficit, and you will lose weight. If you eat and expend about the same amount, you are in caloric balance, and your weight will stay the same (although your health and body composition can still change). If you eat more calories than you expend, you are in a caloric surplus, and you will gain weight.

If you’ve done any research on perimenopause and weight changes, you may have heard someone say, “it’s not about calories, it’s about hormones/insulin/carbohydrates/etc.” They’re wrong… kind of. 

Ultimately, if you’re gaining weight, you are eating more calories than you expend. However, hormone changes, insulin resistance, and the realities of midlife may impact your basal metabolic rate (BMR). This means the number of calories you are expending in a day is lower than you might expect. Therefore, to stay in a calorie balance or deficit, you need to eat fewer calories. 

The Impact of Hormones on Weight

Estrogen

First, let’s talk about estrogen. Outside of reproduction, estrogen also plays a critical role as to where a person stores body fat. During the reproductive years, women have higher estrogen concentrations and lower testosterone concentrations than men. Estrogen typically directs fat storage to the hips, thighs, and buttocks (subcutaneous fat). In contrast, testosterone tells the body to store fat in the midsection (visceral fat).

The good news is that research shows storing excess energy away from our central organs keeps us healthier. The bad news is that when perimenopause comes around and estrogen levels start to decline, women will begin to see that stubborn belly fat, sometimes called the “menopot” or “menopause middle.” It’s not that your metabolism has necessarily changed—it’s just that extra calories are going to a new place on your body, creating a shape you may not recognize.

Insulin

Insulin is the hormone that allows sugar to flow from your bloodstream into your tissues and cells, where it is then used to create energy. We often refer to insulin as the “key” that opens the “locks” on your cell doors. If you have some level of insulin resistance, your keys don’t work as well as they could, or as well as they used to. Insulin resistance can be caused by low-grade inflammation in the body, which estrogen has been shown to reduce. When estrogen levels decrease in perimenopause, inflammation and insulin resistance can then increase.

In the long run, this can lead to Type 2 diabetes. In the short run, it can reduce how much energy you create from the food you eat. This means you eat more because you feel hungry or tired, increasing your “calories in.”

Cortisol

Talk about having a moment. Cortisol is on the lips of every online health, wellness, and fitness influencer these days. Here’s what you need to know: the stress hormone is essential to everyday life. It controls sleep-wake patterns, plays a role in metabolism, and helps reduce inflammation from an acute stress event. After your “fight, flight, or freeze” hormones are released, cortisol comes flooding in to keep you on high alert. It also controls our hunger and fullness signals.

Constantly elevated cortisol levels can result in a feeling of hunger that isn’t satisfied by food. This can become a problem whether you eat more when you’re anxious, or you tend to skip meals under stress. 

Five Lifestyle Factors Working Against You

Midlife tends to mean high stress and very little leisure time, especially for women. Most women at this age find that their old weight-management behaviors are not working like they used to. Here are five common culprits for perimenopausal weight gain:

When you exercise, it’s cardio only. Cardio is good for heart health, but it’s not great at building muscle or burning calories. Increasing muscle mass is the most effective way to maintain or increase your basal metabolic rate. Muscle tissue burns more calories than fat tissue, and it definitely burns more calories than no tissue at all—which is why losing weight can reduce your metabolism.

Having more muscle helps your body better use food to create energy, decreasing how much you need to eat to feel energized. In midlife, women start losing the muscle mass they’d previously built, unless they’re actively working to maintain or build it. The good news is that with a resistance exercise program and adequate calories and protein, you can build muscle mass at any age.

In a recent episode of The Body Pod, Dr. Stacy Sims, the foremost researcher on female athlete physiology and author of two books on the topic, advises:

• Heavy resistance training three times a week. You should be pushing, pulling, squatting, hinging, and carrying weight that is heavier than your purse or briefcase, to the point of fatigue, regularly.
• Sprint training rather than more extended endurance training. Engage in repeated bouts of 10- 30-second all-out intervals of running, biking, swimming, low-weight functional movements, etc.
• Plenty of rest between exercise sessions. This means eating enough calories overall, enough carbohydrates, and getting adequate rest.

You’re sitting for long stretches. Exercise is important, but non-exercise activity (NEAT) more significantly affects your daily energy burn. As we age and technology makes things more convenient, we tend to get less NEAT. 

Maybe you used to push your child in a stroller, and now they’re long past that stage, or you used to have to walk to the company bathroom down the hall from your office a few times daily, and now you work from home, where the bathroom is mere steps from your desk. Whatever the reason, by getting less NEAT, you’ve pushed yourself into an energy surplus by lowering your calories “out,” and you’re gaining weight in your middle.

For most people, this is the biggest area of opportunity for increasing their calorie expenditure in the short term. It takes time to build muscle, and you probably don’t want to spend more time at the gym, but it’s easy to add some steps to your day. You don’t necessarily have to walk 10,000 steps per day, but trying to get more movement throughout the day will increase your energy expenditure.

Try breaking your day into quarters (morning, midday, evening, nighttime) and making sure you get some movement in during each quarter (one quarter might be exercise rather than NEAT). I listen to celebrity memoirs or the Normal Gossip podcast while walking outside, and I have a walking pad under my desk, which I use while reading emails and during meetings to keep me moving throughout the day.

You’re eating more because you’re skipping meals. If you skip breakfast or eat a small, sad desk salad for lunch, you’re almost guaranteed to binge later. When you don’t eat enough early in the day, you end up being so hungry that you seem to have no bottom later on. By eating regularly, you burn calories by digesting, and you’re more likely to eat more reasonable portions later in the day. This makes it easier to hit a calorie balance.

You’re cutting out all carbs when you should be reaching for fruits, vegetables, and fiber. Fruits and vegetables are full of water and fiber, which helps you stay satiated for longer. Complex carbohydrates like oats, whole grain breads, lentils, beans, quinoa, and potatoes slow your digestion down without massive hits of calories. When you feel satisfied after meals, you’re more likely to consume fewer of those BLTs and less likely to overeat.  

Poor sleep and high stress are causing you to overeat. Food and sleep are the only ways your body can restore and produce energy. Neither coffee, energy drinks, nor cold plunges truly give us energy—they just alter our bodies so we forget we’re tired. Perimenopause tends to impact our sleep quality, and poor sleep quality drives us to reach for calorically dense and ultra-processed foods to provide the energy we missed out on overnight. Calorically dense foods tend to be easier to overeat (because they’re delicious), and ultra-processed foods are engineered to be eaten without breaks. 

Like fatigue, stress causes us to reach for high-calorie foods. Sugar and fat release neurotransmitters into our brains that temporarily regulate our moods—which are also affected by perimenopause, and the hellscape that many perimenopausal people live in.

Family obligations, mismatched mental loads at home, demanding careers, patriarchy, capitalism, and world events can all lead to an ever-present feeling of needing to be “on alert.” Of course, then, we need a sweet treat as an afternoon pick-me-up, or a glass of wine (or two) in the evening to wind down, which leads to a late-night snack and poor sleep. Or we lie awake at night thinking about everything on our to-do list for tomorrow, then wake up the next morning exhausted and looking for easy energy (sugar, fat, calories). Or we are too anxious to eat all day, and then we binge at night.

All of that increases our “calories in,” leading to weight gain. And if you’re already exhausted from getting inadequate sleep, you’re less likely to take the stairs to your third-floor office or hit the gym in your only free hour of the day, reducing your “calories out” for the day.

That’s a lot, I know—but there is something you can do about it. Here are my recommendations to maintain a healthy weight during perimenopause:

• Lift heavy weights three times a week to build and maintain muscle mass, increasing your “calories out” across the entire day.
• Walk often, any time you can, for increased metabolism, bone density, and stress release.
• Eat 3-5 times daily; include protein to support your weight training and complex carbohydrates to stay full and improve your gut health.
• Reduce your alcohol intake to improve your sleep quality.
• Find your own stress-management system that doesn’t include food or alcohol.
• Unfollow any fitness influencers under 40—they don’t know about your life. Instead, work with a registered dietitian to create a nutrition plan that works for you.

You don’t have to do all of these things immediately. Take one small, sustainable step forward at a time until you can maintain it; then take the next small step. You have your life ahead of you.

Curious what to do about perimenopausal brain fog? Click here. Got a perimenopause question? Submit it here.  

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