Why do we gain extra weight around the middle in menopause? Now new scientific insights into ‘menopause belly’ offer some surprising and realistic ways to tackle it

There’s no point in denying it: a menopause belly is a thing, manifesting as unwelcome fat around the midriff area that’s hard to lose. It’s long been thought that the hormone fluctuations during menopause have something to do with it; hormonal upheaval, after all, causes so many radical changes that affect our body, mind and skin. Menopause weight gain is something many women complain of but a conclusive link between hormonal changes and a ‘menopause belly’ or ‘menopause muffin top’ - just two charming (not)  monikers doing the rounds - hadn’t so far been made. It wasn’t clear whether it was indeed the menopause and not just the ageing process at play that caused menopause weight gain.

But a new Zoe Predict Study commissioned by the Zoe Health app which was published in the Lancet today in celebration of World Menopause Day 2022 conducts real-world trials on our response to nutrition during menopause. It was behind the Zoe Diet Programme (which we put to the test), led by nutritional scientist Dr Sarah Berry of King’s College, and showed that it is indeed menopausal hormonal shifts, specifically the drop in oestrogen that starts in menopause and continues for life, that negatively impacts weight gain.

As nutritional scientist Dr Federica Amati puts it: “Menopause weight gain is real, not because you automatically put on weight with age, but because your whole metabolism changes when you hit menopause.”

The study found that women who had gone through the menopause had a much poorer blood sugar response (which can lead to an accumulation of fat around the middle) compared to women of the same age who had not yet hit the menopause. Not only that, but they also had a worse blood sugar response than men of the same age. It proves that menopause hampers our ability to regulate glucose and clear it from the blood.

What’s wrong with a bit of a menopause belly?

Should we be upset about a bit of extra fat? No. Are we fat-bashing? No. But there are important reasons why weight gain in menopause is an issue.

  • Number one, women say that it bothers them. As hormone doctor and menopause specialist Shahzadi Harpersays: “Menopause weight gain is the thing women complain most of in my clinic.” It is a sometimes seemingly inexplicable issue that preoccupies and upsets plenty of women, and that makes it worth looking for causes and solutions
  • The type of fat we are dealing with in menopause is unfortunately the dangerous kind. Fat around the hips and thighs, which women lay down in their child-bearing years, is pretty innocuous. But ‘menopause’ fat is “stored around the internal organs, where it can do a lot of harm. It’s the type you really don’t want,” says nutritionist and trainer Zana Morris. It is always better for long-term health to try and minimise this type of fat.
  • High blood sugar doesn’t just lead to weight gain, it also causes chronic low-level inflammation in the body which can lead to all kinds of degenerative diseases such as heart disease and Alzheimer’s. So tackling the issue is as much about longevity and overall health as it is about weight loss.
  • Weight gain can make other symptoms worse. Another as yet unpublished Zoe health study demonstrated that all the menopausal symptoms women suffer from are much more pronounced in women with obesity. A good reason not to let things get that far if you can.
  • If there’s an easy and health-boosting way to deal with menopause weight gain, why not give it a go? And as you’ll find, this is actually the case.

How exactly does the menopause make you gain weight?

Probably unsurprisingly (as it is at the heart of so many menopausal symptoms), plummeting oestrogen levels are to blame for a thickening middle section. “As oestrogen levels drop, we seem to become more insulin resistant,” says Morris. Insulin is the hormone that regulates blood sugar levels. Resistance to it means that the body becomes less effective at converting this sugar into energy, and instead stores more of it as fat. “Basically, you can eat the exact same amount of food but suddenly, it makes you put on weight where it didn’t use to,” says Morris. This ‘insulin-related’ fat, she says, is “stored around the belly or the middle, or as back fat in some cases. But it’s always that area and it’s indicative of fat around the organs – what we call visceral fat.”

The Zoe study has proved the link between the menopausal hormone fluctuations and the accumulation of this so called ‘visceral’ fat. But how does a drop in oestrogen make us more insulin-resistant and therefore more likely to put on weight? It’s all linked to the gut microbiome and how it changes in menopause.

“We have observed that the gut microbiome [a community of a hundred trillion microbes that convert our food into helpful chemicals for the body] plays a central role in all of this,” says Dr Amati. “We all have specific microbes in our gut that help regulate oestrogen and ‘work with’ the hormone to protect us against inflammation, poor glycemic control, and obesity. When oestrogen levels dramatically fall, we end up fewer of these helpful bacteria and more pro-inflammatory, pro-obesogenic bacterial species.” And that’s bad news for our waist as well as our health. “Those pro-inflammatory bugs are very strongly associated with cardiovascular disease and diabetes risks,” says Amati.

Are hormones the only reason for menopause belly?

No, it’s not quite that simple. There are plenty of other reasons it can be hard the keep the belly fat off during menopause, chief among them the stress and sleep deprivation that are often part and parcel of ‘the change’. These can cause a rise in cortisol(stress hormone) levels, which themselves can lead to inflammation and poor insulin control. Also, “being tired all the time make you crave sugar for energy, so it’s easy to get caught in a vicious cycle of glucose spikes,” says Morris. No wonder meno makes you yo-yo!

Hormone-related issues other than the menopause could be at play as well: “You could, for example, have an underactive thyroid,” says Dr Harper. “It could be a good idea to get your hormones checked.”

Can I beat menopause belly with exercise?

If you’ve been jogging yourself into a lather trying to get rid of any excess menopausal weight to no avail, there’s a reason why. “You have to do a lot of exercise in order for the body to burn into the fat stores,” says Morris. “The trouble with this is that you'll start burning into muscle stores too. This creates stress on the body which means you can end up releasing more cortisol, which could end up making you fatter in the long haul.” There is a way out of this: “Short burst of high-intensity exercise (HIIT) are the solution here; this way of working out actually helps bring insulin down and releases beneficial growth hormones in the body,” says Morris. Read more about HIIT here. Lifting weights is great, too: bigger muscles burn more calories from your blood sugar.

What is the best way to lose your menopause belly?

Here’s the interesting part: the Zoe study shows us the best way to tackle that ‘menopause middle’ and seriously improve our health to boot. “We can mediate the unfavourable changes in blood sugar control and inflammation we observe in women,” says Amati. “It’s done by eating in a way that supports and effectively modulates the gut microbiome.”

The best news is that this is not a case of restricting yourself and counting calories. It’s about choosing the right foods and making very do-able tweaks in the way you eat your meals. Here’s what you need to do.

Eat as many different plant species as possible

“We don’t yet know precisely which foods stimulate the specific microbes associated with menopause,” says Professor of epidemiology and scientific co-founder of Zoe, Tim Spector. “But we do know that our gut microbiome should be as diverse in species as possible, and that healthy bacteria thrive on a diet of plant fibres. The aim is to include 30 different plant species a week, including nuts, seeds, herbs and fruits and concentrating on the healthiest, most bug-beloved options. These include cruciferous veg (the cabbage family, including broccoli and Brussel sprouts) and berries,” he says.

If sprouts strike you as hard work, think of the benefits: “We’ve seen that those women who ate more healthy plants were much less likely report suffering with all menopausal symptoms, from sleep disturbance to anxiety to night sweats, hot flashes and weight gain,” says Amati. “In fact, significantly upping plant consumption cut the incidence of these symptoms by a third.”

Start with a salad

“Eating fibrous plants at the start of every meal is a great way to control glucose spikes,” says Morris. This is true even if your salad or platter of crudités is followed by a bowl of pasta. So that’s how the Italians score low obesity rates…

Funnel in fermented foods

“The eating of fibrous plants by gut microbes is a fermentation process that creates healthy postbiotic substances or chemicals that are good for your body,” says professor Spector. Already-fermented foods, such as sauerkraut, kimchi, kefir, aged cheeses and pickles, also have a “very beneficial effect as they pass through the body. Eat or drink small shots of them on a regular basis,” he says.

Pick polyphenols, particularly purples

Polyphenols are plant ‘defence’ chemicals that are recognised by the intense colour they give to the plants they’re contained in. “We use to group them as antioxidants, but they do far more than protect against oxidation,” says Dr Amati. “In the gut, they contribute to the creation of better postbiotics that are really helpful for our overall wellbeing. Serotonin (the feelgood hormone) is a classic example: “its production requires both fibre and polyphenols, so it’s really important to ingest enough of both, particularly during testing times,” says Amati.

The trick is to eat lots of brightly-coloured plants. “Colour helps you make the right choices – the ‘health score’ of a red cabbage versus an iceberg lettuce is like day and night,” says Spector. Every colour has a different function so again, diversity is key. But purple foods come in for particular praise. Blueberries, aubergines, red cabbage, purple sprouting broccoli and the novel (to us) haskap berry should be your new best friends for their nutritional and disease-fighting prowess.

Fill up on ‘fire-fighting’ protein

All these plants should not replace any food groups (unless you consider processed foods and sugar food groups), they should be added to a balanced diet. Protein is another essential that should be eaten with every meal,” says Dr Berry. “Like fibre, it’s a ‘fire-fighter’ food that dampens glucose and insulin spikes.” It also you helps you feel fuller, faster, and builds the muscle mass that burns the sugar in your blood.

Try intermittent fasting

“Eating all your daily meals within a ten-hour window and not eating anything during the other 14 hours appears to be affective at controlling blood sugar,” says Spector. This is intermittent fasting, and means that if you have your breakfast at 8am, you need to eat your dinner no later than 6pm. For Morris, the window is even slightly smaller: “A fasting period of 15 hours is really ideal for effective weight loss,” she says.

Don’t snack in between meals

“Snacking between meals leads to constant insulin spikes with no chance for the body to re-set and clear the blood of glucose, so it isn’t a good idea when you’re fighting this particular type of weight gain,” says Spector. “So, eat two or three meals a day, or four small ones if you must. Just don't graze between them,” says Morris.

HRT helps 

Because HRT (hormone replacement therapy for menopause) supplements oestrogen and counteracts the sharp drop of the hormone as you hit the menopause, it also helps fight your ‘menopause middle’.

Try supplementing with Inositol

Inositol, or vitamin B8, is a component of plant cell membranes found in citrus fruits, nuts, seeds and oats. It mitigates insulin resistance and issues with weight and cholesterol, says Dr Harper, which is why she likes to prescribe it to her patients.

How long does menopause weight gain last?

Unfortunately, your menopause belly won’t abate in the way other menopausal symptoms such as hot flashes will once your hormones have settled. “Menopause is the end result – it’s a pro-obesogenic environment,” says Dr Amati. “Other menopausal symptoms are associated with huge, but more or less temporary, variations in oestrogen levels. But the metabolic and microbiome changes that happen will be set for life. Because this also means the risk of other pro-inflammatory diseases such as type 2 diabetes and Alzheimer’s goes up (in fact, after menopause our risk overtakes that of men), it is important that we make these changes to our diet and lifestyle, and sustain them.”

They are changes that can be rather tasty and that, apart from slimming you down, will give you a far comfier menopause as well as a chance of a much greater ‘healthspan’: a healthier, happier life. That’s a win-win if ever we saw one.