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Apples and pears - the low down on menopausal weight and metabolic health

What is the major driver for weight gain?

On average women in their mid-life years gain about 1.5 lbs per year independent of their original weight or race/ethnicity(1). Age is typically the biggest reason for this gain, but there are a number of others factors that contribute such as medication use (e.g. beta blockers, sleeping tablets)(1), genetics, changes in sleep patterns, eating ultra-processed food, inactivity due to injury, depression and hormone changes through menopause(2, 3).

So, what changes as we age? From 30 years onwards our bodies show a gradual decline in lean muscle mass, which has the effect of reducing the resting metabolic rate (the calories our body needs to perform its most basic functions). Aging is also accompanied by a subtle reduction in our physical activity, which further compounds these muscle losses(3). Weight gain slowly occurs if a person doesn’t change their calorie intake to reflect this lower energy requirement or adjust their physical activity efforts back to previous levels(3).

Weight gain - how important are hormone changes during menopause?

Becoming menopausal can be a truly confusing time for women. In addition to the everyday life disruptors like hot flushes, sleep problems and mood disorders, women are often concerned about metabolic problems such as weight gain, insulin resistance and lipid metabolism disturbances(4).

In the pre-menopause stage the hormone oestrogen is responsible for the ‘metabolically healthy’ accumulation of fat in our bottoms and thighs (the pear shape)(4). However during the peri-menopause dropping levels of oestrogen drive an increase in fat to a women’s waist, creating central fat or an apple shape – a change which is independent of age, physical activity and total body fat(3). In addition to fat distribution changes, reduced oestrogen also affects the activity of our appetite hormones (neuropeptide YY and ghrelin), leading to changes in hunger during menopause(5).

Why is the apple shape a cause for concern?

This central fat or visceral fat (sitting around our major organs) may increase to 15-20% of the total body fat, compared to 5-8% in pre-menopausal women(6). Even at a healthy weight, woman who gain weight around their middles are likely to develop higher blood pressure and elevated LDL cholesterol(6). Visceral fat also causes an increase in inflammation which is a trigger for cardiovascular disease, type 2 diabetes and non-alcoholic fatty liver disease(2,7).

Time to take action?

Menopause can be a time to reflect on the changes that are happening to our body and to take steps to counteract the increased risks these changes can impose. The good news is that visceral fat responds quicker than other fat deposits to weight loss, so we have a good opportunity to make real improvements to our metabolic health(8). With the support of a nutritionist, you can develop the tools you need to improve and maintain your metabolic health, leaving you ready and energized for your adventures moving forward.

Image: Nina H. Niestroj, NHS Photodesign,


  1. Knight M, Anekwe C, Washington K et al. Weight regulation in menopause. Menopause 2022;28(8):960-965.

  2. Fenton A. Weight, shape and body composition changes at menopause. J Mid-life Health 2021;12:187-192.

  3. Kapoor E, Collazo-Clavell M, Faubion S. Weight gain in women at mid-life: A concise review of the pathophysiology and strategies for management. Mayo Clin Proc 2017;92(10):1552-1558.

  4. Kozakowski J, Gietka-Czernel M, Leszczynska D et al. Obesity in menopause - our negligence or an unfortunate inevitability. Menopause Rev 2017;16(2)61-65.

  5. Leeners B, Geary N, Tobler P et al. Ovarian hormones and obesity. Hum Reprod Update 2017;23(3):300-321.

  6. Milewicz A, Tworowska U, Demissie M. Menopausal obesity - myth or fact? Climacteric 2001;4(4):273-283.

  7. Mirza MS. Obesity, visceral fat, and NAFLD: Querying the role of adipokines in the progression of nonalcoholic fatty liver disease. ISRN Gastroenterol 2011;2011:592404.

  8. Liu F, Flatt S, Nichols J et al. Factors associated with visceral fat loss in response to a multifaceted weight loss intervention. J Obes Weight Loss Ther 2017;7(4):346.

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