Writing for the Wall Street Journal, Sumathi Reddy explains why women in their 40s and 50s are more likely to gain weight than men, the potential health risks of this weight gain, and what women can do to combat these extra midlife pounds.

Why women start gaining weight in midlife

According to Reddy, both men and women typically see their weight peak between the ages of 40 and 65 as their metabolism slows down and they lose muscle mass. However, women may see greater weight gain than men due to hormonal changes associated with the transition to menopause.

Even if they keep their same routines, many women in their 40s and 50s often see their weight increase and have a harder time losing weight. According to Daniela Hurtado, an obesity medicine physician and assistant professor of medicine at  Mayo Clinic in Florida, research suggests that women gain an average of 0.8 to 1.5 pounds a year starting in midlife.

Separately, Kathleen Jordan, CMO at  Midi Health, a virtual care clinic for women over 40, said that hormone changes during the transition to menopause, when women's menstrual cycles start becoming irregular, have been associated with an average weight gain of around six pounds.

A "major culprit" of this midlife weight gain in women is a decline in estrogen that occurs with menopause, Reddy writes. This decline can change where fat is distributed on a woman's body, decrease insulin sensitivity, and raise cholesterol levels.

Some studies have also suggested that estrogen may play a role in managing weight. In one study of women over 40, participants who took medication to stop their estrogen production for 24 weeks gained over three pounds of fat. Another study found that women with estrogen exercised more regularly and vigorously than women on estrogen-suppressing medication.

"This at least suggests that there might be a biological driver [behind women's midlife weight gain] and it's not just what you choose to do," says Wendy Kohrt, a professor of medicine at the University of Colorado Anschutz Medical Campus  and the senior researcher on both studies.

The health impacts of weight gain

Body and metabolism changes during the menopause transition put women at a higher risk for health conditions, such as high blood pressure and cholesterol. They may also be at an increased risk of developing type 2 diabetes if they have a hard time maintaining or achieving a healthy weight.

In a  study  published in EBioMedicine  in November, researchers evaluated over 600 women after a high-fat, high-carbohydrate meal and then followed them for an additional two weeks. The researchers found that perimenopausal and postmenopausal women had worse metabolic health than women who were premenopausal.

Compared to the premenopausal women, peri- and postmenopausal women had higher cholesterol and blood pressure, higher glucose and insulin resistance, and more inflammation. According to Sarah Berry, an associate professor in the department of nutritional sciences at King's College London and the study's senior author, even women of the same age saw better health outcomes when they were premenopausal compared to peri- or postmenopausal.

How to combat midlife weight gain

If women are struggling with midlife weight gains, doctors say that menopausal hormone therapy may be helpful. In this therapy, women take a form of estrogen with progesterone to combat menopause symptoms, such as hot flashes.

According to Reddy, some research suggests that hormone therapy can reverse some fat distribution in the abdomen that happens during menopause. It can also alleviate sleep problems and mood issues that may indirectly impact weight gain.

However, doctors note that hormone therapy alone will not be enough to help women manage their midlife weight gain. Women should also try to be active and add strength or resistance training to their workouts to reduce muscle loss.

"A lot of us, we love cardio but you want to try to at least get 50% cardio and 50% resistance," said Sylvia Gonsahn-Bollie, a physician in Silver Spring, Maryland. In particular, people should exercise for at least 150 minutes a week to lose weight and keep it off, though she notes that most people may need closer to 300 to 420 minutes.

Gonsahn-Bollie also notes that it's important to manage your stress since chronic stress can increase cortisol levels, which can then increase insulin resistance and make it more difficult to lose weight.

Aside from exercise and stress management, dietary changes can also help women manage their weight more easily. Women should try to eat more protein and fiber while reducing their sugar intake.

According to Ekta Kapoor, an associate professor of medicine at Mayo Clinic in Minnesota, women under 40 should try to enter perimenopause at a healthy weight, which a doctor can help determine. For women trying to lose weight during this time, she recommends setting realistic expectations since it may be more difficult than expected. (Reddy, Wall Street Journal, 5/2)