Perhaps you’ve noticed it – that little midsection that suddenly appeared one day and just didn’t go away. Nicknamed the “menopause muffin top,” it’s considered medically normal for women to accumulate abdominal fat during midlife. Recently Ms.Medicine hosted Dr. Angela Fitch, associate director of the Massachusetts General Hospital Weight Center, for a clinician roundtable discussion on obesity and weight management at midlife. She gave us the skinny on the “menopause muffin top.” Here’s what we learned.
What causes midlife weight gain?
As hard as it is to swallow, it’s a “normal” aging process for women to gain about 1.5 pounds per year starting at midlife, even without any change in diet or exercise. That extra weight tends to gather around the middle – and even women who don’t see a difference on the scale may notice a redistribution of fat around the abdomen as they wonder why their jeans no longer fit. On the flip side, according to Dr. Fitch, weight loss is not a “normal” process of the body. See the challenge?
While the hormonal changes of perimenopause and menopause certainly play a significant role in that abdominal fat, it’s not the only cause. Aging is also a culprit, as are lifestyle and genetic factors. Case in point: as we age, we tend to lose muscle mass while simultaneously gaining fat. The loss of muscle mass results in a slowing metabolism – which means continuing your lifelong eating habits without increasing calorie burn will quickly result in weight gain.
Then those shifting hormones come back into play. Night sweats and disrupted sleep patterns make it harder to find the energy and motivation to exercise – and when women don’t get enough sleep, they tend to snack, consuming still more calories. As if that’s not enough, midlife women are often the “sandwich generation,” responsible for raising children and caring for aging parents, carrying career responsibilities, and dealing with a cascade of life changes. All that results in increased stress (which brings cortisol, another weight-influencing hormone), little time or energy for getting active, and irregular eating patterns due to crunched schedules.
Ultimately, weight management at midlife can become a “tug of war” of physiologic processes. Weight gain is rooted in a hormone-related slowing metabolism, increased hunger, and decreased satiety (the feeling of fullness that signals our bodies to stop eating), while weight loss is simply rooted in the increasingly challenging combination of reduced calorie intake and increased activity.
What About Obesity?
While mild weight gain can be upsetting, gains leading to obesity can have severe implications for your health.
Obesity classifications have three levels: Class 1 is a BMI of 30-34.9, Class 2 is a BMI of 35-39.9, and Class 3 is a BMI over 40. Dr. Fitch views obesity as a disease process where excess body fat accumulates to a level that may affect health. However, many patients don’t see it that way; only 65 percent view obesity as a disease, versus 80 percent of healthcare providers. And 82 percent of healthcare providers feel responsible for helping patients with weight management, while only 72 percent of patients think they’re singularly accountable for their weight loss efforts.
The risk of hypertension, type 2 diabetes, obstructive sleep apnea, and heart disease increases once your BMI is higher than 30.
The good news is a 5-10 percent weight loss can improve type 2 diabetes, hypertension, and triglycerides. And a 20 percent weight loss can result in the remission of type 2 diabetes, hypertension, and sleep apnea.
What Can We Do?
For slight to moderate weight gain, a lifestyle change often does the trick. Adding a brisk walk daily and strength training twice a week will increase calorie burn and, over time, help the metabolism pick up its pace. Combined with a revised nutrition plan – such as a Mediterranean or plant-based diet – you’ll create the calorie deficit needed to start shedding those extra pounds.
More difficult weight loss and management cases may require medical help. Fortunately, there are lots of options depending on your specific needs and budget. Dr. Fitch describes obesity management using the acronym “SAME.”
- S – Structure
- Weight loss programs (Noom, Weight Watchers, etc.), meal replacements
- A – Accountability
- Weight loss programs, follow-up visits, virtual care, technology (fitness trackers, fitness apps)
- M – Metabolic Advantage
- Bariatric surgery, medications, dietary patterns, exercise intensity, sleep
- E – Environmental Stimulus Control
- Meal replacements, Cognitive-Behavioral Therapy (CBT), acceptance-based therapy
For some, medications like metformin may be helpful. For others, hormone therapy may alleviate sleep disturbances and help boost the metabolism; testosterone therapy can help increase energy and muscle mass. And there are many surgical options available now, including gastric bypass, sleeve gastrectomy, and sleeve gastroplasty. The key is to work with a physician familiar with the most current data and who listens to your concerns.
Thanks to Angela Fitch, MD, FACP, FOMA
Associate Director, Massachusetts General Hospital Weight Center
Faculty at Harvard Medical School
Dr. Fitch is board certified in obesity medicine, internal medicine, and pediatrics. She became a diplomate of the American Board of Obesity Medicine in 2012, and prior to that practiced primary care full time before switching to obesity medicine. Dr. Fitch was medical director of the Weight Center, the Executive Health Program, and vice president of Primary Care at UC Health in Cincinnati before moving to Boston. She currently is serving as vice president of the Obesity Medicine Association and previously served as a trustee and secretary treasurer. She was the 2015-2016 chair of the clinical management section of The Obesity Society. Dr. Fitch is the winner of the 2017 Clinician of the Year Award from the Obesity Medicine Association.
References: Colazzo-Clavell, M. (2019, June 1). Managing obesity: Scaling the pyramid to success. Mayo Clinic Proceedings, 94(6), 933-935.