Midlife Weight Gain: Why Is it So Hard to Lose?

Up to 70% of menopausal women put on weight, and 43% are considered obese. But why are these numbers so high? And why does it feel like the usual strategies—eating healthy, exercising, doing all the right things—just…stop working? Let’s break down what’s really going on.

Why Does the Body Hold Onto Weight During Midlife?

One major reason weight loss feels harder during menopause? Your body is actively trying to hold onto it.

“The body has a set point for weight, and it defends it,” says Dr. Michelle Montville, board-certified OB-GYN, menopause specialist, and Alloy’s Clinical Director. “The body maintains weight within a metabolically regulated range.” 

During midlife, this set point (or natural weight range) often shifts upward, due to a combination of hormonal changes, decreased energy expenditure, and increased appetite. In short, your set point changes. “This leads to weaker metabolic compensation, favoring fat accumulation over time,” she says.

What Causes Weight Gain During Perimenopause and Menopause?

In addition to the set-point phenomenon, there are a variety of reasons that women often gain weight during perimenopause and menopause, and most of them are beyond your control. According to the Mayo Clinic, these changes are both biological and environmental, and they impact nearly every woman in midlife to some degree. Here are some of the biggies:

We Lose Muscle Mass

As we age, it’s normal to lose muscle mass and gain fat more easily. When you lose muscle, your metabolism slows and your body burns fewer calories, which makes it harder to lose weight. That’s why strength training and protein intake become even more important during this life stage.

Genetic Predisposition to Weight Gain

Your genes play a role in how your body stores fat—especially during hormonal shifts like menopause. If your mother or other female relatives experienced weight gain in midlife, there’s a higher likelihood you will, too. Genetic predisposition can influence everything from where you gain weight to how your metabolism adapts over time.

Poor Sleep Quality

If you suffer from hot flashes that interrupt your sleep, you get less sleep—and that slows metabolism even more. There can also be an uptick in general stress (balancing work, kids/elderly parents, and other responsibilities) that can increase anxiety and disrupt sleep. And when we’re fatigued, we tend to move less.

Development of Insulin Resistance

During menopause, your body fat is more concentrated in your mid-section, which can cause insulin resistance. This means your muscle, fat, and liver cells don’t respond as well as they once did to insulin, and your pancreas has to make up for it, so that enough glucose goes into your cells. This can make us feel hungrier and more likely to store the carbs we eat as fat.

How Menopause Changes Your Body Composition

During menopause, body composition changes and weight is redistributed, most noticeably around the belly. Besides impacting your body confidence—we all deserve to feel amazing in our bodies, and confident in our jeans—this can increase your risk for developing some health issues. 

Visceral fat, the kind located deep inside your abdomen as you gain weight in your mid-section, accumulates around your internal organs. Unlike subcutaneous fat, this fat surrounds internal organs and is linked to higher risks of heart disease, insulin resistance, and inflammation. So while it may start as a frustrating cosmetic change, it’s also a metabolic shift that matters.

Traditional Diet and Exercise May Stop Working for Perimenopausal and Menopausal Women

For years, society and the medical community have told us that the only way to lose weight is by eating less and exercising more. But for many, many women in midlife, that’s incredibly frustrating to hear because those methods simply do not work anymore. In fact, at this stage of life, the factors mentioned above (genetics, aging, hormones, and environment) are not in your control. 

Now for some good news! Reducing visceral fat can help prevent serious health issues. You have options for support and help, which you should discuss with your doctor.

Should You Consider GLP-1 Medications for Weight Loss? 

If you are a perimenopausal or menopausal woman who cannot lose extra weight despite your best efforts, you may want to consider medications. In the last few years, GLP-1 medications have helped many women who are obese, or at risk of becoming so, successfully improve their body composition—and their overall health and emotional well-being.

Alloy’s Weight Care program offers GLP-1 medications, including Zepbound®, Wegovy®, and compounded liraglutide, that should be used in conjunction with healthy foods, exercise, and monitoring from your doctor. 

Weight Care at Alloy

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