Why fat loss feels harder after 40, and what to do about it.
10min read
Many women start noticing some stubborn weight gain as they move into their 40s and 50s, particularly around the middle, and it is frustrating, when they have been trying so hard to reach and maintain a healthy weight over the years.
The clothes that fitted last summer no longer fit, or feel tighter in the middle, and the scales may have moved up a bit. Otherwise nothing seems to have really changed. The same walk still happens most days, even a workout routine for those who can, and, if anything, there is more attention being paid to nutrition. Most women have tried at least a few diets over the years.
Then they have been led to believe that they are not disciplined enough, they are not following the rules properly, they lack willpower, or their body is failing because this is simply what happens with age.
None of those tells the whole story, and it is about as helpful to suggest eating less and moving more as it is to tell someone who wants to improve their finances to save more and spend less.
I will try to untangle some of it here.
If you read nothing else, read this
One thing worth knowing: fat loss comes down to a consistent energy deficit. Calories in versus calories out, as you have heard before. But maintaining that deficit depends on many factors. What and how you eat, how you move, your sleep, stress, the support you have and how you enjoy life in general. In midlife several of those get disrupted at once, and need more intentional choices than before.
One thing to ponder: why does fat loss matter to you? Not because the doctor said, not for the dress. What difference would it make for you, now and in ten years?
One thing to experiment with: what could you add to your meals this week to nourish your body and manage cravings? Consider trying a couple of handfuls of veggies at dinner, or some Greek yoghurt at breakfast. After a week or two, check in with yourself. How did it go, and what would you do differently?
Does energy balance still apply in perimenopause and menopause?
There is an ongoing debate in the fitness and wellness world about what it really takes to lose fat and change body composition. One side says eat less and move more, calories in versus calories out. The other side says this ignores hormones, insulin resistance, polyendocrine metabolic ovarian syndrome or PMOS, which used to be called PCOS [1], menopause and other metabolic issues.
The answer is clear. The first law of thermodynamics does apply. Calories in minus calories out equals the change in the body's energy stores, which are fat, glycogen in the liver and muscles, and protein across tissues and organs.
What often gets confused is what influences the calories in and the calories out of that equation.
It is worth saying that when calories are controlled, it makes no significant difference which diet approach is used for fat loss. In 2014, researchers pooled 48 randomised trials covering 7,286 people, median age 46, comparing various known diets against each other. Low carbohydrate, low fat and everything in between all produced significant weight loss, and the differences between them were small. The authors concluded that this supports recommending whichever diet a person will actually stick to [2].
So as long as calories are controlled, the eating pattern does not matter much for fat loss. But if health, longevity and enjoyment matter alongside it, the Mediterranean pattern has the most evidence behind it and happens to be delicious [3]. It is not one cuisine but many across the Mediterranean basin, built on plenty of fruit, vegetables and pulses, olive oil, fish, dairy, eggs, nuts and seeds, with modest amounts of red meat. Also combined with lots of daily physical activity in nature, human connection and an overall positive outlook, even in the most humble surroundings.
Why the energy balance equation is not as simple as it sounds
The energy-in part of the energy balance equation depends on many factors, I will focus on four here:
1. Hunger, fullness and satisfaction after meals.
Hormones play a role here, as do sleep and stress. As estrogen fluctuates and declines in perimenopause, hunger and cravings increase, because estrogen acts directly on the brain areas regulating appetite [4]. Progesterone also declines, and women lose its calming effect, so sleep gets disrupted [5]. For those troubled by hot flushes, sleep can be badly broken. Some notice a weaker bladder and more frequent visits to the toilet at night.
Women with a long history of dieting may try more aggressive restriction, but this tends to increase hunger and preoccupation with food, that food noise, which makes it harder to sustain. And for those who do lose weight, hunger remains an issue. It has been shown that hunger stays raised for a year or more after significant weight loss [6], which is one of the reasons most diets fail in the long run.
Women also become more insulin resistant in perimenopause, which means the body has more difficulty handling glucose. This results in higher blood sugar swings, and more energy and mood fluctuation through the day, which affects more choices than you might think, from the will to exercise to cravings for energy-dense food.
2. The quality of the food.
Protein reduces hunger, and it takes more energy for the body to process than carbohydrate or fat. Fibre adds bulk, gives a sense of fullness, and slows how fast food is eaten and absorbed, so the brain has time to register that enough has been eaten, which usually takes over twenty minutes. Fibre also feeds the gut bacteria that ferment it into short-chain fatty acids, which trigger the hormones signalling fullness [7].
Processing matters too. Whole almonds deliver around a quarter less energy than the label says, because their cell walls trap fat that passes through undigested [8]. Ground into almond butter, most of the energy gets absorbed [9].
Energy density matters, largely because of fat, which provides 9 kcal per gram compared with 4 for protein and carbohydrate. Two plates that look the same can differ by hundreds of calories. So does portion size, particularly combined with energy-dense food: a pub roast, a pizza or a portion of fish and chips can each sit around 1,000 calories, and drinks add a few hundred more, which is how a normal weekend can offset four deliberate weekdays of portion and calorie control.
One study showed people chose to eat 500 calories a day more, and ate it faster, when offered ultra-processed meals compared with unprocessed meals matched for calories, sugar, fat and fibre [10]. This does not mean every processed food is a problem. It shows that the same calories on paper do not have the same impact in practice.
Food is not eaten in isolation but in meals combining different food groups, cooked and raw. Variety is the point, for nourishment, pleasure and satiation. Context matters too. Feeling stressed and rushed affects digestion, enjoyment and whether you register having eaten at all, compared with sitting at a table without distractions, hopefully in good company, taking your time.
Much of this is not fully within our control. Working and commuting for ten or twelve hours a day, living in a food desert where the nearest shops sell mainly packaged food and sugary snacks, with fresh produce not always available or affordable, ultra-processed food is often the cheapest and easiest option.
3. How much is absorbed.
Sometimes less than the label says, and the numbers are estimates in any case. Under UK labelling rules the protein, carbohydrate and fat values on a packet can be up to 20% out, and the calorie figure is calculated from those [11]. Age matters less here than people assume. The digestive system is fairly resilient in healthy ageing, and most absorption problems attributed to getting older turn out to be caused by specific conditions or medications rather than age itself [12]. Digestive conditions such as coeliac disease or inflammatory bowel disease affect absorption directly.
4. What makes people eat.
Often it's not plain hunger. Many of us respond to stress by eating more, snacking more, choosing more energy-dense food [13]. Others do the opposite and forget to eat. Some snack out of boredom or restlessness, or because it is what happens at the cinema, in front of the TV or when friends get together. Food is a real source of pleasure and comfort, and that is fine. It only becomes a problem when it is the only way to cope.
Now let's focus on four parts of the energy-out part of the equation of energy balance:
1. The amount of energy the body uses at rest.
This is the largest part by far, roughly two thirds of the total energy expenditure. Breathing, circulation, kidney and liver function, brain activity, repairing and replacing tissue, holding temperature steady. It is mostly determined by how much lean tissue someone carries, which is why muscle matters, since it is metabolically active and takes energy to maintain. It also varies by body size, sex, age and genetics.
2. Digesting food.
It costs around a tenth of the total. Protein costs the most to break down, carbohydrate less, fat the least. Highly processed food costs less energy to absorb than minimally processed food, because much of the work has been done already by processing, chopping, blending and cooking.
3. Everyday movement.
Everything outside deliberate exercise: walking to the shop, taking the stairs, standing, housework, fidgeting. For most people this is considerably larger than their exercise sessions, and it varies enormously between individuals. It also depends on circumstances, such as having an office job sitting in front of a computer for ten hours, living in a neighbourhood that is not safe or pleasant to walk in, or having pain, injury or a health condition that restricts movement. And spontaneous movement is the first thing to disappear with tiredness, poor sleep or under-eating.
4. Deliberate exercise.
This usually consumes the least amount of energy of the four, so stressing about working out four times a week or signing up for a spinning class hoping to burn more calories is counterproductive, and a fast-track to giving up if you are not used to it and do not enjoy it. Regular exercise is of course important for overall health, strength, longevity, reducing the risk of falls and fractures, brain health, mental health and cancer prevention. It can also support fat loss in the long run. But it is worth putting things into perspective rather than believing you need a boot camp and hours at the gym to see improvements in body composition and health markers.
For context, UK Chief Medical Officers recommend at least 150 minutes of moderate activity a week, or 75 minutes of vigorous, plus muscle-strengthening activity on at least two days [14]. The guidance is explicit that this can be accumulated in bouts of any length, that stair climbing and carrying children count as strength work, and that if you do none, do some, and if you do some, do a bit more. Around two thirds of UK adults meet the aerobic guideline. The strength one is a different story: depending on how strictly it is defined, somewhere between one in four and one in twenty-five women actually meet it [15,16].
For those who use fitness trackers, there are two things worth knowing about the numbers. Trackers and questionnaires rank people's activity levels reasonably well, but they are much less precise about the absolute amount [17]. Their calorie figures in particular are unreliable [18]. And we all misjudge in the same direction: people consistently over-report how much they move, usually by counting light activity as moderate [19], while under-reporting what they eat [20].
Some conditions and medications genuinely shift these numbers, including thyroid problems and PMOS.
What actually changes in midlife
Most of us assume metabolism slows down with age. Total daily energy expenditure, adjusted for body composition, actually holds steady from the twenties until around sixty, measured directly in 6,421 people across 29 countries, and only then declines by about 0.7% a year [21]. Resting metabolism specifically may start declining a little earlier, from the mid-forties. And it is plain aging rather menopause. A study designed to separate the two found the decline tracks age, not menopausal status [22]. Adjusted for body composition is the key phrase throughout.
However, there are several things changing, slowly, over years.
Where fat is stored.
During the reproductive years estrogen directs fat towards the hips, thighs and under the skin. As it declines, subcutaneous fat continues to accumulate, and after menopause more is stored in the abdomen around the organs, which is called visceral fat [23]. That is a change in distribution, and it is why the shape can change without much change in weight. In a longitudinal study following women through the transition, total and regional fat rose by 2 to 14%, with a pronounced increase around the middle, while weight did not necessarily increase because lean mass was falling at the same time [23].
It is worth mentioning how unreliable the number on the scale is on its own. It is useful for tracking a trend over weeks, but it fluctuates widely with water retention from one day to the next. Women who work on building muscle may see the scales stay the same or go up while their shape changes and clothes feel looser, because muscle is denser than fat and takes up less space for the same weight.
Conversely, when body composition changes during perimenopause and menopause, weight may not change dramatically, but there can be progressive muscle loss without consistent training, which affects metabolism, glucose handling, strength, overall health and longevity. There is also fat redistribution to the abdomen, which we do not want, as visceral fat is metabolically active, interferes with hormone signalling, increases inflammation and is associated with insulin resistance.
Hunger rises in midlife, and several things push it up at once.
Estrogen acts directly on the brain areas regulating appetite, so as it fluctuates, hunger rises and meals feel less satisfying [4]. Progesterone starts decreasing even earlier than estrogen, and it is the source of allopregnanolone, a compound acting on the brain's main calming receptors, the same ones targeted by sleep and anxiety medication [5]. Declining progesterone is one reason sleep becomes lighter and more broken, and why so many women describe feeling tired but wired.
Sleep breaks.
For many women, hot flushes and night sweats interrupt sleep, and so does stress. After a short night, hunger and cravings for energy-dense food get more intense the following day and harder to resist [24].
Stress becomes harder to manage.
Hormonal changes, broken sleep and the demands of midlife all reduce the capacity to recover from a demanding day. More responsibility at work, dealing with children and ageing parents at the same time, less cooking at home, no time for a relaxed meal. For anyone who already eats in response to stress, there is more of it and less capacity to absorb it.
Movement drops.
Women arrive in perimenopause already exhausted from the demands of midlife, and it gets harder with the hormonal shifts. The more tired and sleep-deprived someone is, the less inclined they are to go for a walk, let alone follow an exercise plan.
Joints ache more too, and this is not imagination or wear and tear alone. Around 70% of women report musculoskeletal pain during the transition, with perimenopause appearing to be the peak [25,26]. Estrogen acts on bone, tendon, muscle, cartilage and ligament, and its decline is linked to increased inflammation among other changes [25]. The clearest evidence comes from cancer treatment: drugs that sharply lower estrogen cause new or worsening joint pain in around half the women taking them.
Two things are worth knowing. Most women who have this investigated have normal scans, so pain without structural damage is the norm rather than a mystery. And musculoskeletal pain is consistently lower in women who are more physically active. So, worth trying to gently move more, it can help, even if it might not look like it at first.
Muscle strength and mass declines.
It seems to be a result of the hormone decline as well as moving less [27].
Testosterone is worth a brief word, because it is being sold hard at the moment. Levels do decline, but the decline follows age rather than menopause. In a study of over a thousand Australian women aged 40 to 69, testosterone declined from the age of 40, reached its lowest point at around 58 to 59, and then rose modestly, with no impact of natural menopause [28]. Surgical removal of both ovaries, or medical menopause, is different, and testosterone falls by around half [29].
It is not recommended for fatigue or low mood on their own, and it has not been shown to improve muscle mass or strength in women at physiological doses [30]. The British Menopause Society puts it plainly: testosterone is not the third component of HRT, and the misinformation around it is creating unrealistic expectations [31].
There is one indication supported by UK guidance at the moment. A fuller look at testosterone in midlife is coming in a separate post.
Insulin resistance develops.
Estrogen supports insulin sensitivity directly, so as it declines that effect is lost. At the same time there is a tendency to accumulate visceral fat, which is metabolically active and releases inflammatory signals. There is more evidence supporting visceral fat driving insulin resistance than the reverse, and we know that with fat loss insulin resistance can be reversed [32]. It is likely there is a cycle here, where estrogen decline drives more visceral fat, which drives insulin resistance, which drives more fat accumulation.
The main conclusion is that the energy balance equation still holds in perimenopause and menopause, but it is influenced by a large number of different factors. This does not mean losing fat is impossible in midlife, and it does not mean it should feel like a punishment.
It means that even when what used to work is no longer effective, there are ways for every woman to be successful, as long as she has access to reliable information about what really moves the needle, and the support to make the changes she needs in the context of her own life.
It is worth focusing on what is under your control
Aside from genetics, family history and ageing itself, some circumstances may be fixed, at least for a while. Long working hours under constant stress, a long commute, access to affordable quality food, access to safe and enjoyable places to walk, being a caregiver. None of this can be fixed by trying harder. Sometimes having a full life is what it is, and everyone needs to work with what they have got in hand.
That makes self-care even more important, not less. It is not selfish. It is about taking care of yourself so you can be fully present and able to give to others. You cannot pour from an empty cup.
And before deciding on another diet or exercise programme, take a look at your energy levels, your sleep and your stress resilience. It does not need to be perfect, but without systems to protect sleep and manage stress, nothing else holds, and no diet or exercise programme will work.
Sleep is one of the things that makes everything else easier, and it often gets disrupted in midlife. When it goes, hunger, cravings, mood, stress and decision-making all get harder to manage.
That does not mean expecting a perfect eight hours of sleep. In midlife sleep can be genuinely outside your control, particularly with night sweats, hot flushes or bladder symptoms. So the useful question is not how to sleep perfectly, but what gives sleep the best chance of being restorative. Consistent sleep and wake times, a wind-down period, a cool dark room, less alcohol, less caffeine later in the day, and a lighter dinner earlier in the evening are all reasonable places to start. If symptoms are repeatedly waking you, that is not a discipline problem. Talk to your GP to get to the bottom of it.
Relaxation matters more than we admit. It is not about cortisol hacks. It is about helping your body recover from everyday stressors, and helping your brain stay online instead of switching into constant fight or flight. Under constant stress you cannot learn new skills or change habits, you cannot think clearly, and you cannot make good decisions that support your future self. You end up on autopilot when you need to be in the driver's seat.
Anything that genuinely calms you counts. Slow breathing is underrated and very effective, even for disrupted sleep, and can be used anywhere. A walk without your phone. Time outdoors. Time with the people you care about, or with your pet.
Some things add to the load: skipping meals or eating erratically, large meals that leave you uncomfortable, too much alcohol, caffeine, refined sugar, and a diet dominated by highly processed food.
Routine helps more than most people expect. The body likes routine. Meals, sleep and movement at roughly consistent times. Not a rigid schedule, a shape to the week that means fewer decisions have to be made from scratch when you are tired.
Then movement, which does not mean another regime. Many women reach this point having not exercised properly in years, because there was no time or energy for it, and because of aching joints, stiffness, poor sleep, brain fog and mood that comes and goes. A boot camp is not the answer, and it is not necessary for fat loss either.
Movement helps with far more than burning calories: stress, sleep, blood sugar regulation, balance, mood and brain health. Walking is so underrated and so effective. So are movement snacks, three to five minutes every hour or so. Some squats if the knees allow, standing up and sitting down a few times, calf raises, push-ups against a wall or the kitchen counter. They add up, and they compound.
A fifteen-minute walk after a meal is one of the best-evidenced small habits there is. It measurably blunts the blood sugar spike after a meal, and it works through a route that does not depend on insulin, so it still helps when there is insulin resistance [33].
Strength training deserves its own mention. In a one-year trial, postmenopausal women who did supervised resistance training gained lean tissue whether or not they were taking menopause hormone therapy [34]. Hormone therapy on its own appears to slow the muscle loss [35], but it is not protective without the stimulus from strength training, coupled with adequate recovery and quality nutrition, with enough protein and energy to fuel the work.
There is no room for restrictive diets, in any stage of life, particularly in midlife. It is worth thinking about how to add more nutrition rather than restricting the foods you love. The biggest lever that supports both fat loss and overall health is adding protein and fibre at most meals, which are satiating, make a genuine difference to cravings, support a healthy body composition and feed a happy gut microbiome.
Start by adding rather than taking away. A couple of handfuls of vegetables at dinner. Some Greek yoghurt at breakfast. Then after a week or two, if that has held, some nuts, seeds and fruit alongside it.
Home-cooked food helps more than most people expect, mainly because you control what goes in and it tends to be less energy dense. Plenty of people hate meal planning, and that is fair. It does not have to mean four hours on a Sunday. It can be some chopped vegetables in a box, hummus, boiled eggs, a tray of seasoned chicken or fish in the oven, a pot of rice.
Some form of awareness helps, and it does not have to be calorie counting. Given everything above about how imprecise those numbers are, the point is not accuracy, it is noticing. That might be the plate method, hand portions, photographing your meals for a week, or simply paying attention to how satisfied you feel two hours after eating. Choose whatever you will actually keep doing.
And how you eat matters as much as what. Sitting at a table, without a laptop or a phone, eating slowly enough that the meal registers. Ideally with people you like and have fun with.
Hot flushes are a good example of how this works. Triggers vary considerably between women, but some notice alcohol, caffeine, spicy food or large meals set symptoms off. Regular balanced meals, walks after eating and managing stress help more broadly, and the benefits go well beyond the hot flushes.
If hot flushes are significantly affecting sleep or quality of life, they deserve proper assessment rather than being something to put up with, though some women do notice improvement with lifestyle changes.
Where circumstances are fixed there is usually little wiggle room, but there may still be a way around them. Working hours may not be negotiable, but what you store in the house is what you will eventually eat, so it may be worth planning ahead and choosing with intention next time you do grocery shopping. You may be able to take the stairs next time, or go for a ten-minute walk on your lunch-break, or do some squats when you visit the loo, or choose what you eat and what you take with you before a long shift, or carry a water bottle with you at all times.
These are just examples and may not be the right ones for you, but if you take some time to think about it, you may come up with better ideas that work.
What is worth remembering is this: consistency beats intensity.
A moderate calorie deficit that can be sustained beats a severe one that results in more cravings, food noise and bingeing.
The common mistake is starting too hard and changing too many things all at once, when none of it is necessary for fat loss, and then giving up before any results show.
Put your effort where it is most likely to pay back, the big rocks, and start with whatever costs you least, the low hanging fruit.
Where to start
Before changing anything, get specific about what you want. Not the number on the scales, but what you actually want in your life. Is it being able to keep up with your kids? Sleeping through the night? Not thinking about food all day? Then work out what that looks like on an ordinary Tuesday.
Then pick one or two simple actions you can repeat that take you closer to your goal. Not rigid rules, but tools that give you structure and support the behaviours that will take you where you want to go.
Why small changes work
You cannot control how much fat you lose in the next three months, but you can decide whether those three months are easier and more enjoyable than the last three, and whether you finish them with habits that serve you and that you can sustain.
Another intensive plan on an already stretched system is what has failed before. Building some resilience first is not a delay before the real work, it is what makes the real work hold.
If it is difficult, it does not mean you are broken. You are a person with a complex life and real needs, and the way through is a personal one, built in layers.
Successful fat loss that is maintained is for those who opt for the long game. The strategy that works is your own to nail down, and it will change with the season of life you are in.
If you are looking for support to reach your health and fitness goals in midlife, improve your menopause experience and enjoy life, I will be honoured to be your coach. Book a free call to see if we are a good fit.
Next: why muscle strength matters more than the number on the scale in midlife, and what actually builds it.
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