The Menopause Exchange Blog


As the menopause approaches, many women find their waist is expanding. This is often accompanied by weight gain. But even if their weight is steady, waistbands will tend to get tighter.

This article was included in issue 89 (summer 2021) of The Menopause Exchange newsletter.

Why is this happening?
As oestrogen levels start to fall, levels of other hormones, called androgens, begin to rise. You may not have heard of these, but testosterone is a key androgen hormone. Androgens tend to favour tummy fat storage and cause a shift from a pear body shape towards an apple body shape. Even without weight gain, the waist will tend to naturally thicken. Does this matter? Well, yes, it does, as fat around the tummy is linked to an increased risk of heart disease or diabetes. This shift towards tummy fat is unwelcome in terms of overall health as well as clothes size.

What is a healthy size?
There are two things to consider when it comes to your health, the first is your body mass index (BMI), which is a measure of your height in relation to your weight, and the second is your waist size. While weight matters, waist size may be more closely linked to health risks. A healthy waist size will vary according to your ethnic background (see the table below). Measure your waist just above your belly button, standing up, with the tape snug but not tight. It’s a good idea to repeat this measurement to check it’s right.

To work out your BMI, you need your weight in kilogram (kg) and height in metres (m). Multiply your height by your height – which gives height in m2 (metres squared). Then divide your weight by the height in m2 figure to get your BMI. If you weigh 70kg and are 1.50 metres tall – 70 ÷ (1.5×1.5) = BMI of 31.

A BMI between 18.5-24.9 is healthy, between 25 and 29.9 is overweight, and 30 or above is obese. If you’re from an Asian background, you should aim for a BMI between 18.5 and 23. If your BMI is high, your GP may be able to provide help to lose weight via the NHS Diabetes Prevention Programme.

What can I do?
We all know that we should eat a healthy balanced diet, but treats can easily creep in and alcohol will definitely blow the budget. Portion sizes have been gradually increasing, so this might be a good place to start.

Have larger portions of vegetables and salads and moderate portions of lean proteins and starchy foods. Choose higher fibre and wholegrain foods often, as these will keep you feeling fuller for longer. Be honest with yourself about how many fatty or sugary foods you’re eating, whether at mealtimes or as snacks. Try to have three to four alcohol-free days each week. It’s a good idea to cut down on drinking at home and save it for when you’re out socialising.

Be active & be strong!
Half of women reduce their levels of regular exercise during middle age due to the demands of others. You may be part of the sandwich generation, caring for children or grandchildren and ageing parents as well, leaving little time to be active. But less activity means that daily energy needs fall, and lean muscle declines as well. From the age of 50, both men and women will lose lean muscle mass unless they take action to prevent this. Women start with a lower muscle mass compared to men, so the effects are felt sooner. Muscles require more energy to maintain than body fat, so using and challenging muscle strength regularly will help overall health and maintain your metabolic rate (the number of calories burnt in a day). Including protein foods at least twice every day will help to support muscle building.

Activity guidelines are to achieve at least 150 minutes of moderate activity each week PLUS resistance or strength training on two days each week.

Losing weight will help to reduce your risk of heart disease or diabetes and could also help relieve menopausal symptoms. Reductions in body weight, BMI, and/or waist measurement have been shown to result in a reduction in hot flush symptoms (severity and/or frequency).

What if I need to gain weight?
The need to lose weight is more common, but it can be really frustrating to be part of the small percentage who struggle to put it on. Strong muscles are important, so focus on strength and conditioning rather than too much aerobic activity.

Eat more frequently and have five to six smaller meals during the day rather than two or three large meals. Choose nutrient-rich foods: such as wholegrain breads, pasta and cereals; dairy products; lean protein sources; and nuts and seeds. Try to choose milky drinks, smoothies and shakes as a handy energy boost.

Healthy waist size guide

White European, Black African,
Middle Eastern or Mixed Race origin
below 94cm (37 inches) – men                               Ideal
below 80cm (31.5 inches) – women

African Caribbean, South Asian,
Chinese or Japanese origin
below 90cm (35.4 inches) – men                            Ideal
below 80cm (31.5 inches) – women

White European, Black African,
Middle Eastern or Mixed Race origin
94-102cm (37-40 inches) – men                             Take action
80-88cm (31.5-34.6 inches) – women

White European, Black African,
Middle Eastern or Mixed Race origin
102cm (40 inches) or more – men                           High risk
88cm (34.6 inches) or above – women

African Caribbean, South Asian,
Chinese or Japanese origin
above 90cm (35.4 inches) – men                           High risk
above 80cm (31.5 inches) – women

About the author
Angie Jefferson is a consultant dietitian.

Created Summer 2021
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