Garrison: Why women gain weight — and the dreaded ‘meno belly’ — during menopause

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Oh, the holidays. A time of year where we feel so many different feels: excitement, anxiety, love, sadness and, sometimes, epic food guilt, especially if you’re a woman in perimenopause or menopause.

For some, it’s the stuffing and cheesy scalloped potatoes. For others, like me, it’s the pies and sugary Christmas cookies. I just can’t say no to home-baked goods!

Those holiday favorites hit the body differently when you’re a woman in your 40s and 50s. It used to be that I could seemingly neutralize a day of overindulgence with a long post-holiday sweat session and a day or two of healthy eating. But these days, it feels like every cookie turns into another pound no matter what I do to make up for it.

After humming along at a healthy weight for almost 15 years, I put on 20 pounds within six months of turning 44. I wasn’t really eating any differently and I was doing four or five workouts a week, just as I always had, but the pounds piled on anyway.

I tried all kinds of once tried-and-true methods — increasing the intensity of my workouts, calorie counting, fasting, various diet programs — but nothing seemed to work long term. My weight felt like a runaway freight train that I just couldn’t stop.

“I had my own journey with it,” she said. “I was in my mid-40s and just trucking along just fine with my weight the same, and all of a sudden it just started to go up and up.”

Most women, including me, assume a slowing metabolism is mostly to blame for the extra pounds we put on in our 40s and 50s. Turns out, it’s not that simple.

“It’s not like you hit menopause and suddenly your metabolic rate drops,” said Dr. Karen Mann, medical director at Noom. “It’s a gradual shift as we get older, and we don’t see those actual changes in the metabolic rate until later in life, around 60.”

Instead, she said, mid-life weight gain can be attributed to a combination of factors that seem to coalesce around the same time.

First, as early as our 30s, women — and men — begin to lose muscle. Muscle, as most of us know, burns fat. So, the less muscle we have, the harder it is to burn fat. Talk about a vicious cycle.

While it serves a critical function, persistently high levels of cortisol can wreak havoc on our bodies by increasing inflammation and storage of fat.

“Cortisol tells your body there’s an emergency, hang on to everything [including fat], do not let anything go, because we’re not sure what’s going on,” said Dr. Awad.

Cue my favorite meme: “Oh! Are we running from the English again, lass? Dinnae ye worry. We’ll keep ye plump as a partridge to outlast the murderous bastards!”

As if all of this wasn’t enough, once we hit perimenopause, our hormones start to go haywire. Estrogen, the hormone that’s helped keep our fat mainly in our butt and thighs, starts to decline, resulting in a redistribution to … yep, you guessed it — our gut, helping to create the dreaded “meno belly.”

“It’s almost as though it’s this perfect storm of the natural things that happen when we’re aging, and the hormonal changes specific to women that cause this shift in our weight,” Dr. Mann said. “It’s very frustrating.”

“Approach this midlife not with resentment, but with curiosity,” said Dr. Mann. “What does it take for me to get into a body that I can love and feel good in? I would argue that you want to start with loving your body before you can change it.”

I’ll be the first to admit that it’s hard to love a body you don’t recognize anymore. In fact, when Dr. Mann suggested this, a big part of me balked. But then I realized that this body birthed two babies. This body learned to downhill ski at age 40. And this body, at age 45, completed a quarter Olympic duathlon, placing 3^rd in my class. Not too shabby considering my 20-something body couldn’t even run a mile without stopping 12 times.

Both Dr. Mann and Dr. Awad also stress that going back to basics — tracking food, prioritizing protein and eating mostly whole (not processed) foods — can really help move the needle.

Some of their other tips include:

“The food that we eat, tracking, weighing, all of the habits that go into weight maintenance, those still count,” said Dr. Mann. “But we’re going to shift how we eat and how we take care of ourselves.”

Still, they are no panacea.

Like any drug, GLP-1s come with side effects, the most innocuous and common of which include nausea, vomiting, diarrhea, bloating and indigestion. They’re also expensive — think $250 to $1,000 a month — and often not covered by insurance for weight loss purposes unless the patient has a qualifying condition such as diabetes.

While the consensus among doctors and users is that GLP-1s do indeed support weight loss, there isn’t as broad agreement about whether women experiencing menopausal weight gain are well served in taking them.

True confession: I opted this summer to start microdosing tirzepatide, a type of GLP-1, after I hit my weight loss wall. Microdosing involves taking a fraction of the normal dose and results in slower weight loss.

For me, it wasn’t just about the weight. It was about the uncomfortable bloating that made it hard to breathe when I was sitting down. It was the pain in my knees, which were protesting under the extra weight I was carrying around. And it was a burning desire to feel more like myself again.

Now, with any luck, if I just focus on the basics as Dr. Mann and Dr. Awad stressed, I’ll hopefully be able to hold steady through the holidays and beyond.