How Women Can Maintain Lean Body Composition After Forty

How Women Can Maintain Lean Body Composition After Forty

Weight management is a common health concern for the majority of my patients.  What I’ve noticed when patients go through my weight management program is that women over forty have the hardest time losing weight.  Specifically, they struggle with achieving and maintaining a healthy body composition.  What this means is that they are having difficulties losing stubborn fat and are not able to gain muscles.  For more information on this topic please CLICK HERE

Menopause transition starts in your forties when periods become irregular and ends with last menstrual period.

As women age and approach menopause, they tend to gain weight around their midsection while their arms and legs begin to lose definition.

Women gain approximately 3.8-4.4% of fat per year during transition to menopause.

Is it hormones? Is it poor diet and lack of exercise? Or both?

Some studies suggest that alternations in body composition begin before hormonal changes of menopausal transition.

I will touch on current research that looks at what women can do to maintain healthy body composition to offset undesirable effects of menopause.

What Causes Weight Gain?

Studies have looked into hormones as a possible culprit of menopause-related weight gain.

For instance, estrogen protects women from obesity and over nutrition.  However with onset of menopause, estrogen levels begin to drop and excess calories are easily stores as fat.

Does this mean that if estrogen levels were replaced with Hormone Replacement Therapy or HRT, consumption of excess calories will not result in weight gain?

According to studies, it does not appear to be so.  Cochrane Database reports that there is no evidence of preventive effects nor adverse effects of HRT use on BMI during menopause.  Studies mostly indicate reduction in overall fat mass, central obesity, improved insulin sensitivity and lower rate of development of type 2 diabetes with estrogen-progestin therapy.

As estrogen production decreases with menopause, levels of transport protein known as Sex Hormone Binding Globulin (SHBG) decline while testosterone increases.  According to the Chicago SWAN Fat Pattering Study, higher levels of testosterone are associated with increased visceral fat in women.

Visceral fat is type of fat that gets deposited around vital organs such as the pancreas, liver, and intestines.  Higher visceral fat means higher cardiovascular risk for women transitioning through menopause.

Beyond Menopausal Status

Aside from hormone fluctuations, there are other aspects of your health to keep in mind.

A strong predictor of accumulating abdominal fat after 40 is how physically active you are when you are younger. The less active you are, the more likely you will have that stomach pouch.  Physical activity appears to be protective of lean muscle loss.

Midlife weight gain may also be due to age and not menopausal status itself.  However, hormonal changes across perimenopause may contribute to increase in belly fat and obesity.  An estimate of 0.5 kg per year weight gain may be a result of aging rather than menopause status.

Tendency to gain abdominal fat seems to be strongly correlated with higher body mass index or BMI.  Post-menopausal women have the greatest amount of intra-abdominal fat compared to pre-menopausal women.  Belly fat can then act as an organ that secretes hormones closely associated with diabetes, insulin resistance and metabolic syndrome.

Stay Lean with these Evidence-Based Strategies

Active women have an advantage over their sedentary counterparts as they approach menopausal transition.  Sedentariness affects weight gain and waist circumference more than aging or menopause itself.  Physical activity was shown to protect women against fat gain, central obesity and loss of muscle mass.  Sixty minutes of daily moderate intensity and resistance training can help to preserve lean body mass and prevent obesity.

It appears that the amount of time spent being physically active rather the intensity may be more effective strategy for maintaining healthy body composition over menopausal transition phase.

Fun fact: Evidence suggests that exercise may be more superior for maintaining healthy body composition and lean body mass when compared to diet.

Speaking of diets; a diet that is below energy requirement but higher than 800 calories per day is best suited for long-term adherence.  Ideal diet should include no more than 30% of calories from fat and comprise of fish, nuts, legumes and poultry.  Low-fat vegetarian diet can help to lower cholesterol in pre and post-menopausal women.

Oily fish and fresh legumes (peas, beans, lentils) can even delay onset of natural menopause by 3 years!

A heart-healthy Mediterranean Diet has been shown to benefit both bone and muscle mass in post-menopausal women.  Generally, this diet consists of fruit and vegetables, olive oil, seeds, fish, low in saturated fats with moderate amount of red wine.  It has also been linked to lower rates of heart disease, diabetes and cancer.

As you are working on exercise and diet to help you lose weight, there is a risk of losing some muscle mass in the process.  A diet that is rich in protein may help to reduce weight loss-induced loss of muscle mass by 45%! The recommended amount for a high protein diet is approximately 1.2 grams per kg of body weight per day.

In order to maintain lean body composition, older women need to consume more protein in comparison to younger individuals.  This is to compensate for inadequate protein intake, to offset inflammatory and catabolic conditions of chronic and acute diseases, and body’s reduced ability to use dietary protein as compared to younger adults.

According to ESPEN Expert Group, healthy older adults over the age of 65 need at least 1.0 to 1.2 grams of protein per kg of body weight per day.  Those who suffer from acute or chronic illnesses require 1.2 to 1.5 grams protein per kg of body weight per day.  Protein requirements for individuals with severe illness or injury are even higher.

In a 2007 study by Campbell et al., positive effects of protein intake of greater that 1.0 grams per kg of body weight per day were observed in 50-80 year old adults who are followed resistance training for 3 months.

Intermittent fasting or IF can also help to preserve healthy body composition.  Just four weeks of IF has shown to reduce weight and waist circumference.  One study found that IF can also protect the heart by reducing blood pressure, heart rate and improve cholesterol levels.

What else?

Acupuncture is an optional adjunct therapy for weight management.  From Western medicine viewpoint, it works by stimulating the nervous system to release neurotransmitters or hormones and works on electromagnetic bio-information system.  Acupuncture may influence adrenocorticotropin (ACTH), insulin, thyroid hormones, growth stimulating hormone, beta-endorphin, white blood cell production and plasma cholesterol levels.

From Eastern viewpoint, acupuncture helps to deal with the underlying causes of weight gain by eliminating phlegm, drying damp, reinforcing spleen and replenishing Qi.  Once the body’s balance is restored, weight should no longer be an issue.

In 44 randomized controlled trials, 2 weeks to 4 months of acupuncture treatments have demonstrated to be more effective than placebo and lifestyle changes (4.03 kg decrease and 2.76 kg decrease in mean body weight respectively in comparison to acupuncture).  Acupuncture’s efficacy is also comparable to anti-obesity drugs.  A 0.08 kg mean difference in body weight was observed with acupuncture versus 0.65 kg decrease on anti-obesity drugs.

Acupuncture can also effectively manage hot flashes!

In Summary

To preserve lean body composition, stay active well ahead of menopause and maintain a healthy diet.  Low-carb, low-fat diet that is rich in protein, fish and legumes is supported by evidence.

My Gift to You

Because I want you to take action TODAY towards achieving lean body composition, I have prepared a FREE 7-Day Mediterranean Meal Plan.  To download your plan CLICK HERE.

It contains delicious, time-saving recipes that are high in fiber, nutrient-dense foods including fruits, vegetables, legumes, and whole grains.  In addition, it includes a good dose of heart-healthy fats such as olive oil, avocados, nuts and seeds. Quality protein from dairy, poultry and fish is also included.

For custom meal plans, please contact Dr. Anna HERE.


  1. Deutz, Nicolaas E. P. et al. “Protein Intake and Exercise for Optimal Muscle Function with Aging: Recommendations from the ESPEN Expert Group.” Clinical nutrition (Edinburgh, Scotland) (2014): 33.6 929–936.
  2. Karvonen-Gutierrez, Carrie, and Catherine Kim. “Association of Mid-Life Changes in Body Size, Body Composition and Obesity Status with the Menopausal Transition.” Ed. Sampath Parthasarathy. Healthcare3 (2016): 42. PMC. Web. 4 July 2018.
  3. Smith, Gordon I., Yoshino, Jun, Kelly, Shannon C., Reeds, Dominic N., Okunade, Adewole, Patterson, Bruce W., Klein, Samuel, and Mittendorfer, Bettina. “High-protein intake during weight loss therapy eliminates the weight-loss-induced improvement in insulin action in obese postmenopausal women.” Cell reports. (2016)17,3. 849-861.
  4. Nowson, Caryl, and O’Connell , Stella. “Protein Requirements and Recommendations for Older People: A Review.” Nutrients. (2015): 7, 6874-6899.
  5. Dugan, Sheila & Lange-Maia, Brittney & Karavolos, Kelly & Kazlauskaite, Rasa & S. Hollings, Chiquia & Avery, Elizabeth & Nackers, Lisa & Lynch, Elizabeth & Ventrelle, Jennifer & Normand, Patricia & Johnson, Tricia & Fullam, Francis & Shipp-Johnson, Karla & Wilbur, Joellen & H. Powell, Lynda. “Design of a lifestyle intervention to slow menopause-related progression of intra-abdominal adipose tissue in women: The Women in the Southside Health and Fitness (WISHFIT) study.” Contemporary Clinical Trials Communications. (2016): 4. 10.1016.
  6. SC Ho, S Wu, SG Chan and A Sham. “Menopausal transition and changes of body composition: a prospective study in Chinese perimenopausal women.” International Journal of Obesity (2010): 34, 1265–1274.
  7. Pradeep M. K. Nair, and Pranav G. Khawale. “Role of therapeutic fasting in women’s health: An overview.” J Midlife Health. (2016): Apr-Jun; 7(2): 61–64.
  8. Varlamov, Oleg. “Western-style diet, sex steroids and metabolism.” Biochimica et Biophysica Acta (2017): 1147–1155.
  9. Janssen, Imke et al. “Testosterone and Visceral Fat in Midlife Women: The Study of Women’s Health Across the Nation (SWAN) Fat Patterning Study.” Obesity (Silver Spring, Md.)3 (2010): 604–610.
  10. Avis NE, Coeytaux RR, Isom S, Prevette K, Morgan T. “Acupuncture in Menopause (AIM) study: a pragmatic, randomized controlled trial.” Menopause. (2016): Jun;23(6):626-37.
  11. Kongnyuy EJ, Norman RJ, Flight IHK, Rees MC. “Oestrogen and progestogen hormone replacement therapy for peri-menopausal and post-menopausal women: weight and body fat distribution.” Cochrane Database of Systematic Reviews (1999): Issue 3. Art. No.: CD001018. DOI.
  12. GORDON, M.M. et al. “EFFECTS OF DIETARY PROTEIN ON THE COMPOSITION OF WEIGHT LOSS IN POST-MENOPAUSAL WOMEN.” The journal of nutrition, health & aging8 (2008): 505–509.
  13. Bauer, Juergen & Biolo, Gianni & Cederholm, Tommy & Cesari, Matteo & J Cruz-Jentoft, Alfonso & Morley, John & Phillips, Stuart & Sieber, Cornel & Stehle, Peter & Teta, Daniel & Visvanathan, Renuka & Volpi, Elena & Boirie, Yves. (2013). Evidence-based Recommendations for Optimal Dietary Protein Intake in Older People: A Position Paper From the PROT-AGE Study Group. Journal of the American Medical Directors Association. (2013): 14. 10.1016.
  14. Campbell,Wayne W, & Leidy, Heather J. “Dietary Protein and Resistance Training Effects on Muscle and Body Composition in Older Persons.”Journal of the American College of Nutrition. (2007): 26:6, 696S-703S.
  15. Sui Y, Zhao HL, Wong VC, Brown N, Li XL, Kwan AK, Hui HL, Ziea ET, Chan JC. “A systematic review on use of Chinese medicine and acupuncture for treatment of obesity.” Obes Rev. (2012). May;13(5):409-30.
  16. Li J, Lu Y, Shi YM, Lenon G, Shi Y. Acupuncture for overweight or obese people (Protocol). Cochrane Database of Systematic Reviews (2010): Issue 7. Art. No. CD008612. DOI: 10.1002/14651858.CD008612.
  17. The Endocrine Society. “Mediterranean diet is linked to higher muscle mass, bone density after menopause.” ScienceDaily. ScienceDaily, 18 March 2018. <>.