Dietary changes are critical to weight loss, but they’re only one part of the equation, particularly for women during perimenopause and beyond. Research shows that obesity & excess fat storage is not simply a matter of willpower or food intake—it’s a complex condition influenced by genetics, hormonal regulation, metabolism, and more. 

In fact, most diets fail because they’re not sustainable. Oftentimes, dieters turn to extreme calorie reduction, severely limit or cut out certain food groups, lose primarily water weight, muscle mass or take other measures that can’t be incorporated into daily life over the long term. 

Metabolic adaptation 

Cutting calories slows your metabolism, making weight loss harder. Sustainable weight loss focuses on gradual changes and prioritizes nutrients over rigorous restrictions.  

Set point theory

Your set point is an evolutionary mechanism that aims to maintain health by regulating caloric intake and expenditure. This system ensures that when caloric intake decreases, the body continues to function efficiently by conserving calories.

The evolution was crucial for survival when humans depended on plentiful crops to endure long winters. However, it is less relevant in today's world of supermarkets and convenience foods.

Humans evolved a set point to prevent starvation, which means the body tries to maintain weight close to its higher point. The key is that you should be eating nutritious foods — like lean proteins some fruits and lots of veggies. Your body triggers hunger hormones to prevent starvation when you overly restrict your diet.

Preserving and adding muscle mass will change your metabolic rate and help change your set point. That’s because muscle burns calories faster than fat. Increasing muscle mass can assist in surpassing the weight-loss plateau and reducing your set point. Strength-training exercises, such as weightlifting, Pilates, and kettlebell training, can be particularly advantageous. Managing stress with techniques like meditation, deep breathing, and yoga can lower stress levels and enhance your quality of life.

Hormonal imbalances

Hormones such as leptin, ghrelin, and insulin are important in regulating hunger, fullness, and fat storage. Individuals with excess weight or obesity often have imbalances in these hormone levels. Addressing these imbalances is crucial for successful weight management. 

Oestrogen

Oestrogens play a role in glucose homeostasis by acting as an insulin sensitizer at various levels, including skeletal muscle, liver, and adipocytes. (1) Oestrogen reduces inflammation, improving insulin sensitivity. (2,3) Pancreatic islet cells possess oestrogen receptors, which, upon activation, enhance beta cell function and promote their survival. (4)

A deficiency in oestrogen contributes to metabolic dysregulation, increasing susceptibility to obesity, metabolic syndrome, and type 2 diabetes. (5)

Visceral fat (fat around the central organs or meno belly) increases in conditions of low oestrogen levels, such as those observed during menopause.  Estradiol regulates body weight by decreasing appetite and increasing feelings of satiety. Estradiol regulates appetite by acting on specific sites within body cells and interacting with the hormones leptin, ghrelin, and insulin. (6)

These changes in body fat composition can be prevented by adaptations to macronutrient ratios (read more on this in my article titled Say goodbye to calorie counting for good ) as well as oestrogen replacement therapy (HRT) (7)

Cortisol

The stress hormone Cortisol has an interplay with a number of other hormones, medications and health states, some of which are illustrated in the table below.

Its thought that depression and/or alcoholism may slightly increase cortisol levels too.

Cortisol may affect zinc metabolism, impacting insulin signalling and potentially leading to insulin resistance in obesity. Changes in zinc levels in obese individuals can disrupt insulin synthesis, secretion, and action. (8)

The relationship between stress-related obesity and cortisol activity is still under investigation, with the literature showing conflicting results. This topic presents challenges due to various confounding factors, and thus requires well-defined studies for further research.

Thyroid hormones

Hypothyroidism is associated with weight gain and a reduced metabolic rate. Additionally, there is a correlation between serum levels of Thyroid stimulating Hormone (TSH) and Body Mass Index (BMI) within the normal range. Some cross-sectional population studies indicate that a slightly elevated serum TSH may play a role in excess body weight and could be considered a risk factor for overweight and obesity. (9,10)

Further investigation is required to determine if the relationship between TSH and BMI indicates causality (mild thyroid failure leading to obesity) or represents adaptive changes (physiological or pathological) to a new homeostatic state of increased body weight. 

What we do know is prevalence of hypothyroidism is increased with age and many women are diagnosed with hypothyroidism during the menopause transition.

Insulin

Eating raises your blood sugar, prompting your pancreas to release insulin to transport glucose into body cells. Muscles, fats, and the liver absorb some glucose, with the liver storing insulin as glycogen. Insulin also helps in fat storage and burning, nutrient absorption, cognition improvement, and hunger regulation with leptin and ghrelin.

During the later stages of menopause, when oestrogen levels begin to decrease, the pancreas reduces its production of insulin. Due to reduced insulin levels, the liver releases its stored glucose. Additionally, low oestrogen can cause widespread cellular inflammation, leading to symptoms of insulin resistance.

Although menopause can contribute to insulin resistance, the reverse is also true. When insulin regulation is disrupted, it can exacerbate menopause symptoms, particularly hot flashes and night sweats. Insulin resistance can also lead to persistent fat deposits, making weight loss more challenging.

Read more about this hormone and its relationship with oestrogen and the menopause in my articles here: #Menopause Myth Busting: Fat Vs Sugar for weight gain and Say goodbye to calorie counting for good

Behaviour and emotional well-being

Stress not only causes some people to eat more but food triggers not only a chemical reaction, but an emotional response, too, all to try to help you feel better and take away your stress. Emotional health influences eating habits and weight. Without addressing this, even the best healthy diet plan may not yield lasting results. See my blog titled emotional eating & menopause for more detail on this topic.

Stress causes that cycle of raising levels of the hormone cortisol. If you have more cortisol, you end up with higher insulin and lower blood sugar levels – which leads to cravings, To prevent this put down the fork and try meditating or talking to a trusted friend.

Sleep patterns, sleep deprivation raises cortisol levels, too. It also affects decision-making & your ability to stick to healthy habits. Seven to nine hours every night is the range in which most need to help manage stress. It also helps your body work with you — and not against you — when it comes to weight loss.

The interplay of sleep deprivation & these key hormone levels in your body:

• Ghrelin, a hormone that signals to your brain when your stomach is empty and it’s time to eat is increased with sleep deprivation

• Leptin, a hormone released by body fat cells, helps your body maintain its normal weight on a long-term basis is reduced with sleep deprivation

• One of your main stress hormones, Cortisol, is produced and released into your bloodstream by your adrenal glands. Production increases with lack of sleep.

Exercise works best for preventing weight gain (not initiating weight loss), so recognize that binging on exercise can be just as bad as binging on food. Exercise can make people super hungry, while it makes others tired and inactive, which can negate the activity they did. For women in the perimenopause and beyond life stages, weight bearing exercise that builds and conditions muscle rather than focusses on cardiovascular activity is considered the most effective in raising metabolic rate, improving appearance and overall markers of health.

Lifestyle-related barriers

Most of us have access to healthy food but admittedly we now pay more for organic unadulterated foods that were once the basic standard. Additions and modifications now seem to be the default practice and we pay more for foods that haven’t gone through such treatment. Genetic modification and pesticide treatments can reduce nutrient density of foods, making them less healthy in a multitude of ways.

Time constraints, a busy lifestyle’ is often a factor quoted as the origin of a junk/fast food decision and cultural factors often limit people’s ability to sustain dietary changes. If your work schedule suddenly changes and makes it challenging to meal prep or cook food according to your diet’s guidelines or restrictions, you’re more likely to give up your weight loss efforts altogether—whereas if you have a well-rounded plan in place that prioritizes additional factors like exercise and sleep, you can more easily offset a lapse in healthy food habits. 

Achieving sustainable fat loss requires more than following a healthy diet to lose weight fast—it requires addressing the complex interplay of biological, behavioural & emotional, and sustainable lifestyle changes, offering a holistic and science-backed path to better health.

References

1 Ylli D, Sidhu S, Parikh T, et al. Endocrine Changes in Obesity. [Updated 2022 Sep 6]. In: Feingold KR, Ahmed SF, Anawalt B, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279053/

2 Mauvais-Jarvis F, Clegg DJ, Hevener AL. The role of estrogens in control of energy balance and glucose homeostasis. Endocr Rev. 2013;34(3):309–338. [PMC free article] [PubMed]

3 McNelis JC, Olefsky JM. Macrophages, immunity, and metabolic disease. Immunity. 2014;41(1):36–48. [PubMed]

4 Tiano JP, Mauvais-Jarvis F. Importance of oestrogen receptors to preserve functional beta-cell mass in diabetes. Nat Rev Endocrinol. 2012;8(6):342–351. 

5 Chawla A, Nguyen KD, Goh YP. Macrophage-mediated inflammation in metabolic disease. Nat Rev Immunol. 2011;11(11):738–749. [PMC free article] [PubMed]

6 Vigil P, Meléndez J, Petkovic G, Del Río JP. The importance of estradiol for body weight regulation in women. Front Endocrinol (Lausanne). 2022 Nov 7;13:951186. doi: 10.3389/fendo.2022.951186. PMID: 36419765; PMCID: PMC9677105.

7 Lundholm L, Zang H, Hirschberg AL, Gustafsson JA, Arner P, Dahlman-Wright K. Key lipogenic gene expression can be decreased by estrogen in human adipose tissue. Fertil Steril. 2008;90(1):44–48

8 Morais JBS, Severo JS, Beserra JB, de Oiveira ARS, Cruz KJC, de Sousa Melo SR, do Nascimento GVR, de Macedo GFS, do Nascimento Marreiro D. Association Between Cortisol, Insulin Resistance and Zinc in Obesity: a Mini-Review. Biol Trace Elem Res. 2019;191(2):323–330. 

9 Knudsen N, Laurberg P, Rasmussen LB, Bulow I, Perrild H, Ovesen L, Jorgensen T. Small differences in thyroid function may be important for body mass index and the occurrence of obesity in the population. J Clin Endocrinol Metab. 2005;90(7):4019–4024. 

10 Biondi B. Thyroid and obesity: an intriguing relationship. J Clin Endocrinol Metab. 2010;95(8):3614–3617.