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Female Middle Aged Spread

Female middle age spread – what are the causes and solutions to rising belly fat as women age.

As women age they notice an increase in belly fat (visceral fat which gathers around the intra abdominal organs). This is often associated with weight gain but not always. Generally as we age our metabolism slows due to lifestyle and hormone changes. Once you get into your 40s you probably need about 200 fewer calories a day, which means if you keep eating the same as you did in your 20s you will gain weight.

High carbohydrate, low protein and low fibre diets contribute as does lack of exercise. However where we gain weight is governed by our hormones and imbalance can lead to an increase in belly fat. To lose this stubborn fat you need optimal hormone balance in addition to diet and exercise.

Menopausal women are a good example. They may not gain weight, but their bodily proportions change. This is due to the influence of estrogen, testosterone and progesterone. As these hormones fall cortisol, and insulin rise leading to change in the bodily proportions.

Estrogen is protective against belly fat gain contributing to the lower risk of heart disease in females which rises after menopause. Estrogen and progesterone balance prior to menopause are also important and estrogen is the biggest factor in increasing fat storage at the hips and thighs providing the classic female shape.

Progesterone balancing estrogen reduces the storage of fat around the waist. High stress has been shown to negatively impact progesterone, so a woman who sees fat accumulating around the waist may want to work to reduce stress and raise progesterone.

Another important hormone impacting belly fat is cortisol, this is the hormone that is produced during stress, and can be in the form of any stress on the body such as dieting, over exercise, psychological stress and lack of sleep.

Excess insulin and insulin resistance lead to an increase in intra abdominal fat which in turn increases insulin resistance and then further weight gain.

Thyroid disorders become more common as we age and 1 in 8 women will develop a thyroid disorder and more have a borderline issue which can still impact weight.

Ways to reduce belly fat:

Get enough sleep, at least 7 hours.

Moderate exercise, too much high intensity exercise can lead to an increase in cortisol.

Avoid stress, look at stress release activities such as yoga and meditation.

Reduce alcohol – moderate alcohol consumption correlates with abdominal distribution of body fat.

Eat a high protein diet and reduce high GI carbohydrates.

If you are struggling have your hormones including thyroid, insulin and cortisol assessed.

Article written by Dr Nichola Salmond. Registered Hong Kong General Practitioner.

MBChB (Glasgow), Dip Derm Sc (Cardiff).


The Optimal Family Health team have experience in addressing the hormonal and lifestyle issues relating to belly fat.