It started with a popped pants button. I was presenting at a conference and right before I hit the stage, it went — shooting at a high rate of speed and landing in front of my shoe. My favorite black pants that fit like a glove in my 30s and early 40s would no longer conform to a changing midsection. The button-popping incident (along with hot flashes and sleep disturbances) was a sign of something I had detected and denied for some time — I was in perimenopause.
Perimenopause is a period where the body begins the transition to menopause. According to the Cleveland Clinic, the process can take years and is associated with a loss of estrogen and may include accompanying symptoms such as hot flashes, increased belly fat, mood swings, vaginal dryness and disrupted sleep. Menstrual cycles are often irregular; once you go 12 months without one, you are officially in menopause.
Belly fat in menopausal women
Menopausal weight gain, which impacts between 60-70% of menopausal women, has been associated with a decline in muscle mass due to hormonal changes. The shifting hormones also cause a redistribution of abdominal fat. One study found that perimenopausal women doubled their fat mass in the years preceding menopause. And holding fat in this area comes with health risks: Studies show that increasing belly fat may impair insulin sensitivity and increase the risk of certain cancers and cardiac risk factors such as hypertension, obesity and dyslipidemia.
A 5-step dietary approach to reducing belly fat and improving health
These are some of the diet changes I put in place (and have advised my patients to consider) that have worked for me in combating menopause-related belly fat. However, it has taken time and hard work and an attention to multiple components of lifestyle beyond diet (like sleep, for example).
Of course I had an aesthetic goal of reducing belly fat. But the increased attention to my health as it pertains to holding fat in the midsection was also motivating to me. Knowing the data on belly fat and incidence of insulin resistance, for example, motivated me to take steps to reduce it so that my kids can have me on this earth longer. And it's always easier to commit to diet and lifestyle changes when you have a motivation beyond just the way you look.
It’s important to remember that it won’t be as quick of a transformation as it might have been in your 20s or even 30s. But while results won’t happen overnight, you can start to see positive changes in your body composition from consistently making these adjustments.
Choose foods that take longer to digest
Studies show that a low-glycemic index diet may be beneficial for managing weight and blood-sugar levels associated with menopause. The glycemic index (GI) is an indicator of how great an impact a food has on blood sugar and insulin.
On a scale of 1-100:
- Foods with a high impact (are digested quicker) have a score of 70 or higher.
- Foods with a moderate impact are scored from 56-69.
- Foods with a low impact (digested slower) have a score of less than 55.
To get started, focus on a low GI, Mediterranean approach that emphasizes lean meats such as fatty fish and poultry, healthy fats like nuts, seeds, avocado and extra virgin olive oil, moderate amounts of beans, lentils and intact grains, and abundant consumption of low-GI fruits and vegetables such as apples, pears, berries, oranges, stone fruits, leafy greens, cruciferous vegetables, carrots, tomatoes, cucumbers, celery and green beans.
Adding in these lower-GI foods also means limiting higher-GI options. A recent study found that eliminating desserts and sweetened beverages helped with keeping menopausal weight off long term. While aiming for foods lower on the GI index, studies show that moderating the total amount of carbohydrates you consume may also help.
Finally, a low-GI diet is also associated with a reduced risk of cardiovascular disease and diabetes in postmenopausal women. It may play a role in reducing hot flashes as well.
Get to know isoflavones
To get more bang for your menopausal diet buck, consider soy. This low-GI food may benefit menopausal women due to the presence of isoflavones. Isoflavones are phytoestrogens (acting like estrogen in the body) associated in studies with reducing menopausal symptoms, especially hot flashes.
In addition to reducing hot flashes, they may help lower cardiac risk factors associated with menopause and protect bone health. Consider adding shelled edamame as a snack, tempeh as a protein source on salads or miso soup as an appetizer to a meal. Though science provides plenty of good news on soy, there is continued debate in the research on how effective soy is for menopause, so more research is needed.
Eat more soluble fiber
Soluble fiber slows gastric emptying. That means it keeps you fuller, longer. One study found that for every 10-gram increase in soluble fiber daily, belly fat was reduced by 3.7%. Soluble fiber is found in cruciferous vegetables, beans, avocados, oats, nuts and seeds. Ten grams of soluble fiber equates to having half an avocado on whole-grain toast for breakfast, adding beans to lunch, and pairing a protein at dinner with a side of Brussels sprouts.
Promote protein
Observational studies have linked higher protein intake with increased lean body mass in postmenopausal women. Further, studies addressing belly fat found that a low carbohydrate, higher protein dietary combination may yield the most effective results. Consuming protein throughout the day will help ensure you’re hitting the daily recommendation. For example, consider yogurt with nuts and berries for breakfast, a bean-based soup for lunch, cheese and an apple for a snack, and wild salmon and greens for dinner.
Lose the booze
I altered my diet considerably after entering perimenopause. One habit that significantly improved my weight was limiting my alcohol intake. This dietary modification has also made a difference in the menopausal patients I've counseled. The data on alcohol’s benefits and risks are mixed, but research is clear that alcohol can disrupt sleep (a risk factor for belly fat) and add excess calories. While studies do show some benefit associated with light to moderate drinking, many of my patients were surprised to learn they were engaging in heavy drinking (having more than three drinks on any day or seven to eight drinks per week), which poses a risk to both health and weight. Limiting alcohol to a few days per week and no more than 5 ounces daily may assist with weight management.
Beyond diet: Lifestyle habits to combat menopausal weight gain
Diet is not the only solution to reducing menopausal belly fat. Studies show that managing stress, improving sleep quality, and increasing aerobic activity and resistance training may also help. Discussing hormone replacement therapy with your physician is another option.
The lifestyle changes I've made to get my black pants back on have taken more time and hard work than they would have in my younger days. It’s slowly working, but the benefit to my health is worth it. As far as that stubborn belly fat goes — I hope to replace that button soon.