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If you find that your favorite dress is getting tighter every year, it’s probably not your imagination. Research shows that adults gain an average of one to two pounds per year. You may have heard that the culprit is a slowing metabolism. If that’s true, how can you best maintain a healthy weight into middle age and beyond?

What is metabolism?

Simply put, metabolism converts the calories from the food and drink you consume into energy through chemical reactions. This process helps your body circulate blood, control body temperature and perform other life-sustaining functions. It does this constantly, even while you sleep.

Your body burns energy in three main ways:

  • Basal metabolic rate, or BMR (also called resting metabolic rate, or RMR), the number of calories you burn while at rest. Surprisingly, this accounts for most of the energy you burn every day. (You can use an online calculator to determine a good estimate of your BMR.)
  • Dietary thermogenesis, the energy used to digest food
  • Physical activity — everything from running a marathon to making dinner

While it is understood that obesity is a complex and chronic disease state and not just a matter of simple math, we know that the amount of calories that you consume over what you burn plays a significant role in helping you maintain a healthy weight. In short, you have to burn more calories than you consume to be able to successfully lose weight.

What happens to your metabolism as you age?

The conventional wisdom has been that BMR declines in midlife, making it harder to lose weight. You may have also heard that women have a harder time dropping extra pounds because they have a slower metabolism than men.

Here’s some good news: Neither of these is exactly right.

A groundbreaking study published in Science in 2021 challenges the assumption that metabolism slows down during middle age. Data from more than 6,000 people show that from ages 20 to 60, metabolism remains steady.

Researchers found that metabolism does change over the course of a lifetime, but only during these periods:

  • Infancy to 1 year (period of highest metabolic rate)
  • 1 year to 20 years old, when metabolism declines by almost 3% per year
  • After age 60, when metabolism declines by 0.7% per year

The study’s authors also found that men and women have similar metabolic rates after controlling for other factors.

Researchers are still working to understand the mechanisms driving a declining metabolism after age 60. One theory relates to the high energy requirements of the liver, heart, brain, and kidney — organs that account for 65% of someone’s BRM. A slower metabolism after age 60 could mean that these organs aren’t working as well as people age.

What are the implications of this study? For one, middle age weight gain can’t be pinned solely on a slowing metabolism. Coming back to the equation of weight gain (“calories in” is greater than “calories out”), researchers suggest that behavior is at the root of it. Scientists point to lack of exercise, poor diet, decreased energy levels and chronic stress as potential factors at play.

Is there a relationship between weight gain and menopause?

Women and men may have similar metabolic rates, but women have a special consideration as they age — the effect of menopause. Many women gain weight during this time, which is the stage of life when menstrual cycles have stopped for 12 months. Factors that can affect middle age weight gain include:


From puberty through perimenopause (the stage before menopause), women typically store fat in their hips, thighs and buttocks. This is subcutaneous fat, meaning that it’s located just under the skin.

During menopause, low estrogen levels cause body fat to be redistributed to the abdomen. This is visceral fat, meaning that it’s stored deep inside the abdomen, surrounding your organs. Visceral fat is particularly bad for your health, as it’s associated with:


Muscle mass declines as you get older, while fat typically increases. That’s because the balance between cell growth (anabolism) and cell teardown (catabolism) is no longer in harmony. Your body becomes resistant to normal growth signals, leading to muscle loss (sarcopenia). This can cause your metabolism to slow and weight easier to gain.

Genetic factors:

Studies suggest that body fat distribution has a strong genetic component. You’re more likely to carry extra belly fat if your close relatives do.


Your habits play a significant role in weight gain (or lack thereof) during menopause. You may find yourself gaining weight if you are sedentary and consume too many calories. (No surprise there.)

Poor stress management increases risk for poor coping mechanisms, such as emotional eating, sleep disturbance and increased risk for depression or anxiety as well as an increase in hormones, such as cortisol — all of which can impact weight.

Lack of sleep can also be to blame. When you’re overtired, you may snack more, thereby increasing your calorie intake. Recent research also suggests that women’s increased nighttime awakenings during menopause can cause the body to use less fat for energy. Eventually, this may lead to fat storage and weight gain.

Poor Stress Management

The risks are real.

As women age, the dangers of weight gain go beyond the inconvenience of ill-fitting clothes. The risk of cardiovascular disease — the leading cause of death in women — increases after menopause. Being overweight after menopause can also increase your risk of:

Luckily, there’s plenty you can do to help avoid these health problems while maintaining a healthy weight over the years.

Keep the weight off (and potentially boost your metabolism)!

Lift weights.

When you build lean muscle mass, you’ll burn more calories when resting. That’s because muscle requires more energy than fat does while at rest. As women (and men) age, muscle mass tends to diminish. This is associated with an increased risk of cancer, diabetes, Alzheimer’s and heart disease.

Starting a low-impact weight training routine not only helps halt muscle loss — it can help control your blood sugar, improve your balance and coordination, and lower your risk of injury. Weightlifting should be part of the 150 minutes of physical activity per week recommended by the U.S. Department of Health and Human Services.

Eat more protein.

Because you’re at risk for losing muscle mass as you get older, protein is more important than ever. Many health experts recommend that women 50 and older consume 1 to 1.5 grams of protein per kilogram of weight (1 kilogram equals 2.2 pounds). Grass-fed beef, wild salmon, and eggs are protein-rich options. If you’re vegetarian or vegan, consider organic whey protein powder, quinoa, beans and seeds.

Avoid extreme dieting.

Drastic weight loss can cause your body to use less energy when it’s at rest. “Metabolic adaptation” is a well-documented phenomenon that describes how losing a lot of weight in a short period of time leads to a slower BMR. This, of course, creates the likelihood of future weight gain. Fortunately, gradual weight loss does not seem to affect metabolism, nor does surgically induced weight loss. You can also help keep your metabolism running smoothly by eating smaller, frequent meals and not going more than three hours without eating.

Prioritize good nutrition.

Eat plenty of nutrient-dense foods — think whole grains, vegetables, fruit and lean meats, which have a high nutrient-to-calorie ratio. At the same time, avoid processed foods, which can be loaded with sodium, sugar and “empty” calories. Calories can add up quickly, so consider keeping a food journal to track your choices, then see where you can swap processed food for healthier options. If your goal is to lose weight, some experts recommend hiding your scale for the first few weeks, as it can be discouraging if you see your weight fluctuate or level off. And be patient: Losing one to two pounds per week is a reasonable rate of weight loss.

Get plenty of sleep.

We’ve already addressed sleep problems during menopause and how it may affect weight gain. Adequate sleep supports a healthy balance of hormones, including those that regulate metabolism. Try to get at least eight hours of sleep per night. To help, consider lifestyle changes such as:

  • Establishing a nighttime routine, one that includes taking a bath, reading, listening to peaceful music or another relaxing activity
  • Avoiding napping in the afternoon or evening
  • Aiming to go to bed at the same time every night
  • Exercising regularly

Melatonin, a sleep hormone, can be taken as a supplement, but it’s not recommended to take for longer than one to two months.

Manage stress.

Manage chronic stress to increase good hormones, such as prolactin and dopamine and decrease stress hormones, such as cortisol — which can slow metabolism. Here are a few tips to keep your stress levels in check:

  1. Take breaks from watching, reading, or listening to negative news.
  2. Take care of your mind and body.
  3. Make time for hobbies you enjoy.
  4. Spend time with friends.
  5. Connect with your community or faith-based organizations.
  6. Avoid drugs and alcohol.

We’re still learning.

Not everyone is on the same metabolic trajectory. Individual variations exist, and while researchers can identify some of the factors that affect someone’s metabolic rate (age, genetics, the amount of lean muscle in the body), they still don’t know why some people seem to naturally burn more calories than others. As scientists continue to study metabolism and how it relates to aging, your best defense against an expanding waistline is making permanent lifestyle changes for a healthier, happier you.

Are you struggling with your weight? WakeMed offers a variety of services and specialties to help.

Obstetrics & Gynecology

At WakeMed Obstetrics & Gynecology, we provide a full range of services for women of all ages in Raleigh, Cary, Clayton, Holly Springs, North Raleigh, Brier Creek and Morrisville, North Carolina.

Primary Care

If you schedule an appointment with one of our WakeMed Primary Care providers, we are happy to talk more about weight loss and your specific situation.

Medical Weight Loss

From our board-certified physicians with expertise in medically-directed weight loss, to bariatric surgery and non-surgical weight loss procedures, to our multidisciplinary team of diet and exercise specialists, our Medical Weight Loss team enjoys working closely with our patients to determine the best path to good health.

Outpatient Nutrition Services

Our licensed, registered dietitians in outpatient Nutrition Services are committed to providing evidence-based, scientific nutrition advice. They can help with weight management and nutritional care related to bariatric surgery.
















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Tiffany Lowe Clayton DO