WEIGHT LOSS

At Belleage we mainly concentrate on weight loss or maintenance during the perimenopausal and menopausal period of your life.

Body Types

Causes of weight gain

Not everyone is born with the same metabolism, and many factors can influence body shape and weight including:

Gender
Age
Diet
Hormones
Genetic Makeup
level of physical activity
lifestyle factors e.g Alcohol

Diet

There have been a number of genes specifically associated with increased obesity. In terms of genetic obesity, the mutation can be from deficiency of one gene(Monogenetic -which is rare) or Multiple genetic variants (Polygenic, has an accumulative effect) or syndromic which is associated with other signs of a developmental disorder.

Areas of the brain such as the hypothalamus can be involved in rare causes of non genetic obesity. this occurs from lesions or tumours in this area of the brain.

Modifiable factors

These are referred to as epigenetic changes that are acquired via from environmental factors.

Twin studies have estimated heritability of obesity to be around 40-70%.

It is proposed that obesity in mothers has been strongest risk factor for obesity in childhood.

Not unusually physical inactivity is associated with obesity. Those with higher genetic risk scores benefited the most even from light exercise. [1]

For some time, it has been believed that calorie deficit can assist with weight loss. However the research suggests that that the causes of obesity/weight gain are more complex than the balance of calories in vs calories out.

It is proposed that diets high in carbohydrates causes post prandial increase in insulin, and the high insulin shifts the calories into the fat cells rather than into lean tissues and this leads to an overall sense of starvation which leads to a reduced metabolic rate resulting in increased hunger.

Other proposals by Hall and colleagues in 2022 [2] suggest that there is a complex relationship between metabolic, endocrine and nervous system. They suggest that the endocrine nature of adipose tissue secretes leptin and other adipokines for increased food intake.

There are also theories around obesity being linked to rapid emergency of fast food chains and meal sizes.

Medications

There are several drugs which can cause obesity including some antidepressants, anti psychotics, anti diabetics, adrenergic agonists and steroids.

Environmental influences

Some environmental compounds are linked to obesity such as organic pollutants (e.g PCBs, DDT, Parabens, phyto oestrogen, BPAs (use in manufacture of plastics.

More recently gut flora known as gastrointestinal microbiome has been associated with obesity. There are about 100 trillion microbiome in the gut including, Firmicutes, bacteroides, Proteus, actinomycetes and Fusobaceria. The two most commonly associated with obesity are the first two. Bifidobacteria has Benn used to treat obesity in young people and improve insulin sensitivity

1. Masood B, Moorthy M. Causes of obesity: a review. Clin Med (Lond). 2023 Jul;23(4):284-291. doi: 10.7861/clinmed.2023-0168. PMID: 37524429; PMCID: PMC10541056.

2. Hall KD, Farooqi IS, Friedman JM et al. The energy balance

model of obesity: beyond calories in, calories out. Am J Clin Nutr

2022;115:1243-1254.

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Hormonal Changes

Perimenopause

This period can start from the age of 40 onwards. Up till recently little attention was paid to this particular period,. However mood swings, hot flushes, skin changes, sleep disturbance, joint aches, memory changes, low mood and weight gain can be recognised during this period and vary between individuals.

The key hormones involved include:

Oestrogen: the levels of oestrogen fluctuate during this period. general trend is that oestrogen levels start to reduce. Your menstrual cycle may continue to be normal or irregular

Progesterone: This is often the first hormone to decline. As a result ovulation is irregular, and periods may become heavier and more unpredictable. The change in this hormone can also result in bloating, breast tenderness, headaches and heavy bleeding Levels vary and are not as well balanced with oestrogen.

testosterone: Levels slowly decrease. As a result libido can be lowered, there is a change of muscle mass and body composition and fatigue is experienced.

Follicular stimulating hormone: As the ovaries are less responsive during this time, there is increased FSH produced by the brain and therefore blood tests can show increased FSH.

In general the sequence of events may look like this:

Early perimenopause

Period changes begin
PMS worsens
Anxiety or irritability increases
Sleep more disrupted

Mid perimenopause

Hot flushes/night sweats may start
Brain fog more noticeable
More fatigue
Libido changes

Late perimenopause

Periods become far apart
More dryness (vaginal, skin, eyes)
Bone density begins to decline faster

Menopause

Menopause is the point where it has been 12 months since your last period and your ovaries have almost stopped producing the reproducing hormones. Although the fluctuation of hormones is less than in the perimenopausal stage, they are much lower.

Oestrogen: becomes permanently low. As such the predominant effects include

Hot flushes and night sweats
vaginal dryness and painful intercourse
thinning of the vaginal and urinary tissues
increased urinary tract infections
drier thinner skin in general
faster bone loss
changes in cholesterol profile
Joint aches

Progesterone also becomes very low to absent which may result in:

No monthly cyclical symptoms
Sleep may still be affected (from low oestrogen rather than progesterone)
Less cyclical breast tenderness or bloating compared to perimenopause

Testosterone: remains low but present and have the following possible side effects:

Reduced libido or sexual desire
Lower energy or motivation
Loss of muscle mass over time
Changes in body composition (more fat around abdomen)

FSH: as the ovaries are no longer responding, the brain continues to produce FSH and therefore this may remain high despite low oestrogen.

Why weight gain?

Weight gain is not simply “getting older.” It is driven by predictable biological changes that alter metabolism, fat distribution, appetite, muscle mass, sleep and stress hormones.

1. Falling oestrogen changes where fat is stored

Oestrogen helps keep fat distributed to hips and thighs (“gynoid pattern”).
As oestrogen falls, the body shifts toward abdominal (visceral) fat storage — the deeper fat around the organs.

This means many women notice:

A flatter bottom
Wider waist
More central “belly” fat
Even if overall weight gain is small.

This type of fat is more metabolically active and linked with higher risks of insulin resistance, cardiovascular disease, and inflammation.

2. Slower metabolism (resting metabolic rate drops)

From around your 40s onward:

Muscle mass naturally declines (sarcopenia)
Muscle burns more calories than fat
Less muscle = fewer calories burned at rest

If you eat the same as before but have less muscle, weight gradually creeps up.

This is a major reason many women say:

“I eat the same but gain weight.”

3. Insulin resistance increases

Lower oestrogen makes your body less sensitive to insulin, meaning:

Blood sugar stays higher for longer
More energy is stored as fat
Cravings for carbs/sweets can increase
Weight gain becomes easier, especially around the abdomen

This is why some women develop prediabetes or metabolic syndrome during this transition.

4. Stress hormones (cortisol) drive abdominal fat

Perimenopause is often a high-stress life stage (work, teens, ageing parents, sleep disruption).

Poor sleep + stress → higher cortisol → more belly fat.

Even “healthy” women can gain weight if cortisol is chronically elevated.

5. Sleep disruption contributes to weight gain

Hot flushes, night sweats, anxiety, and insomnia are common.

Poor sleep leads to:

Higher hunger hormone (ghrelin)
Lower satiety hormone (leptin)
Increased cravings for sugar and processed carbs
Reduced motivation for exercise

This creates a cycle: bad sleep → weight gain → worse sleep.

6. Reduced activity and strength over time

Many women naturally become less physically active with age due to:

Joint pain
Fatigue
Time pressures
Hormonal symptoms

Without regular resistance training, muscle loss accelerates — which further slows metabolism.

Belleage approach to weight loss

The process of assessing your weightless journey is multifactorial. At Belleage, we mainly concentrate on weight loss during the perimenopausal and menopausal period.

The process may involve one or more of the following:

Questionnaire
initial consultation
Maintaining food and exercise diary
Nutritionist advice
Referral to Personal Trainer
Medication