Many people think that your fat gain and loss is all about calorie counting and willpower: eating less and exercising more.  

I thought so too. It was what I was taught in medical school and residency.  

Calories in (less than) Calories out = fat loss.  

As it turns out, that line of thinking has been proven by modern obesity research to be largely inadequate.  

Your weight is controlled, largely, by hormones, which in turn are influenced dramatically by the quality of the nutrition you consume, and less by the quantity of the food you are eating.  

Hormones determine your level of hunger, your level of satiety, how and where you store fat, and how and when you burn fat. Non-optimal levels of these hormones are linked not only to obesity, but to chronic inflammation, heart disease, stroke, diabetes, and more.  

The interplay between these hormones is complicated, especially during menopause. 

Fortunately, finding the right hormone balance that fights inflammation, weight gain, and obesity is pretty simple and nutrition based.  

The problem with weight gain in midlife is not as simple as just putting on pounds. The bigger problem is where the fat is distributed in the body. Women tend to carry fat on our thighs and hips when we are younger, and then the fat distribution shifts to the abdomen beginning in perimenopause.  

This abdominal fat (called visceral fat) is not found under the skin but instead fills that space between organs and over the intestines. Unlike other fat in your body, the visceral fat produces hormones and other substances that cause inflammation, increase insulin resistance, and increase your risk of cancer. 

Unfortunately, fat deposition patterns can reflect health risks. Our superficial fat carries little health risk apart from impacting our psyche and our joints. The visceral fat around our internal organs and blood vessels produce the inflammatory proteins that generate obesity's major health risks of obesity. These intra‐abdominal fat cells directly affect the liver are linked to the metabolic syndrome with a higher risk of diabetes mellitus, elevated cholesterol and lipids, and resultant cardiovascular disease.

There are several important lifestyle changes that women tend to adopt as they go through menopause: they tend to exercise less than other women, muscle mass naturally diminishes with age - so without resistance training, your body composition will tend to shift to more fat and less muscle, which slows your metabolism (average decrease of 5% per decade).  

If a woman continues to eat as she normally has through the menopause transition she will gain body fat, and most of it visceral fat. 

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