Understanding Perimenopause Nutrition from a Weight-Inclusive Approach
When we’re talking about perimenopause and midlife nutrition, the topic of weight is usually at the center.
Everywhere we look, there’s a menopause diet plan, another supplement touting fat loss, and a study out in the news listing the dangers of weight gain in midlife and beyond.
The impact of all that noise is palpable. Each week, people show up in my private practice with body image distress and confusion about weight at the top of their list of concerns.
If we haven’t met, hello, 👋, I’m Melinda Staehling. I’m a Certified Nutrition Specialist based in Oregon, and a Menopause Society Certified Practitioner.
This post offers a practical look at where midlife weight gain may come from, and an exploration of what’s real and what might be a social construct in how we perceive changes in the body.
We’ll discuss real-world solutions to shift the perimenopause nutrition focus from weight to a weight-inclusive and non-diet approach for real midlife health.
Before we dive in, let’s take a look at what “weight-inclusive” can mean.
DEFINITION
Weight-Inclusive: Weight-inclusivity is a framework that prioritizes health and well-being without the emphasis on weight. A weight-inclusive perspective challenges the idea that there is a specific body size related to health.
This approach can help improve health markers in a broad range of contexts. This perspective differs from the traditional weight-centric model in healthcare.
A weight-inclusive approach acknowledges that weight bias and weight stigma are rooted in systems of oppression.
To begin, it’s important to I say that I’ve lived and am living in a straight-size body. I walk around the world with multiple privileges. I don’t go to the Doctor’s office and get offered a weight loss plan instead of the care I came in for. These are privileges that I want to acknowledge. While I know the inner talk of aging, and am a highly perimenopausal myself, I don’t experience weight stigma and the accompanying barriers to healthcare.
I also want to acknowledge that I’ve learned a great deal about this topic and have shifted my way of thinking from many thoughtful practitioners. Here are some of the resources that have been important in my learning:
Recommended Resources:
I. Introduction
Overview of Perimenopause and Menopause: Menopause is a natural, biological event that affects half of the people on the planet. It’s essential to point out that the menopause experience isn’t universal. We all go through this differently.
Fluctuating hormones throughout perimenopause can contribute to a wide range of symptoms well into the menopause transition, some of which are more pronounced than others. Your experiences are unique and may vary.
READ: For more info on the stages and symptoms of menopause, visit this post.
The Common Concern - Midlife Weight Gain: There’s no way around it. Our society is focused (read, totally obsessed) with midlife weight gain and how to address it through dieting, exercise, hormone therapy, and supplements. Unfortunately, many of these methods have not proven effective in addressing midlife body changes. And, ugh, they can cause real and significant harm.
Shifting Towards Non-Diet and Weight-Inclusive Approaches: This guide focuses on how we might shift toward a weight-inclusive approach to menopause nutrition, healthcare, and body image.
II. Why Bodies Change in Menopause
The Oversimplified Hormone Story
A dominant narrative in both media and some healthcare settings is that “weight gain in menopause is caused by falling estrogen.” This oversimplification fuels a booming market of hormone therapy, supplements, and restrictive diets promising to “fix” midlife weight. But research shows that while hormones play a role, they’re only one piece of a much larger picture.
For example, a longitudinal study in Obstetrics & Gynecology followed over 1,500 women through the menopause transition and found that while estrogen decline influenced fat distribution, the majority of weight change was better explained by aging, sleep patterns, and physical activity level, and not hormones alone [1].
SOMETHING TO CONSIDER - Fat tissue also helps cushion bones, which lose density with age. Is there potentially also a protective nature to these body changes at menopause?
Body Fat Redistribution
One of the most visible changes during the menopause transition is where the body tends to store fat. This can be distressing when we don’t know where this shift is coming from. So, let’s talk about it.
Many people notice that fat seems to “move” from hips and thighs toward the abdomen, even without significant weight changes. This shift, called body fat redistribution, is real, and it’s also often misunderstood.
What’s Actually Happening: During reproductive years, higher estrogen levels support fat pattern that stores more fat in the hips and thighs. As estrogen declines, fat storage patterns gradually shifts toward a pattern that concentrates more around the abdomen.
However, it’s important to note that this shift is not always due to weight gain. It’s a redistribution of existing fat tissue influenced by hormonal changes, aging, and genetics.
Insulin Resistance and Blood Sugar
Midlife often brings increased insulin resistance. What does that mean?
It’s harder for your body to move glucose (aka blood sugar) from the bloodstream into cells. This doesn’t automatically cause weight gain, but may coincide with it.
Case Study: One of my clients, a 52-year-old attorney, noticed mid-afternoon crashes and sugar cravings at work. Instead of blaming “willpower,” we adjusted her meals to include protein and fiber throughout the day.
These changes improved energy and helped her feel more stable, without the focus on weight loss.
Aging and Muscle Mass
We can’t separate menopause from the normal aging process. With age, all of us lose lean muscle and become less efficient at building it (sometimes called anabolic resistance). This shift in body composition can affect metabolism.
Research shows that we lose about 3–8% of muscle mass per decade after age 30, and even more quickly after 50 and into post-menopause. Less muscle means fewer calories burned at rest, but this isn’t inevitable - resistance training and adequate protein help support muscle health.
NUTRITION TIP: Include lean protein in your meal plan, and resistance training at the level of your ability. That doesn’t mean we need to sacrifice the other macronutrients, like carbs, and healthy fats.
Lifestyle and Life Load
Stress, disrupted sleep, and caregiving responsibilities are often at their peak during perimenopause. These stressors can impact eating, movement, and body rhythms.
Case Study: A 47-year-old client shared that they went from being an active parent chasing kids around to sitting at a computer all day for work, then caring for aging parents in the evening. Their “mysterious weight gain” became more understandable when seen in the context of a life change, which is not a personal failing.
It’s hard to notice a potential decrease in activity levels. Many of my clients see shifts in their routines during perimenopause that can influence weight changes over periods of time. I noticed this myself. We’ve been through a pandemic where we stayed closer to home, and I now have a sedentary job, and my sleep is … not great.
If we’re exhausted from the day-to-day of work, life, and sleepless nights of peri, it’s no wonder we’re moving less.
The Shadow of Dieting and Weight Cycling
Many women entering perimenopause already have decades of dieting behind them. Repeated cycles of weight loss and regain lead to a loss of lean mass and a higher proportion of regained fat, especially in the abdominal area.
In fact, research has found that weight cycling itself, and not higher weight, was associated with increased cardiovascular risk [2]. And, a 2025 study from Applied Physiology, Nutrition, and Metabolism highlights that women in midlife are at greater risk of developing or relapsing into disordered eating during menopause transitions [3].
Case Study: One client shared that they had been dieting since she was 15. Each attempt left their weight a little higher and body image worse. When they entered menopause, they felt like it was “failing again.” Our work together focused on stabilizing their eating pattern and providing new tools to think about body image, not shrinking their body. This shift improved digestion, sleep, and energy (far more than any past fad diet plan).
I don’t think we can say this part loud enough. The physical changes during perimenopause, combined with a society obsessed with youth and thinness, can significantly harm your body image. Over 80% of women report high body image distress in perimenopause [4].
Dissatisfaction with body image and weight changes is strongly linked to disordered eating and eating disorders. People in perimenopause or menopause are at a higher risk for developing or relapsing into disordered eating and eating disorders.
Putting It Together
Understanding these changes through a weight-inclusive lens helps us see them not as failures to be corrected, but as natural, multifactorial shifts that deserve compassionate support rather than restriction and shame.
III. Challenging the Weight-Centric Menopause Nutrition Narrative
If midlife body changes are the result of many overlapping factors, not just hormones, then why does every ad, article, and supplement company continue to push weight loss as the solution?
The truth: diet culture thrives on making menopause a “problem to solve.” The menopause diet and supplement industry is projected to be worth over $24 billion by 2030.
Companies profit from women’s fears of aging, while offering products that rarely deliver long-term results.
The message to “do whatever it takes to lose weight” is not really about health; it’s about fear of fatness, aging, and the loss of social value attached to thin, youthful bodies. Researchers like Ragen Chastain and the Center for Body Trust remind us that weight stigma itself is an independent risk factor for poor health outcomes, regardless of body size.
Shifting the Perimenopause Nutrition Focus
If diets don’t work and stigma causes harm, what does help? So glad you asked.
Research shows that health benefits like improved blood pressure, blood sugar, cholesterol levels, and mental well-being can be achieved through behavior change without intentional weight loss.
Weight does not equal worthiness.
Weight is not a behavior or a lifestyle.
Health benefits can be achieved through behavior change without the focus on change in body weight.
IV. Thriving Through Perimenopause: A Weight-Inclusive Approach
Despite the challenges, there are effective strategies to support your body, mind, and spirit through this natural change. The goal is to focus on flourishing health while embracing body diversity and acceptance, rather than weight loss.
Here are some ways to navigate perimenopause with a weight-inclusive, non-diet approach:
Some Ways We Can Prioritize Self-Care:
Managing Stress: This includes asking for help, setting boundaries, moving your body, spending time outdoors, connecting with others, engaging in hobbies, meditating, journaling, and resting.
Eating Regular and Nourishing Meals: A consistent eating pattern with a mix of proteins, fats, and carbohydrates helps manage blood sugar and energy levels, especially with increased insulin resistance. Eating consistently helps build trust and energy.
Moving Your Body to the Level of Your Ability: Engaging in enjoyable or tolerable physical activity helps maintain muscle mass, bone health (strength training, weight-bearing exercise), heart health (cardio), and mobility (stretching, balancing activities).
Prioritizing Sleep: While perimenopause can make sleep elusive, making an effort to create opportunities for rest is important. Poor sleep can exacerbate insulin resistance and amplify hunger cues.
Hydrate: Hormonal changes can lead to dryness. Listen to your thirst and observe urine color (pale watery yellow) for hydration needs. Hydration comes from water, other beverages, and fruits/vegetables.
Quitting Smoking, Limiting Alcohol and Caffeine Intake
Body Image and Body Acceptance During Perimenopause:
Body acceptance is about respecting your body as it exists today, recognizing that its shape is largely influenced by factors beyond your control, like genetics, environment, and age.
It doesn't require loving every part of your body, but rather showing it respect.
Practical steps include: wearing comfortable clothing, tossing out your scale, limiting body-checking behaviors or comparisons, and appreciating what your body can do (like digesting your food, carrying groceries, and keeping you ticking).
Cultivating a nurturing, compassionate, and supportive inner voice
V. Nutritional Needs & Health Concerns in Perimenopause
Midlife is often when nutrition becomes most tangled up with weight concerns. But if we step back from diet culture, we can see that nutritional needs in perimenopause and menopause are real, valid, and worth honoring, without centering the scale.
Changing Metabolism and Nutrient Requirements
Metabolism naturally shifts in midlife, influenced by hormonal changes, muscle loss, and aging. Instead of seeing this as a “problem,” we can approach it as a cue to support the body with steady, consistent nourishment.
Protein requirements may be higher in menopause to help maintain muscle mass. This doesn’t mean following a high-protein fad diet, but rather ensuring meals and snacks contain a balance of protein, carbohydrates, and fats.
Case Study: One client, age 51, was frustrated by feeling “weaker” even though her weight hadn’t changed much. By focusing on adding protein to her breakfast and incorporating resistance training, she noticed better energy and muscle recovery.
Essential Nutrients in Midlife
Some nutrients deserve some extra attention during this life stage. My clients and I often discuss:
Calcium & Vitamin D: These are crucial for bone health as estrogen declines.
Iron: Needs often decrease after menopause, but some women still experience low stores from years of heavy periods. Checking ferritin levels with your provider can help guide supplementation.
Magnesium & Potassium: These nutrients support cardiovascular and nervous system health, which is especially important given the increase in high blood pressure in midlife.
Omega-3 Fatty Acids: Found in fish, nuts, and seeds, omega-3s are associated with improved cholesterol levels and cognitive function.
Common Health Concerns to Address Through Nutrition
Bone Health: Estrogen decline accelerates bone loss. Beyond calcium and vitamin D, a diet including protein, magnesium, and phytonutrients supports bone structure. Resistance training is also protective.
Cardiovascular Health: Heart disease risk rises after menopause. Research shows that patterns with higher fiber and lower saturated fats—rich in plants, fish, olive oil, and legumes—can reduce risk, even without weight loss.
Insulin Resistance & Type 2 Diabetes: Regular meals with balanced macronutrients support stable blood sugar. Skipping meals or overly restricting carbohydrates can worsen fatigue and cravings.
Cognitive Health: Nutrients such as omega-3s, antioxidants, and B vitamins may play a role in maintaining brain health. Hydration and regular eating also support concentration and memory.
Sleep Disruption: Poor sleep worsens insulin resistance and increases daytime cravings. Having balanced evening meals and limiting caffeine or alcohol later in the day can help. Outside of nutrition, therapeutic options like CBT-I can be especially supportive in menopause.
VI. Seeking Professional Support & Cultivating Empowerment
Building a Supportive Team: Menopause is not a journey meant to be navigated alone. A supportive healthcare team can provide guidance that honors both body and mind. This may include a primary care provider, psychiatrist, registered dietitian or licensed nutritionist, therapist, and movement professionals.
For those considering hormone therapy, consulting with a Menopause Society Certified Practitioner (MSCP) or other specialists can be invaluable. At my own recent appointment, I left with a recommendation for CBT-I (Cognitive Behavioral Therapy for Insomnia), a reminder that support can be both medical and lifestyle-based.
Embracing Complexity: Midlife body changes in weight, shape, or energy are influenced by a web of factors, from hormones to stress to shifting routines. These changes aren’t the result of a single cause, nor are they solved by a single approach. Recognizing this complexity helps release the pressure to “fix” the body and instead opens space for curiosity and care.
Empowerment Through Self-Acceptance: While not without its struggles, menopause offers a unique moment to pause, reassess, and realign. It’s a time to nurture health goals that feel meaningful, to reconnect with values and passions, and to embrace care practices that sustain well-being. Letting go of weight-centered protocols and rejecting cultural messages that objectify bodies creates room for empowerment, self-acceptance, and authentic health.
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🌿 If you’re curious about how to support your body, mind, and well-being during menopause, I’d love to connect with you. Consider booking a free introductory call with me where we can explore your goals, your unique challenges, and what kind of support feels nourishing for you. 👉 Book Your Introductory Call, Here
I’m in network with insurance, which may cover the cost of visits. See more about the plans I accept on this page.
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Sternfeld B, Wang H, Quesenberry CP Jr, Abrams B, Everson-Rose SA, Greendale GA, Matthews KA, Torrens JI, Sowers M. Physical activity and changes in weight and waist circumference in midlife women: findings from the Study of Women's Health Across the Nation. Am J Epidemiol. 2004 Nov 1;160(9):912-22. doi: 10.1093/aje/kwh299. PMID: 15496544.
Montani JP, Schutz Y, Dulloo AG. Dieting and weight cycling as risk factors for cardiometabolic diseases: who is really at risk? Obes Rev. 2015 Feb;16 Suppl 1:7-18. doi: 10.1111/obr.12251. PMID: 25614199.
Vincent C, Bodnaruc AM, Prud'homme D, Guenette J, Giroux I. Disordered eating behaviours during the menopausal transition: a systematic review. Appl Physiol Nutr Metab. 2024 Oct 1;49(10):1286-1308. doi: 10.1139/apnm-2023-0623. Epub 2024 Sep 4. PMID: 39229895.
Vincent C, Bodnaruc AM, Prud'homme D, Olson V, Giroux I. Associations between menopause and body image: A systematic review. Womens Health (Lond). 2023 Jan-Dec;19:17455057231209536. doi: 10.1177/17455057231209536. PMID: 37994043; PMCID: PMC10666711.