Why You’re Gaining Weight in Midlife—And What Actually Works

Midlife weight gain is common—and frustrating. Hormonal shifts, genetics, aging, and environment all play a role, and the old "eat less, move more" advice often falls short during perimenopause and menopause. The good news? It’s treatable.

In our recent expert-led webinar, Alloy contributor and former Women’s Health Editor-in-Chief Liz Plosser was joined by Dr. Disha Narang, a leading endocrinologist and obesity medicine specialist. Together, they unpacked the real drivers behind midlife weight changes, talked about evidence-based treatments (including medication), and offered practical strategies for improving metabolic health through nutrition, movement, and stress management.

We’re sharing some highlights from their interview below, which have been edited for clarity and brevity. To see the full webinar, which we recommend, head over to our YouTube. As always, our webinars are for educational purposes only and should not be used as personal medical advice. 

Liz Plosser: Let's start at the beginning. A lot of women gain weight during midlife, especially in the belly area, even if nothing else is changing in terms of how they eat or move. Can you explain what’s happening? 

Dr. Disha Narang: This is such a common complaint. I see it every day in my clinic. One of the things I always tell my patients is that they’re not alone. This is very much a part of body physiology. And with most of my patients, it’s not due to a lack of effort. And it’s frustrating when you feel like you’re doing everything you should be, and it’s not working. 

The reason that happens is our estradiol levels are going down, which causes an accumulation of belly fat, which is directly tied to insulin resistance. And that visceral adiposity is important to watch out for, because obviously people don’t like the look of it, but it’s also a sign of metabolic disease. Plus, increased inflammation increases cardiovascular risk.

Liz Plosser: Thank you. I think it’s helpful to understand that a lot of this stuff is just the physiology of our bodies. The human body can be magical, but it can also be frustrating. Let’s get to 2025’s hottest topic: GLP-1s.  What are they, and how do they work to support weight loss and metabolic health?

Dr. Disha Narang: GLP-1 is a hormone that we all have naturally. The medications, called GLP-1 agonists, basically make that hormone a bit more powerful. They enhance the hormone function and allow for greater concentration in your body. We’ve been using them since 2005, in the diabetes world, and in the last six to eight years, they’ve been approved by the FDA for weight management.  

A lot of patients with type 2 diabetes may have obesity. We noticed that in patients with diabetes, GLP-1 medications really helped to improve blood sugar. It helps with glycemic control and helps lower blood sugar and A1Cs. It also works at the appetite center of the brain, and slows down gastric emptying to make somebody feel fuller faster and for longer. We’ve seen benefits to the heart, we’ve seen benefits to the kidneys. There are studies in place right now, so we don’t have FDA indication for this yet, but we’re seeing improvements in the liver, and we’re seeing improvements in patients with PCOS. We’ve seen a lot of benefits.

The way it supports weight loss is it suppresses the hunger hormone. It decreases the stimulus of the hunger hormone in the reward center of your brain, and it decreases food noise, which we hear a lot about in the media. And as we lose weight, that supports metabolic health, and helps to lower people's blood pressures, it helps to lower cholesterol, helps lower diabetes, it improves sleep apnea, and when we improve all those things, we decrease the risk of heart attack and stroke. 

Liz Plosser: Amazing. Thank you. I’ve been seeing a lot in the news about benefits that actually have nothing to do with weight loss. That leads me to the question of risks. Are there any that women should keep in mind? 

Dr. Disha Narang: So, first let’s talk about side effects. The most common ones are GI-related. Some people may feel fatigue, and some may have a lowering of blood sugar where they feel mildly hypoglycemic, but that is more rare.

In terms of long-term risks, we’ve used these medications for two decades at this point, and we intend for them to be long-term agents. We need to think of weight as a chronic disease. These drugs are not meant to be used for three to six months, and you lose weight and then are good to go. It doesn’t work that way. If you go off them, the drive to eat and the cravings would all go back up. So, we do expect weight regain if people stop the medication. It’s important to use them properly to mitigate risks. Liz Plosser: That’s helpful. One thing that’s important, which Alloy does, is that with their program you’re constantly checking in with your doctor, and adjusting your dose if needed, and looking at what’s happening in your body. You have a support system. One thing that I’ve heard about recently is oral doses coming out. Can you talk about those? Dr. Disha Narang: We actually already have an oral GLP-1 that is basically an oral form of Ozempic. It’s called Rybelsus. It’s been around for some years now, but it’s only approved for patients with type 2 diabetes. And Eli Lilly is coming out with another one, but it also is going to be approved for diabetes only. We are expecting good success with blood sugar control, A1C reduction, and weight reduction as well. And when there are studies that show it’s effective for weight management, it may be approved for weight management as well.  

Liz Plosser: Awesome. Thank you for clearing that up. How can a woman assess if she's a good candidate for this type of medication?

Dr. Disha Narang: This is a great question. I don’t necessarily believe that these medications should be doled out like candy, because some patients may not be great candidates for them. Per FDA guidelines, people with a BMI above 27 with a weight-related comorbidity (pre-diabetes, sleep apnea, high blood pressure, high cholesterol, osteoarthritis, heart disease) would be eligible for an anti-obesity medication. I would love to be able to expand beyond BMI because in the weight management community, that’s only one number. There are a lot of other things we look at to understand somebody’s metabolic health. But, the FDA and the insurance companies are a bit behind. So when we look at the indication for the medications per FDA approval, those are the guidelines. 

Liz Plosser: You mentioned when folks go off the medication that they experience a yo-yo, and then they go back on, and that can be hard on them. Do you mean physically or emotionally? 

Dr. Disha Narang: All of the above. Physically, it’s hard on your body. You’re not meant to go on and off these medications. But, sometimes people have to—there’s an affordability issue with GLP-1s, and insurance companies sometimes drop coverage of them. So you have patients who are doing really well, and they’re forced to come off of them because they have to pay out of pocket and it’s too expensive. And then people gain weight, so they go back on. And sometimes the second time, it’s not as effective. All of these things can be stressful.

I always say there’s no secret to weight management. It’s consistency. That means consistency in lifestyle, but also consistency in treatment. 

Liz Plosser: This is a question I think we all hear a lot: What if I have just 10 pounds to lose? They’re not sure if it’s an urgent medical thing, but they can’t get the last 10 pounds off. 

Dr. Disha Narang: That's a very common complaint. It’s going to require a conversation with your physician. And you’re going to want to rule out things like uncontrolled thyroid disease, which can account for a 10-15 pound weight gain, and would make someone a not-great candidate for GLP-1s. But, for some people, it may be what they need. It’s just a question of your specific situation. 

Liz Plosser: Can we talk about diet, and how to eat while you’re on these medications? Dr. Disha Narang: Sure. First, it’s important that your diet is sustainable. If you’re looking at a dietary pattern, you need to think to yourself, “Am I going to be satisfied eating this way in 20 years?” And if the answer is yes, then it’s a good plan to stick to. It’s always good to cut back on processed foods in favor of more whole foods. But whatever you’re doing has to be something you can do long-term. There are also side effects of medications. Some people feel nothing, but some feel nausea, or other GI issues. So, in terms of diet, it can help to eat simple foods, more bland foods, and to eat smaller portions, more times per day. And, remember to hydrate. When you’re not hungry, you’re not going to want to eat or drink. But it’s important to make sure you’re meeting your nutritional needs. 

Liz Plosser: Nutrition continues to be important, even after medication. I think it goes without saying, but these drugs are not a replacement for eating healthy. You still need vitamins and micronutrients and everything else we get from whole foods. Let’s shift for a minute to exercise. Can you talk about why it’s important to prioritize building lean muscle mass or protecting what you already have when starting these medications? 

Dr. Disha Narang: So, outside of perimenopause and menopause, we actually start losing muscle at age 30, and resistance exercise and muscle building becomes important. When you get to perimenopause and menopause and are losing estradiol and progesterone, it becomes even more important. So, resistance training needs to happen whether or not you’re on medication. Weight loss leads to muscle loss, regardless of whether you’re on medication or not, and regardless of what your path is. So, no matter what, I recommend resistance training. If you can, personal training is wonderful, to prevent injuries. Weightlifting is great. If you’re walking, add a weighted vest or ankle weights. It really can be that simple. 

Liz Plosser: Can we talk about combining Menopausal Hormone Therapy with GLP-1s? There seems to be a synergy there. Dr. Disha Narang: I think that there’s an indirect synergy. If you’re on MHT, you’re going to be able to better focus on weight management. If you’re not having hot flashes, and are sleeping better, and aren’t having joint pain, you’ll have more energy to focus on your diet and exercise. If you’re a good candidate for MHT, I’m all about it. 

Liz Plosser: That’s great to hear. We really appreciate all of your insights. Thank you so much for joining us.

Dr. Disha Narang: Thank you for having me! 

To learn more about Alloy’s Weight Care Program, which was created specifically for women in midlife, go to myalloy.com/weight. And, to see Liz Plosser and Dr. Disha Narang’s whole conversation, go to our YouTube! 

To learn about upcoming webinars and events, follow us on Instagram @myalloy.