You can be slim everywhere else and still struggle with stubborn belly fat, particularly after 50. Experts explain why menopause, stress, sleep and muscle loss can change where your body stores fat – and what may help
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If you are relatively slim overall but still have a belly, it can understandably be frustrating, particularly if you have tried hard to shift it. Sadly, being thin doesn’t make women immune to abdominal fat.
And while it is tempting to blame your diet or lack of exercise, there are several reasons why fat can accumulate around your middle – particularly as you get older.
To understand belly fat and why we get it, even if the rest of your body is relatively toned, it is important to understand the difference between the two main types: subcutaneous fat and visceral fat.
Many people have both at the same time. While visceral fat is generally considered the more concerning type for health, some body fat is normal and necessary.
What’s the difference between subcutaneous and visceral fat?
In a nutshell, Dr Hussain Ahmad, a UK consultant practitioner from Click2Pharmacy, explains:
“Subcutaneous fat is a metabolically benign layer of fat you can pinch just beneath the skin.
“Visceral fat is found deeper inside the body wrapped around the liver and the pancreas and the intestines. You can’t feel it and it acts like an active organ by releasing chemicals that raise your blood pressure, cholesterol and resistance to insulin.”
The good – or bad – news is that belly fat is extremely common, he adds.
“It’s not just caused by diet as other factors including poor sleep, a high alcohol intake, your genetics, chronic stress and being inactive or sitting down for long periods of time all play a part as well.
“A combination of the menopause and a reduction in oestrogen causes a change in how fat is distributed in women over 50. Fat moves from the hips and thighs to the abdomen causing a woman’s body shape to change but not her weight. Muscle loss due to ageing is another cause of the resting metabolic rate slowing down.
“Slim women can still have visceral fat. As scales and BMI can both miss it, waist measurement is a better guide, with anything exceeding 80cm indicating a raised risk in women.”
Why some belly fat isn’t necessarily a bad thing
It is important to remember that not all abdominal fat is harmful to your health.
Pointing out that most of the time subcutaneous fat is not harmful to your health, physician Carol Eisenstat, founder of Slim.md, says: “It can even be beneficial in some areas of your body.”
This is because subcutaneous fat can help with insulation to keep the body warm and provide protection for the body.
The bigger concern is visceral fat, which is stored around your internal organs.
“This fat surrounds your organs. Your liver, intestines etc. This type of fat is dangerous as it secretes fatty acids and pro-inflammatory factors directly into your liver. It is associated with insulin resistance, diabetes and fatty liver disease, as well as cardiovascular disease.
“There are many reasons someone can store excess visceral fat. Genetically, elevated cortisol from stress and/or lack of sleep, alcohol, carbs and being sedentary can contribute.”
Why does belly fat increase during menopause?
For many women, menopause can bring a noticeable change in body shape. You may not necessarily gain significant weight, but you may find that more of your existing body fat starts to settle around your abdomen.
As a menopausal woman who has tried everything to get rid of my stubborn belly fat, I am keen to understand why it creeps up on many of us at this stage of our lives.
“Menopause doesn’t always cause you to gain weight but does change where you will store fat,” explained Carol Eisenstat.
“As we lose estrogen our bodies will start to hold on to visceral fat more than before. Most of my patients say they haven’t gained weight since menopause but their bodies have. They are correct.”
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Why stress, sleep and muscle loss can make a difference
In her work as a menopause specialist and an OB-GYN, Dr Anna Cabeca, Dr Anna Cabeca, regularly sees patients who can’t shift their belly fat.
“This is such a common frustration, and I hear it all the time from my patients. Belly fat is incredibly common, especially in midlife. The biggest drivers include hormonal changes, insulin resistance, chronic stress and elevated cortisol, poor sleep, loss of muscle mass, a sedentary lifestyle, and a diet high in refined carbohydrates, added sugars, and excess alcohol. Genetics also play a role in where your body prefers to store fat,” she explains.
“For women over 50, menopause absolutely contributes. As estrogen declines, the body shifts from storing fat primarily in the hips and thighs to storing more around the abdomen. At the same time, visceral fat often increases.
“Sleep disruption, stress, and reduced physical activity during this stage of life can further contribute to this shift. Insulin sensitivity also tends to decline with age, making it easier for excess calories, particularly from refined carbohydrates, to be stored as abdominal fat.
“That is exactly why a woman can be slim overall and still carry excess belly fat. She may have a normal BMI but still have a disproportionate amount of visceral fat because of hormonal changes, chronic stress, poor sleep, insulin resistance, or loss of muscle mass. It is not just about how much fat you have. It is about where it is stored and how metabolically active it is.”
So, what can you do about belly fat?
There isn’t a single food, exercise or diet that can specifically target belly fat. Instead, focusing on your overall metabolic health, activity levels, nutrition, sleep and stress may help.
Below, Dr Cabeca advises on some of the approaches she recommends for reducing abdominal fat.
Focus on a nutrient-rich diet
Dr Cabeca recommends following a Keto-Green lifestyle, reducing refined carbohydrates and added sugars while emphasising alkaline vegetables such as spinach, broccoli, asparagus, cucumber and leafy greens, alongside healthy fats and quality protein.
While individual dietary approaches can work differently for different people, focusing on nutrient-dense, minimally processed foods and getting enough protein and fibre can support a healthy diet.
Consider intermittent fasting
When appropriate, Dr Cabeca says intermittent fasting may improve insulin sensitivity, encourage your body to use stored fat for energy and support metabolic health.
However, intermittent fasting isn’t suitable for everyone and isn’t essential for losing belly fat. If you are considering it, particularly if you take medication or have an underlying health condition, speak to a healthcare professional first.
Prioritise strength training and movement
Building and maintaining muscle becomes increasingly important as we age.
Dr Cabeca recommends strength training and HIIT, explaining that building muscle can improve insulin sensitivity and help increase resting metabolic rate.
Regular walking is another simple and sustainable way to increase your daily movement and support overall metabolic health.
Don’t overlook sleep and stress
Stress and poor sleep can affect appetite, activity levels and metabolic health, which is why they deserve attention when you’re trying to improve your overall wellbeing.
“Chronically elevated cortisol is associated with increased abdominal fat accumulation,” says Dr Cabeca.
She recommends prioritising restorative sleep, stress reduction, meaningful social connection and practices that support oxytocin and overall wellbeing.
Be realistic about supplements
Dr Cabeca also recommends considering nutrients including omega-3 fatty acids, vitamin D when deficient and magnesium, as well as targeted botanicals such as maca, as part of a comprehensive approach to metabolic and hormonal health.
However, supplements aren’t a shortcut to losing belly fat. If you think you may be deficient in a particular nutrient, it is worth speaking to your GP or another qualified healthcare professional before taking supplements.
Small changes can make a difference
Ultimately, you don’t need to completely overhaul your lifestyle overnight.
“Start with one sustainable change, even if it is simply improving your breakfast or adding a daily walk. Small, consistent habits create lasting results. Remember, this is a marathon, not a sprint.”