What an Expanding Waistline After Menopause Means for Your Health

Menopause and an expanding waistline

It’s not uncommon for women to gain weight after menopause and some of that fat ends up around the waistline as “love handles.” Sometimes, increased fat manifests only as an expanding waistline. The 24-inch waist you sported for years is replaced with one several inches larger. You might not like how your expanding waistline looks, or that it makes it harder to button your pants, but new research from the University of Pennsylvania finds that increase in waist circumference has health implications too.

For the study, researchers looked at information on 362 women as part of the Study of Women’s Health Across the Nation (SWAN) Heart Study. The participants in the study underwent imaging studies to measure the quantity of visceral adipose tissue they had in their abdominal cavity. Visceral adipose tissue is the deep belly fat that wraps around organs, such as the liver, and often shows up as an expanding waistline.

Scientists now know that visceral fat is the most dangerous type from a health standpoint since it produces inflammatory chemicals that can damage tissues. In contrast, subcutaneous fat, a more superficial type of fat you can pinch between your fingers doesn’t carry the same health risks. So, where you store body fat matters for your health.

Along with measuring visceral fat in the women, researchers measured how thick the subjects’ internal carotid arteries in their neck were. The internal carotid artery carries blood and oxygen to the brain. When the artery thickens, it’s a sign of plaque build-up that could lead to a stroke. A thickened carotid artery is also a marker of a higher risk of a heart attack.

Interestingly, the scientists found a strong correlation between increases in visceral abdominal fat and thickening of the carotid artery. Each 20% increase in visceral fat was linked with a 2% boost in the thickness of the carotid artery. So, an increase in visceral fat is a marker of higher cardiovascular risk after menopause and that includes a greater risk of heart attack and stroke.

Waist Size Matters

Is there a way to know how much visceral fat you have without an expensive imaging study? Waist size is a rough marker of visceral fat and it’s something that too few people monitor, including health professionals. A rapid increase in visceral fat shows up with a large increase in waist size and it raises red flags about cardiovascular risk. The author of the study points out that visceral fat increases, on average, goes up by 8% per year during the menopausal transition.

Why is waist size so often ignored? Rather than measuring waist size, most healthcare professionals use body mass index (BMI) as a marker of health and health risks. Yet, a number of studies show waist size may be a better indicator of cardiovascular risk and the risk of other health conditions than BMI. Plus, BMI is misleading in certain groups of people. For example, it doesn’t distinguish between body fat and lean body mass, only total body weight relative to height.

Athletes who develop a lot of muscle from their training may build up a significant amount of muscle and wind up in the overweight or obese category when they have a healthy body composition. At the other end of the spectrum, the elderly may have a normal BMI, based on calculations, but have a high body fat content relative to muscle. Measuring BMI only is not a reliable indicator of cardiovascular risk. Waist size, as a marker of visceral fat, reveals more.

Waist Size vs. BMI for Cardiovascular Risk

Another study of 700 Korean women found that BMI was not a good indicator of the risk of developing heart disease or stroke. In the study, obesity was not a strong marker for cardiovascular disease, but central obesity, as determined by a large waist size, was. Therefore, you can have a normal BMI and still be at higher risk of heart disease or stroke if you have a large waist size.

How large is too large? As a guideline, experts believe your waist size should no larger than half your height. If it’s greater, you may be at greater risk of cardiovascular disease. Keep a tape measure handy and measure your waist size every month. Record the values and monitor for changes over time. Another guideline: A waist size greater than 35 inches for women and 40 inches for men is red flat for higher cardiovascular risk.

Lifestyle Can Reduce Waist Size and Visceral Fat

If you measure your waist size and aren’t happy with the results, it’s time to make lifestyle changes. Physical activity, including strength training and aerobic exercise, will help reduce visceral fat. However, more intense exercise may be more beneficial for diminishing visceral fat than low to moderate-intensity exercise.

Look at the composition of your diet, too. Some studies show that a low-carbohydrate diet is more effective at reducing visceral fat but eliminating refined carbohydrates and sugar will likely have similar benefits. Sugar and refined carbs cause an increase in insulin that makes it easier to store belly fat. In contrast, healthy carbohydrate sources, like non-starchy fruits and vegetables do not.

Getting enough sleep and stress management matters too. Even if you eat right and stay active, stress and lack of sleep raise the stress hormone cortisol, making it easier to store belly fat. In fact, one reason visceral fat increases after menopause is cortisol levels rise and growth hormone decreases. Staying physically active without overdoing it helps restore a healthier balance between cortisol and growth hormone.

The Bottom Line

Don’t just follow your body weight and BMI, monitor your waist size too. It’s a marker of how much visceral fat you have and that is correlated with cardiovascular risk. It’s one more reason to keep your eye on your waistline.


  • Saad Samargandy, Karen A. Matthews, Maria M. Brooks, Emma Barinas-Mitchell, Jared W. Magnani, Imke Janssen, Rasa Kazlauskaite, Samar R. El Khoudary. Abdominal visceral adipose tissue over the menopause transition and carotid atherosclerosis. Menopause, 2021; Publish Ahead of Print DOI: 10.1097/GME.0000000000001755.
  • Jun Hwan Cho, Hack-Lyoung Kim, Myung-A Kim, Sohee Oh, Mina Kim, Seong Mi Park, Hyun Ju Yoon, Mi Seung Shin, Kyung-Soon Hong, Gil Ja Shin, Wan-Joo Shim. Association between obesity type and obstructive coronary artery disease in stable symptomatic postmenopausal women. Menopause, 2019; 1 DOI: 10.1097/GME.0000000000001392.
  • The Journal of Clinical Endocrinology & Metabolism, Volume 93, Issue 5, 1 May 2008, Pages 1655–1661, https://doi.org/10.1210/jc.2007-2677.
  • Toth, M., Tchernof, A., Sites, C. et al. Effect of menopausal status on body composition and abdominal fat distribution. Int J Obes 24, 226–231 (2000). https://doi.org/10.1038/sj.ijo.0801118.


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