Why Does Fat Gather Around Our Middle as We Get Older — And What Can We Do About It?
You exercise.
You’re reasonably active.
You eat fairly well most of the time.
But somewhere from your 40s onwards, you might begin to notice something changing.
Your waist isn’t quite where it used to be. Your trousers fit differently. Perhaps the scales haven’t changed dramatically, yet your body shape has.
And you find yourself asking:
“Why is it all going around my middle?”
Firstly, this doesn’t mean you’ve done something terribly wrong.
Women’s bodies change as we age. Hormonal changes beginning around the menopausal transition can influence where fat is stored, while ageing itself can bring changes in muscle mass, activity levels and energy requirements.
But here’s the positive part:
There is a great deal we can do to influence our body composition and, much more importantly, our health.
And exercise is a big part of that.
Not exercise as punishment.
Nor endless abdominal exercises.
And not trying to recreate your 25-year-old body.
Exercise that makes you stronger, fitter, healthier — and that you enjoy enough to keep doing.
First, let’s understand what’s actually sitting around our middle
When we talk about “belly fat”, we’re actually talking about different types of adipose tissue.
And understanding the difference is important.
Subcutaneous fat — the fat underneath your skin
Subcutaneous fat sits between your skin and your muscles.
It’s the softer tissue you can usually pinch around your stomach, hips, thighs and other parts of your body.
And here’s something we perhaps don’t hear often enough:
Body fat has a purpose.
Adipose tissue stores energy and has important endocrine and metabolic functions. Subcutaneous fat provides a relatively safe storage site for excess energy, and where we store fat appears to matter considerably to our metabolic health.
That doesn’t mean unlimited amounts of subcutaneous fat are harmless. Excess total body fat can still affect health.
But subcutaneous abdominal fat and visceral fat are not metabolically identical.
Visceral fat — the fat deeper inside your abdomen
Visceral fat is different.
Rather than sitting immediately underneath your skin, visceral adipose tissue sits within the abdominal cavity around internal organs.
You can’t simply grab it between your fingers.
Visceral fat is metabolically active and differs from subcutaneous fat in its cellular behaviour, blood supply, hormonal responsiveness and inflammatory characteristics. Excess visceral fat is more strongly associated with insulin resistance, type 2 diabetes, cardiovascular disease and other cardiometabolic problems.
So when I’m talking to a woman about reducing her waist measurement, I’m not simply thinking:
“Let’s make your stomach look smaller.”
I’m thinking:
“Let’s improve what’s happening on the inside as well.”
And that’s a much more worthwhile goal.
But how do I know which type of fat I have?
This is where it gets interesting.
You cannot accurately determine how much visceral fat you have simply by looking at your stomach or pinching it.
We can measure visceral fat much more precisely using imaging such as MRI or CT, but that’s obviously not something we’re going to do every few weeks during an exercise programme.
Instead, we can use some very simple measurements to help us monitor central fat distribution.
One I like is the waist-to-hip ratio.
Measure around your waist and around the widest part of your hips, then:
Waist measurement ÷ hip measurement = waist-to-hip ratio.
This isn’t a direct measurement of visceral fat, but it gives us useful information about where you are carrying your weight.
Large prospective studies and meta-analyses have found that waist circumference, waist-to-hip ratio and waist-to-height ratio are associated with cardiovascular risk.
BMI can also provide useful information, particularly as a screening measure, but it doesn’t tell me everything I want to know about an individual woman.
So rather than allowing one number on the scales or a BMI category to define success, I want to build a bigger picture of your health.
So can we actually reduce visceral fat?
Yes — and this is where the message becomes really encouraging.
Visceral fat is responsive to lifestyle change.
We don’t need a special “visceral-fat exercise”.
Regular exercise can reduce visceral adipose tissue, and systematic reviews of randomised controlled trials have found benefits from aerobic exercise, resistance training, combined aerobic and resistance training, and HIIT.
That gives us options.
You don’t have to choose the one supposedly “perfect” exercise.
We can build a week of movement that supports your health and that you actually enjoy.
You might walk.
Go to Pilates.
Lift weights.
Cycle.
Swim.
Do some intervals.
Practise yoga.
Go dancing.
Walk up hills with friends.
The important thing is that we then make sure your overall programme contains enough of the things your body needs.
That’s very different from forcing yourself through an exercise programme you hate because somebody told you it’s the quickest way to lose belly fat.
What would a good week of exercise look like?
This is where I think about variety rather than punishment.
Some cardiovascular exercise
Walking absolutely counts.
Brisk walking, swimming, cycling, jogging, dancing and many other activities challenge your cardiovascular system.
And they can be enjoyable.
Regular aerobic exercise is also one of the forms of exercise shown to reduce visceral adipose tissue.
So if you love walking — keep walking.
We’re not going to take something you enjoy away because there’s a fashionable new exercise on Instagram.
Some resistance exercise
I also want you strong.
Resistance training helps us preserve and develop muscle — something that becomes increasingly important as we get older.
Muscle is metabolically active tissue, although I don’t want to exaggerate that into the popular claim that adding some muscle suddenly makes you burn hundreds more calories while sitting on the sofa.
Its importance goes far beyond that.
Muscle helps us move, lift, push, pull, climb stairs, get off the floor and remain physically independent.
It also has an important role in glucose metabolism and overall metabolic health.
So I’m interested in improving your ratio of healthy, useful muscle tissue to excess body fat, rather than simply trying to make the number on your scales smaller.
Some higher-intensity work — if it’s right for you
HIIT can also be useful.
Research comparing different exercise approaches suggests that higher-intensity aerobic exercise and HIIT can be particularly effective options for reducing visceral fat in people with overweight or obesity.
But HIIT doesn’t have to mean collapsing on the floor after a workout.
“High intensity” is relative to you.
For one woman it might be running intervals.
Or another it might be short, faster periods on a bike.
Others, someone may be returning to exercise, a brisk uphill walk might provide quite a challenge.
That’s why you’ll often hear me ask:
“Was that challenging for you?”
Your exercise needs to challenge your body, not somebody else’s.
And yes, Pilates and yoga belong in the week too
I don’t want Pilates and yoga positioned as second-rate exercise simply because they’re not necessarily the biggest calorie burners.
They give us something different.
Strength.
Mobility.
Balance.
Control.
Breathing.
Body awareness.
Time to move without constantly racing against the clock.
And perhaps most importantly, if you enjoy your Pilates class or yoga practice, you’re far more likely to keep doing it.
Health isn’t created by the workout you tolerate for six weeks.
It’s supported by the movement you can make part of your life.
That’s why my own exercise week can contain different intensities and different types of movement.
Not every session needs to leave you exhausted to have value.
Rest belongs in your programme too
Here’s another positive change I want women to make:
Stop feeling guilty about recovery.
Training provides a stimulus. Recovery gives your body the opportunity to respond and adapt.
As we age, recovery between harder training sessions deserves consideration, and individual recovery responses can vary considerably. That doesn’t mean women over 40 are fragile or shouldn’t train hard — quite the opposite. It means we want to combine challenge with appropriate recovery.
A recovery day might include a walk, some mobility, gentle yoga or simply normal daily activity.
And sometimes a proper rest day is exactly that:
rest.
That’s part of your health programme too.
But exercise can’t do all of the work
This is probably the conversation that requires the most honesty.
You can have a really good exercise programme and still consume more energy than your body requires.
And it isn’t necessarily coming from enormous meals.
Sometimes it’s the bits we barely remember eating.
A couple of biscuits with a cup of tea.
Crisps while watching television.
A few handfuls of nuts.
Alcohol at the weekend.
A larger portion because it was delicious.
Finishing what’s left on somebody else’s plate.
None of those foods needs to be labelled bad.
But they’re not invisible either.
And this is why, when I work with someone on weight management, I don’t immediately hand them a diet.
First, we find out what’s actually happening.
For one week, be curious about what you eat
One of the first things I ask my clients to do is keep an hour-by-hour food and activity diary for a minimum of seven days — including the weekend.
I want the real week.
Not the unusually good Monday-to-Thursday version.
And this isn’t about judgement.
It’s about information.
What time are you hungry?
How large are your portions?
Are you getting enough protein?
Are there long gaps between meals?
When do you snack?
What happens at 3pm?
What changes on Friday night?
How much alcohol are you actually drinking?
Are you eating because you’re hungry — or because it’s simply what you always do?
Sometimes a small adjustment repeated every day is far more useful than a dramatic diet you can only tolerate for three weeks.
Know yourself before you try to change yourself.
We don’t have to attack body fat — we improve body composition
This is the message I particularly want women to understand.
Body fat isn’t the enemy.
We need adipose tissue.
What we’re interested in is excess body fat, where it’s being stored, what else is happening to your health and how much healthy muscle tissue you’re maintaining as you age.
And the really encouraging part is that the same behaviours that can help reduce excessive visceral and subcutaneous fat also support so many other areas of health:
Move regularly. Build muscle. Challenge your heart and lungs. Eat well most of the time. Recover. Sleep. Enjoy your life. And keep doing it.
Exercise studies show that regular aerobic exercise, resistance exercise, their combination and HIIT can improve waist circumference and body fat as well as visceral adipose tissue.
So we’re not trying to wage war on your stomach.
We’re creating a healthier body.
This is why my Weight Management Programme lasts six months
I don’t think changing a woman’s relationship with food, exercise and her body should be squeezed into a quick-fix six-week challenge.
My Honest Body Weight Management Programme consists of seven 1:1 sessions spread over approximately six months.
We start by understanding where you are now.
Your movement, your strength, your exercise, your measurements, your lifestyle, your eating habits and your goals.
You’ll keep your food and activity diary so that we’re working from your real life, rather than an idealised version of it.
Then we build your programme.
There might be resistance training, cardiovascular training, or some HIIt training.
Pilates or yoga might be part of it and walking might play a huge role.
And we’ll look at the small changes to your diet that could make a meaningful difference without making food miserable.
Then you go away and live with it.
You come back.
We measure > we talk > we progress your exercise > we adjust what s not working.
And gradually, you’re not simply following my programme anymore.
You’re learning how to manage your own body.
Because six months gives your body time to adapt — but just as importantly, it gives your brain time to practise different behaviours until they start becoming normal.
Your body isn’t asking you to give up. It may just need something different.
If your waist has changed since your 40s, I don’t want your response to be:
“I’m getting old. There’s nothing I can do.”
And I don’t want it to be:
“Right. Diet starts Monday. No wine. No chocolate. HIIT five times a week.”
There’s a much better middle ground.
Find movement you enjoy.
Challenge yourself.
Build and maintain muscle.
Look after your cardiovascular health.
Give your body recovery.
Take an honest look at what you’re eating.
Make changes you can actually maintain.
And measure progress by far more than the bathroom scales.
You aren’t trying to punish your body into becoming smaller.
You’re investing in the body you’re going to live in for the next 20, 30 or 40 years.
And that’s a very different reason to exercise.
Know your body.
Trust your body.
Improve your body.
Honest Body Weight Management Programme
7 private 1:1 sessions over approximately 6 months
Understand what’s happening now. Build the right programme for you. Create habits that can last.
Book you Honest Body 1:1 session here