[Angela Foster] (0:00 - 0:15)
I'm Angela Foster and welcome to this masterclass on one of the most frustrating things women deal with in midlife. Stubborn belly fat that just won't shift no matter how hard you're working. I've pulled together the most useful conversations from my podcast to explain what's actually going on and what to do about it.

[Ben Azadi] (0:15 - 0:19)
The body will not burn fat if it feels like it's under a threat.

[Dr Sarah Berry] (0:19 - 0:25)
There was this poorer metabolic response to consuming carbohydrates and postmenopausal women.

[Cynthia Thurlow] (0:26 - 0:36)
We have 40 times more cortisol receptors in our abdomen. When someone says to me, I went through a stressful period, I noticed I had body composition changes. I understand that physiologically why that happens.

[Mary Claire Haver] (0:36 - 0:40)
This is a expected biological consequence of hormonal chaos.

[Angela Foster] (0:40 - 1:01)
In midlife, the bigger issue is visceral fat and insulin exposure. And the fix is simpler than you've been led to believe. If you're training, eating well, and still feeling like your body's fighting you, this is for you.

Let's get into it. One of the things that so many women struggle with is belly fat. Would you say that cortisol is a big driver of stubborn belly fat in women?

[Ben Azadi] (1:02 - 3:53)
100% yes. Here's the reason why. I talk about this in the KetoFlex revised book.

As women go past 35 and then 40s and 50s and beyond, they are going to become more insulin resistant, first and foremost. The second part here is as the ovaries are putting in their two weeks notice, or in some cases, months notice, and then eventually retiring, it is the adrenal glands that are going to pick up the slack. As you talk about, Angela, the adrenal glands are what produces cortisol.

It doesn't mean cortisol is bad. Cortisol and adrenaline are not bad hormones. There are no bad hormones.

However, when you're in this constant fight or flight state, especially women after 35, where the adrenal glands need extra support, that cortisol, when it's elevated and it stays elevated, it is going to pack on fat around your midsection, especially your belly fat, and especially the fat that you can't necessarily see, the visceral organ fat. That's because inside of your organs, your liver, your heart, your pancreas, you have receptor sites for fat, of course, but there are three times as many receptor sites for cortisol in your visceral fat than other areas of your body. You're going to pack on that fat.

It's called the cortisol belly. That is really important to understand because you want to make sure you're not getting rid of stress. Angela, you talk about the importance of adapting to the stress.

It's about becoming more resilient. It's about looking at things like heart rate variability and increasing that, looking at your sleep and recovery. These are things that you talk about a lot.

Once you start tackling that, here's what's going to happen. Then you start signalling to your body or metabolism, you're safe. Release the stored fat.

Lower the cortisol. Increase oxytocin, which counteracts cortisol. You see, the body will not burn fat if it feels like it's under a threat.

That threat could be an actual physical threat, like some animal that's about to kill you, or it could be emotional threats, like what's happening in the world, doom scrolling on social media, relationship stress, financial stress, traffic stress. The body is going to react the same way and it's going to do what it needs to do to survive. That's the number one priority for the body.

It'll raise cortisol. It'll raise adrenaline. It does not want to burn fat.

That is not a priority. It wants to preserve that fat, especially that metabolically active fat around your organs. It is so important to become more resilient to those stressors.

In some cases, that means dialling down the stress. In other cases, that means just focussing more on recovery and becoming more resilient or even a combination of both. Once you do that, you change the signals to your metabolism.

It feels safe instead of the threat. Then it starts burning belly fat.

[Angela Foster] (3:53 - 5:06)
When you look at just where we started with the visceral fat, you mentioned quite a few things. We have poorer blood glucose control. We see inflammation going up.

Cortisol is playing a part that's rising. We've got these changes in oestrogen. When you look at visceral fat developing, if you have visceral fat, it seems that you're now more prone to insulin resistance.

If you have insulin resistance, it seems to drive visceral fat. Do we know what is driving it? I guess if I look at myself, just as an example, I've been monitoring my data using DEXA scans across the perimenopause transition.

I've seen a very minuscule rise. It's still below the radar, the level of visceral fat, but it's hard to isolate these things because I exercise daily. That, I think, makes a difference.

Then I try and eat as many of the types of foods that you're eating. All of those things are also lowering inflammation, improving blood glucose control. Do we know, is there a thing that's the starting point of causing this and then the others are coming off the back of it, or is it just this whole metabolic issue that's all going on at the same time?

[Dr Sarah Berry] (5:07 - 10:37)
That's a good question. It's a hard question. It's a bit like the chicken and egg.

We don't know which comes first. We do know that there is a biodirectionality. We do know that if you increase your visceral adiposity, then you increase your chances of insulin resistance due to particular hormones and chemicals that are released from your adipose tissue.

We know that if you are insulin resistant, then in turn, that also therefore means that we're not metabolising food in the same way. We're not processing our blood lipids, our cholesterol in the same way because insulin has a role with lots of other hormones as well. All of that can then contribute as well to weight gain.

It's this circular process. I think what I often say to during the menopause transition is to remember that it's a really challenging time in terms of you've got all of these symptoms going on. We see in our own data, and we've collected this data in hundreds of thousands of women, that although we typically talk about heart flushes, actually the most prevalent symptoms are anxiety, mood swings, depression, brain fog, poor sleep.

If you're feeling pretty damn fed up and you're not sleeping, how motivated are you to eat well? How motivated are you to do physical activity? You've got all of that going on, plus the fact that this loss of oestrogen is directly causing as well this increase in or this change in where your fat is deposited.

We know that. We know that oestrogen in simple terms directs the fat to your hips. We know if you lose oestrogen in simple terms, it then is more predisposed to going around your belly.

You've got the direct action of insulin increasing your adiposity around your belly. You've got the indirect effects of the fact that 85% of people report poor sleep. 80% say they feel anxious, depressed, fed up, low mood.

Therefore, less likely to want to partake in physical activity or even eat well. Then we also know that during the menopause transition, it can impact factors like your hunger signals. We hear so many people saying, I'm eating the same that I always had, but I'm so much more hungry.

We know that it impacts also how you metabolise food. Again, we've published some research from our ZOE predict studies where we looked at about 600 women and we looked at those who were pre or post menopausal. We gave these women exactly the same breakfast with exactly the same amount of carbohydrate.

It was a very high carbohydrate meal. Those who were post menopausal had a significantly higher postprandial glucose response, meaning that they had a significantly greater short-term change in their circulating blood sugar levels compared to the menopausal women. We then took this a step further because we know menopause is an age-related disease, or age-related event.

Sorry, that was an error. We know that menopause is an age-related event. What we did was we then, with our cohort, took an age-matched group of pre and post menopausal women.

We had an equal amount of people of the same age who were pre and those who were post menopausal. We still found that dependent on not your age, but your menopause status, there was this poorer metabolic response to consuming carbohydrates in post-menopausal women compared to pre-menopausal women. We know that this can go on to cause bigger glucose dips, so bigger dips in that circulating blood sugar two to four hours after consuming a high carbohydrate meal.

Again, we know from our own research that those dips in circulating blood glucose or blood sugar cause people to consume more, sets them off on this kind of roller coaster. If people have this dip, our research shows they consume about 320 calories more over the day compared to if they don't have that dip. You've got all of these factors working against you.

Then it's at a time where so many women are being so hard on themselves. Now, I'm not saying, sit back, eat what you want, don't be physically active. Yes, absolutely.

It's one of the most important times to be physically active. I do think as well that we need to be really aware of how, unfortunately, nature is working against us. I don't mean to paint a doom and gloom picture, but I think it's important to be aware of this.

A 49-year-old woman, when I see these pictures of Jennifer Lopez, Halle Berry with their most perfect washboard belly and perfect figures, it can be hard to think, wow, how can I live up to that? Now, I can't because I have kids, I have jobs. Also, I want to enjoy my life.

I want to enjoy my food. I don't want to be on a treadmill all day long and only eating carrot sticks. I just think it's really important that we recognise that our bodies are changing.

That is a natural part of what happens as we age, as we go through the menopause transition. Plus, we have all of these other factors that are working against us. Yes, absolutely, let's still try and be physically active.

It is a point in time as well to be even more mindful than before about what food we're eating.

[Angela Foster] (10:38 - 11:12)
One of the things that gets mentioned so much is the change in the way that we store fat and how it moves to our abdomen, which is a very, very common thing. There's two types here, right? Some women will notice that they can kind of pinch it, right?

They're putting on weight adipose tissue around their waist. Other women are less aware of it. Actually, they may even have more of what's known as visceral fat that you can see on a scan.

What do you think is behind that? I know changes in hormones seem to affect it, but how is the gut playing a part in the changes in body fat?

[Cynthia Thurlow] (11:12 - 17:04)
Yeah, so I think every woman listening, it's important that we are getting bioimpedance ratings. We're getting a sense of our fat-free mass to our muscle mass because that is objective. As opposed to you step on a regular scale, it gives you a number, but it's not differentiating how much is muscle, how much is fat-free mass.

That's number one, but there's a lot of things that impact metabolic health as we're ageing. Number one is loss of skeletal muscle. The less skeletal muscle we have, the less insulin sensitive we are.

That skeletal muscle decline starts at 40. It's anywhere from 3% to 8% per decade. I would imagine if you have not been lifting and not been exercising, that skeletal muscle mass loss may be more significant.

To give everyone a visual depiction of what we're talking about, think about a fillet versus a ribeye. Now, equally yummy, right? One has a lot of fat and marbling, that's the ribeye.

The other is predominantly muscle meat. The muscle meat is young muscle. The sarcopenic loss of muscle mass is the ribeye.

We don't want to be the ribeye, so we want to actively work against this. Number one, loss of muscle mass will yield loss of insulin sensitivity. I always think of that as the first tip-off.

Number two is with less oestrogen in our bodies, we lose insulin sensitivity. Those are two things that tend to have a large net impact. Depending on the individual, some women may also have a loss of testosterone.

Testosterone can impact body composition quite significantly. I would add fourth to that, and I will loop this all back to the gut, is this stress resilience. We become less stress resilient.

When cortisol goes up, we tend to put fat deposition around our abdomen. We'll talk about truncal obesity. It doesn't have to be overt.

We have 40 times more cortisol receptors in our abdomen. When someone says to me, I went through a stressful period. I noticed I had body composition changes.

I understand that physiologically why that happens. Let's be very clear. This is that sandwich generation, as you astutely stated.

Our kids are getting older. Our parents are getting older. We're probably at a time in our careers where we have more responsibility.

I think for a lot of people, middle age is both wonderful and also stressful. I think we add that in. Then when we're looking at the gut microbiome and what's changing, we know that with a decline in hormones, we're getting alterations in insulin sensitivity.

We are getting alterations in inflammation. Some of that is a byproduct of changes in diversity. Think about it as there's different species of bacteria and other microorganisms.

It tends to become much more inflammatory. Just by virtue of changes in diversity, we have a reduction in short-chain fatty acids, which are important signalling molecules that help reduce inflammation. I mentioned the estrobilone.

The estrobilone is the oestrogen processing part of the microbiome. It's designed to help. The oestrogen gets broken down through the liver, ends up in the gut.

We're designed to break down with the use of an enzyme called beta-glucuronidase. Break that oestrogen down and poop it out. If we're chronically stressed, guess what?

We're going to recirculate that oestrogen. It magnifies all the effects. When I think about how many things about body composition are impacted by the health of the gut, that is at a very basic level.

It is literally everything. The gut is this main communicator with the rest of the body. Plus, when we are inflamed, we are sending inflammatory signals and cytokines and things through the vagus nerve, through the bloodstream.

I think about we're more prone to leaky gut, and leaky gut will provoke an immune response and then lead to underlying food sensitivities because we'll leak food particles into the bloodstream. There's many, many layers to shifts in body composition, not the least of which, I'm going to say this again, if we are not dealing with our underlying stress and trauma, that will absolutely contribute. If your body does not feel safe, and for a lot of women, they have subjugated their childhood experiences.

We know that based on research, individuals that had significant underlying trauma as a child, and we're not necessarily talking about big T trauma, we're talking about the more insidious little T trauma, neglect, abuse, substance abuse by a parent, etc., financial stressors, that puts you at greater risk for metabolic disease, greater risk for substance abuse, greater risk for autoimmune conditions. Once you've had one autoimmune condition, you're more likely to have others, and women are four to five times more likely to develop autoimmune conditions.

These are things like celiac, rheumatoid, lupus, Hashimoto's. You are four to five times more likely in perimenopause and menopause to be diagnosed with an autoimmune condition. I have four, all in remission, but it's because I do a lot to quiet my parasympathetic nervous system and support my body.

I think a lot of people do not necessarily think about body composition changes with gut health, but I would make the argument that if you're not thinking about what's going on in the gut, you're missing out on opportunities. There's a whole other conversation around keystone bacteria and things that can be impacted vis-a-vis these declines in beneficial bacteria, but I'll save that for another conversation because it can get a little bit in the weeds. There's a lot to body composition changes beyond being incredibly frustrating, unfortunately incredibly common, but they are not permanent per se.

I think that's one thing I want to make sure that I say is that these do not have to necessarily be permanent issues. There are definitely things we can do to buffer up against those changes that are happening.

[Angela Foster] (17:04 - 17:07)
What about belly fat? This is so super common.

[Cynthia Thurlow] (17:07 - 17:09)
Oh, yeah.

[Mary Claire Haver] (17:09 - 18:01)
That's what brought me to my knees. I've had thin privilege most of my life. All of a sudden, this new body composition change, so new accumulation of belly fat, this is an expected biological consequence of hormonal chaos.

If you do nothing different, you will slip weight to your abdomen. That's it. There's very few women who can get through menopause without this happening.

Now, is it inevitable? No. Is there stuff we can do?

Absolutely. It's more than cosmetic. No one wants a big tummy because the way we were socialised, that we all should look like 14-year-olds, but actually, the intra-abdominal fat is metabolically dangerous.

In our clinic, we have a body composition scanner, so every single patient leaves my office knowing how much muscle mass she has, how much total body fat, and how much visceral fat she has. We don't even talk about her weight. We don't care what she weighs.

[Angela Foster] (18:02 - 18:05)
What have you found are the best ways to shift the visceral fat?

[Mary Claire Haver] (18:06 - 18:52)
Yeah. That was the evolution of the Albertson diet. Anti-inflammatory nutrition is huge, so really, really focussing on whole grains, legumes, seeds, nuts, plants, heavily plant-based, as close to nature as we can get it, avoiding processed foods, avoiding simple carbohydrates as much as possible, not counting fruits and vegetables.

That's God's fruit. That's God's sugar, and that's usually fine because it comes with vitamins, minerals, nutrients, fibre. Very, very different than heavily processed foods where all the nutrients have been stripped away, and they're adding chemicals and all these things that disrupt the way we're really supposed to eat, making sure we're getting enough protein.

That really seems to turn the needle. Healthy fats can be amazing for satiety and helping people stay full longer.

[Angela Foster] (18:52 - 30:09)
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In midlife, the bigger issue is visceral fat and insulin exposure. And the fix is simpler than you've been led to believe. By the end of this video, you'll know the levers that move the needle, and I'll tell you how to get clarity on which one your body needs first with my biosyncing quiz.

You've probably heard my metabolism has slowed. It's menopause. Oestrogen is gone, so fat loss just doesn't work anymore.

Your experience is real, but in a lot of cases, we're blaming the wrong mechanism. And when you blame the wrong thing, you apply the wrong solution, and you stay stuck. So let's get clear on what's actually changing, what visceral fat is, and the levers that reliably work in midlife.

First, what changes in midlife isn't always dramatic weight gain. One of the most consistent findings across the menopausal transition is a change in fat distribution. Before menopause, women tend to store more fat in a gluteofemoral pattern, that is, the hips and thighs.

After menopause, storage often shifts towards the abdomen. And that shift matters because not all fat behaves the same. Subcutaneous fat, that's the fat under your skin, can be frustrating aesthetically, but it's not the biggest metabolic risk driver.

Gluteofemoral fat is also not really dangerous, and in some research, it's even associated with a more cardioprotective metabolic profile. The bigger concern is visceral fat. Visceral fat sits in and around your organs, and it can infiltrate them.

It's strongly associated with inflammation, insulin resistance, and cardiometabolic risk. That's the fat we care about reducing. And here's a nuance most women never get told.

You can gain visceral fat even if the scale doesn't move much. Some imaging research shows fat redistribution can happen even when body weight, and sometimes even waist measurements, don't fully tell the story yet. So if your body feels different, but the numbers don't explain it, you're not imagining it.

Now let's deal with the metabolism myth, because this is where a lot of women get misled. You've been told your metabolism collapses in menopause, but the best data we have doesn't support metabolism collapsing across menopause. In fact, when researchers measure resting metabolic rate and adjust for fat-free mass, your metabolically active tissue, it tends to stay fairly stable throughout midlife for most women.

Any meaningful decline often shows up later, and even then, it's not the dramatic cliff people make it out to be. So if it's not a broken metabolism, what is it? In many cases, it's total daily energy expenditure.

Not what you do in your workout, what you do the other 23 hours of the day. Across midlife, a lot of women move less, they sit longer, they have more life load, more deep work, more responsibilities, less incidental movement without even realising it. And that matters, because you can train three or four times a week and still have your overall daily output drop if your non-exercise movement quietly disappears.

Now we stack one more piece on top, because this is the part that makes belly fat feel stubborn even when effort is high. Insulin exposure. Visceral fat is tightly linked to insulin resistance, and insulin is one of the main signals that influences whether your body stores fat or releases it.

Here's the simplest way to think about it. When insulin is elevated for large parts of the day, your body becomes less efficient at mobilising stored fat. When insulin exposure comes down and insulin sensitivity improves, your body often becomes more responsive again.

This is why just try harder often fails. You can train harder and eat less, but if insulin stays elevated most of the day, fat loss can feel disproportionately difficult, especially around the middle. Let's do a quick self check-in.

If you wake up at 2 or 3am, run on caffeine, feel flat during the day, crave sugar in the afternoon, and sit for long stretches, even though you're training, you're a prime candidate for this pattern. Higher life stress plus disrupted sleep plus less daily movement plus worsening insulin sensitivity. So what actually works?

I'm going to give you five levers. They're not extreme, they're not punishment, they're the right things in the right order. Lever number one.

Break up sitting and rebuild daily movement. This is the multiplier. This one is underestimated because it doesn't feel like fitness, but it's one of the fastest ways to improve glucose handling.

Long uninterrupted sitting reduces insulin sensitivity, even in people who work out. So your target. Every 45 minutes, take a two-minute movement break.

Walk, a few squats, a quick mobility flow, walk up and down stairs, anything that gets your muscles contracting. Then add one more simple habit. Walk for 10 to 20 minutes after meals when you can.

That habit alone can noticeably change glucose and insulin responses for many women. This is one of the reasons midlife belly fat creeps in. Not because you became lazy, but because modern life quietly removes movement while your biology becomes less tolerant of that loss.

Okay, so lever number two. Prioritise resistance training. Three sessions per week.

Resistance training improves insulin sensitivity at the muscle level. Your muscles become better at pulling glucose out of the bloodstream with less insulin. That's a metabolic advantage.

And you don't need complicated programming. For most women, three full body sessions per week is enough to create a meaningful effect, especially when paired with more daily movement. Lever number three is to use HIIT strategically when your recovery can handle it.

HIIT, or high intensity interval training, has also been shown to significantly reduce abdominal fat in women. HIIT essentially means short bursts of intense effort followed by recovery periods. For example, 20 to 40 seconds hard, then 60 to 90 seconds easy, repeated for 10 to 20 minutes in total.

The key is to keep the overall HIIT session short. And when researchers zoom out and pull the evidence, meta-analyses that include dozens of studies show HIIT can significantly reduce body weight, total fat mass, and abdominal fat in women. Two rules so this helps instead of backfiring.

First, HIIT is a dose, not a lifestyle. One to two sessions per week is plenty. Second, if your sleep is already fragile, you're waking at 3am, or you feel wired and tired, start with walking and zone 2 training first, then add HIIT later.

Your nervous system has to be able to recover. Okay, so lever number four. Choose fibrous, whole food carbs, not no carbs.

This isn't about cutting carbs to zero. It's about changing the glucose curve. Vegetables, legumes, and whole grains in appropriate portions, slow glucose absorption, and blunt spikes.

That means lower insulin exposure across the day. And that is exactly the environment visceral fat responds to. If you want a simple rule, build your plate around protein and plants first, then add carbs based on your activity, your goals, and how your body responds.

Lever number five, sleep and stress resilience, because it's metabolic. This isn't Poor sleep and high stress worsen glucose and regulation and can prolong insulin responses to meals. When your nervous system is stuck on on, you're more likely to sleep lighter, wake up overnight, crave quick energy, move less, and see worse glucose control.

So part of reducing belly fat is improving your ability to down regulate your nervous system. That might be a walk outside, breath work, music, a short wind down routine, connection, and laughter. A hard stop on work.

Remember, you're not trying to be perfect. You're trying to give your biology a signal of safety often enough that it can recover. Now, this is a question I get asked a lot.

Where does faster training fit? If it does, faster training can be a helpful tool for pulling visceral fat for some women because insulin levels are typically lower in a fasted state. And physiologically, when you are in a calorie deficit, that can help to make fat more accessible.

This does not mean you need to punish yourself. It does not mean you need high intensity, and it doesn't mean that it works best for everyone. Here's how to use it without making it a religion.

If you feel good training fasted, start with something simple, a fasted walk, zone two cardio, or even resistance training if you tolerate it well. Keep it consistent, keep it moderate, and make sure the foundations are in place. Enough protein across the day, enough total food to recover, and resistance training so you're protecting muscle.

And if you don't feel good fasted, then have something small to eat first. You're not failing. You're choosing the version that you can sustain.

The point is, fasted training can be a useful lever to reduce insulin exposure and support fat mobilisation, but it works best when it sits on top of the other levers, not instead of them. So the takeaway is simple. Midlife belly fat is often less about a broken metabolism, and more about fat distribution plus insulin exposure, made worse by long sitting blocks, poor sleep, and a nervous system that never fully comes down.

And here's the part most women miss. The lever that matters most for you depends on what's driving your pattern. For one woman, it's sleep disruption and stress load.

For another, it's glucose swings and insulin resistance. For another, it's training that's too intense for her recovery right now. And if you keep guessing, you'll keep doing good things that don't work for your body.

If you're training hard, eating well, and still watching your waist thicken, I want you to hear this: you are not lazy, and your metabolism is not broken. Something else is going on, and once you see it, belly fat stops feeling like a mystery you can't crack.

So I called in four people I trust most on this, Ben Azadi, Dr Sarah Berry, Cynthia Thurlow, and Mary Claire Haver. Together we get into why cortisol parks fat right around your middle, how losing estrogen quietly reroutes fat from your hips to your belly, and why the exact same meal spikes your blood sugar far more after menopause than it did before. We go deep on the pieces most women never get told about, the muscle you're losing, the gut and estrobolome shifts, and the insulin exposure that makes this fat feel so stubborn.

Then I hand you the fix. My five levers, in the order that actually works, from breaking up long sitting to resistance training, smart HIIT, whole-food carbs, and protecting your sleep and stress. And I tell you honestly where fasted training helps and where it just becomes another way to punish yourself.

If you're a busy woman over 40 who's done with "eat less, move more" and wants to know which lever your body needs first, this one's for you

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WHAT YOU WILL LEARN

- Does cortisol cause belly fat in women over 40?

- Why does fat move to your belly during menopause?

- Is menopause belly fat caused by a slow metabolism?

- What is visceral fat and why is it dangerous?

- Can you gain visceral fat even if the scale doesn't move?

- Why do post-menopausal women have higher blood sugar spikes?

- How does insulin resistance drive stubborn belly fat?

- Does the gut microbiome affect body composition in midlife?

- How does breaking up sitting improve insulin sensitivity?

- Does resistance training help you lose belly fat after 40?

- Does HIIT reduce abdominal fat in women?

- Does fasted training help burn visceral fat?