Hidden Causes of Weight Loss Resistance for Midlife Women
Every week, I meet women who are doing everything “right”—they’re tracking every bite, doing the workouts, skipping the wine—and still… nothing. The scale won’t budge, their pants don’t fit, and they’re exhausted from trying.
So what do most women do?
They blame themselves.
“I just need more willpower.”
“My mom struggled with her weight too.”
“This must just be how it is now.”
Eventually, many women reach the same point: they give up. I call it F-it syndrome—when you feel so defeated that you stop caring altogether. Because what’s the point, right?
Here’s what I wish more women knew: weight loss resistance in midlife is rarely about calories in, calories out. It’s not about willpower. It’s about physiology.
If you’ve hit a wall, it’s time to look deeper. Below are three of the most common hidden causes I see in women 40+, and what to do about them.
Today, I want to tell you what the hidden causes of weight loss resistance are.
1.Hormonal Imbalance
Our hormones don’t just regulate our periods—they’re the master conductors of our entire system. And when they start shifting in midlife, everything feels harder.
Two of the most important players for metabolism are estradiol and cortisol.
Estradiol
Our estradiol levels start to decline after age 35 and estradiol plays an important role in regulating our metabolism. As this hormone gets lower, our body’s ability to regulate glucose levels starts to decline. Women with lower estradiol levels are also more prone to storing fat – especially in their midsection.
There are lifestyle factors that can help to combat depleted estradiol levels. These include eating a nutrient-rich diet and making sure you are getting adequate amounts of key vitamins (such as vitamin B, vitamin D, and DHA/EPA). There are also certain supplements that can help keep your estradiol levels in check (like vitex and maca). However, estradiol decline is going to happen no matter how healthy you are, and at some point, you may decide the best thing to do is hormone replacement therapy (after careful evaluation of the risks and benefits and discussion with your provider).
Cortisol
Cortisol gets a bad name - we actually need it. However, it needs to be secreted in a rhythmic pattern - highest in the morning, and steadily declining to it’s lowest in the evening and overnight.
Cortisol imbalance can impair insulin sensitivity, which can lead to insulin resistance and pre-diabetes. It can also obstruct our hunger signaling by reducing our body’s sensitivity to the hormone leptin. Ever find yourself grazing in the pantry after a stressful event like you’re in a trance?
Here are some of my recommendations for combating cortisol imbalance:
Prioritize sleep. The most important person in this life is you - and you need sleep.. Reverse engineer your days so that you can guarantee enough sleep (whenever possible). You need to make time for consistent, deep sleep in order to have balanced cortisol levels.
Fix your circadian rhythm. I recommend getting direct sunlight within the first hour of waking and getting daily dusk light after dinner. You should also be putting away blue light-emitting devices several hours before bedtime. I know putting the phone down after a long day can be challenging, but trust me when I say your cortisol levels will thank you.
Manage your stress levels. Easier said than done, Emily! I get it. Trust me, I have four kids and a very busy life, and life is just stressful sometimes. However, you need to set aside time each day to focus on your mental health and bring down stress levels. This might mean deep breath work, meditation, playing with your children (unless you need a break from them!), a 15-minute walk, or a break in the sauna. Whatever it is that makes you feel more at peace – make time for it.
2. Metabolic Dysfunction
By the time we’re in our late thirties and forties, many of us are developing low-grade insulin resistance—even if we’re not technically diabetic. In fact, nearly half of U.S. adults are insulin resistant, whether they know it or not.
When this happens, your body becomes less efficient at processing glucose, so instead of using it for energy, it stores it as fat. This is especially common in women with midlife belly weight that seems stubborn no matter what they do.
Here’s how I approach it:
Follow a high-protein diet. Aim for 100g a day minimum—but ideally 1g per pound of your ideal body weight. So, if your target weight is 135 pounds, you should be trying to consume 135 grams of protein each day. Protein keeps blood sugar stable, reduces cravings, and supports lean muscle. It’s a metabolic powerhouse. It slows down digestion, makes you feel full, and slows your glycemic response (how much your blood sugar jumps when you eat).
Try time-restricted eating. This does not mean skipping meals – passing on a nourishing, high-protein breakfast is one of the worst things you can do for your metabolism. Instead, this means eating within a certain window. I recommend that women wait at least an hour before eating breakfast and also not eating dinner too late into the evening (we want plenty of time to digest before bed). Most importantly, I advise against extreme intermittent fasting, such as not eating anything until the afternoon.
Pick up the right exercise routine. Strength training (especially with heavy weights) is one of the best forms of exercise for balancing your blood sugar. While some women benefit from occasional intense cardio sessions, such as HIIT workouts, I do not recommend making it your go-to exercise. Instead, incorporate strength training and regular walks into your routine.
3.Inflammation
Chronic, low-grade inflammation underpins nearly every modern health condition—including weight loss resistance.
This is the invisible stuff—the low-level gut issues, environmental toxins, stealth infections—that keep your system in a constant state of alert. And when your body is inflamed, it doesn’t want to let go of fat.
Here’s what I recommend starting:
Gut issues. The best place to start with gut imbalances is an elimination diet. Start with a gentle elimination diet to figure out which foods support you and which inflame you. Add in a high-quality probiotic and focus on anti-inflammatory foods like berries, greens, salmon, and olive oil.
Toxic overload. We are exposed to so many chemicals and toxins each day. I know it can be overwhelming to know where to start, so I recommend starting small. I love using the Environmental Working Group database (*insert EWG link) which provides ingredient hazard scores for household items and beauty products. Get rid of any items in your home with high scores now and slowly start removing items with medium-level scores over time. Eliminating alcohol, sugar, and smoking from your lifestyle is also going to make a huge impact.
Mold exposure. This is a common inflammation trigger that many people aren’t aware of. Make sure to get plenty of fresh air each day and use an air filter in your home. I also recommend a home inspection for some clients who are dealing with chronic fatigue, thyroid issues and sensitivities.
Chronic infections. Many of us are suffering from infections that have gone undetected for years (or even decades), such as H. pylori and Epstein-Barr. I recommend working with a functional medicine provider who can test you for the most common culprits and has experience treating them.
I find that it tends to take a bit longer for women who are limited by systemic inflammation to start losing weight than those only dealing with hormonal or metabolic issues. It can feel complex at times and can require pretty big shifts in our daily habits and environment. However, making consistent changes in your day-to-day life can make a world of difference.
The Bottom Line
Weight loss resistance is not about laziness or lack of discipline. It’s about biology.
And while midlife changes are inevitable, suffering is not.
When you address the real root causes—hormonal shifts, metabolic slowdowns, and inflammation—you stop fighting your body and start working with it. That’s when things get easier. That’s when you start to feel like yourself again.
If this resonates, you don’t have to figure it all out alone. My team at Aurelia is here to help you map a plan that’s tailored to your body, your goals, and your life stage.
Ready to get unstuck?
If you’re struggling to lose weight, and my approach resonates with you - reach out. We’re currently accepting clients in several states in our medical weight loss program. Find out more here. And set up a call with me and my team here.
Sources:
https://pubmed.ncbi.nlm.nih.gov/34473288/
https://pubmed.ncbi.nlm.nih.gov/36419765/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10141000/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8707429/
https://pubmed.ncbi.nlm.nih.gov/21184659/