FAQ Episode 84: Weight Loss for Women over 30

Healthy Habits for Women with Migraine

Apr 11, 2025

The curse of creeping midlife weight gain - and how to stop it

I’m going to take a different direction today. I know that subscribers to this substack are interested in practical strategies for managing and clearing migraine headaches. I also know from your comments that as a group you are interested in good health, daily vitality and smart decisions about managing the aging process. Going forward I will add to my weekly posts on migraine management some episodic columns about the “taking charge of your health” advice I give women (and men) in my integrative medicine practice, where I still see patients five days a week. I’ll keep bringing you my regular Natural Migraine Relief postings; this will be a little extra on the side.

One of the things I really love about Substack is how by regularly scanning the work of ~40-50 writers I discover insights that I would not have come up independantly. Each of us live in a world of our own, we really do. Your collection of connections, lived experiences and data collection-which for me is mostly reading…I discount info from TV by ~50%, gives a view of our shared reality that is unique. When someone collects and crystalizes that perspective in a Substack column-or any blog format for that matter, I get to briefly see the world through their eyes. That doesn’t mean I take their advice or beliefs to the bank, but it gives me more to consider in the “informed consent” process of pursuing life, well lived. I mention this because today’s posting was inspired by the synergy of one of these writer’s postings and my own daily clinical experience.

Exercise: one of the Core Four

I’m going to start with a theme that my own patients might roll their eyes over, since they hear me ask “what are you doing for daily exercise these days?” or my advice to “do something everyday to physically challenge your body’s comfort zone” at most every visit. One can define several versions of “what are the key elements of maintaining physical health,” and I would divide that into four parts: Nutrition, Exercise, Sleep/Restoration and Hydration/Detoxification. I’d like to take the next five minutes of your time to take what I hope will be a fresh perspective on the power of regular exercise to transform your health.

I recently read a substack column by “Vittorio” titled Minimum Viable Muscle: The Least You Must Do To Not Fall Apart. It might be summarized by his posing a question about “a pressing biological reality: what is the minimum effective dose (of exercise) required to prevent accelerated decay.” It echoes a comment often used by exercise trainers: “you’re never standing still. You’re either moving ahead, or you are falling back.” If you are nearing age 40-50, or beyond, you intuitively understand this. Up until ~age 40, what I call the “vitality of youth” allows you to seemingly slide by with lax self-care habits. But you will pay eventually, nonetheless, by becoming less than what you should be down the road, and at a time where making up for lost ground is harder to achieve.

How did I get here?

Women age 30-55 are the largest demographic of my practice. And one of the most common concerns I hear about is: “How can I lose weight?!! I’m not eating more than I was 5-10 years ago. I was 125 lbs, now I’m 150…what happened?”

Yes, hormonal changes happened, and that can be a big part of the picture. And the debilitation caused by a recurring or chronic disorder like migraines can take the wind out of your sails for effective self-care.

But mostly, what happened was a one day at a time transformation from the “fat burning machine” of your late teens, to the the “fat storing machine” we morph into as we approach and pass 40. The unfortunate and uncomfortable truth is that the daily cares of family and/or a career and etc. got in the way of a regular “minimum effective daily dose of exercise.” This allowed your muscle based calorie burning engine to be downsized and deconditioned. This drop in metabolic rate is said to be 1-2% per decade after 20. So at 40, a cumulative 4% drop in calorie burning doesn’t sound too bad, right? But let’s do the math: 365 days at ~1800 calories intake per day at 4% less efficient = 26,000 less calories burned per year. A pound of body fat is 3500 calories. So, a 4% reduction of metabolic energy (from 20 to 40) would add 7.4 lbs of fat per year at age 40 plus. Even a more optimistic “only lost 2% metabolic efficiency over 20 years” number would pack on an extra 3.7 lb fat per year. Per year. WOW! Let’s not even do the numbers for a 50 year old! While most of us can probably eat less and smarter, there’s obviously a limit to diet alone as a sustained weight loss or weight gain prevention strategy. We need to enhance our daily metabolic calorie burning capacity.

There’s no doubt that age related metabolic decline is somwhat inevitable, especially after 55-60, but let’s go on to discuss which parts can be remediated. For those of you readers still in your 20’s-early 30s, don’t tune out just yet, as this is your chance to get ahead of this curve.

It may not be fair, but its true

Let’s go on and add insult to injury to the aging thing. Let me pose a question for you: “if you (a female) and a guy you know both go on the same diet and exercise plan, who gets to lose weight first?” Yes, that’s right. There is and always has been only one right answer here. And its not right, but it is true. All he did was to quit eating junk food, showed up to the gym three times a week and lost 10 lb in 3 weeks.

Even though he probably did not follow the plan as faithfully as you, a guy:

1) almost certainly has more muscle mass than you

2) has vastly higher testosterone (anabolic hormones) levels than you, and probably due to this advantage also

3) has on the whole, a more fit muscle mass than you do.

This all adds up to a better calorie burning machine. So how can you get in on some of this action without trading genders?

Basic maintenance of your calorie burning machine

I’ll review four basic, non-negotiable factors you need to address to keep your motion and metabolism system in order. The first three were nicely reviewed in the Minimum Viable Muscle article referenced above. Here is a summary, with most of the first three points being primary material from that article1:

You must do Resistance/Strength Training at least twice weekly…Minimum!
-each major muscle group must experience mechanical tension at least twice weekly to maintain tissue integrity.
-muscle protein synthesis remains elevated approximately 24-36 hours following resistance exercise.
-two weekly sessions spreads this anabolic signal optimally to maintain continuous protein synthesis and muscle repair.
-falling below this twice-weekly minimum creates measurable consequences. Research shows that reducing training frequency to once weekly preserves only about 50-60% of strength gains, while complete cessation results in strength declining approximately 5-10% weekly. This means that taking several months at a time can erase a previous year’s gain. Unless you’re injured, don’t take time off!
Daily movement baseline
-research establishes the minimum daily movement threshold at approximately 22 minutes of moderate activity (exercise, chores, walking the dog, etc. Yes, even sex. Tell your partner you need at least 22 minutes and see what happens…)
-muscle contraction activates calcium-dependent pathways that upregulate glucose transporters independent of insulin. Without ongoing activation, these transporters rapidly downregulate, moving in the direction of insulin resistance within 48-72 hours of inactivity.
-walking represents the basic movement pattern, although even standing substantially improves metabolic markers compared to sitting.
You need a weekly intensity spike
-research consistently demonstrates that high-intensity effort creates adaptations that moderate activity simply cannot stimulate, regardless of volume.
-one weekly session approaching maximum effort, whether through heavy resistance training, sprint intervals, or high-intensity circuit work or a class will maintain mitochondrial function, anabolic hormone sensitivity, and cardiovascular capacity that otherwise deteriorate.
-even one single weekly high-intensity sessions maintains performance values, whereas moderate continuous activity alone results in gradual erosion of capacity.
-one weekly session approaching muscular failure preserves approximately 80-90% of strength adaptations, while submaximal training produces significantly inferior retention.
You deserve adequate anabolic hormone support
Although the medical profession pays little attention to female testosterone or adrenal function in one’s 30s to 40s+, these levels WILL drop, sometimes significantly during these years. I’ve found women in their late 30s who already had testosterone levels so low they did not even register (i.e. a Free Testosterone level with ‘normal’ typically a 1-4.5, and they were running “<0.2” or as I say: “so low we don’t even measure it that low.”)
Fortunately, both testosterone and adrenal markers like DHEA are not affected by monthly cycles, so they can be tested at any time. Unfortunately, we don’t know what your ‘prime of life’ numbers ran back in your 20s. Maybe your testosterone was at one time a 3.5 on the above noted 1-4.5 range and now you are at 1.3 According to many, you’re now “still in the normal range…you’re fine” despite dropping almost 2/3 of your previously healthy output.
Your testosterone may not be sufficient for your needs if:
-you’re easily fatiguable
-you aren’t able to gain fitness or muscle tone despite regular intense exercise
-you don’t recover well from from musculoskeletal injuries
-cognitive focus is diminished
-your sexual interest and responsiveness are down…even with a good partner
And this isn’t just a libido thing. Testosterone supports a full spectrum of passion expressivity, including creativity, curiosity and enthusiasm.
If this sounds like your story, please find a health partner who will test for and then if need be treat this as indicated. See my article FAQ Episode 78: Finding a local integrative minded doc for help on that journey.

Bottom line: Taking action to build your own calorie burning machine

“Going to the gym for five minutes may not improve your performance, but it reaffirms your identity.” -James Clear

While this isn’t the “ultimate guide” to shrinking fat and building muscle, if you will apply these action items, you can begin to correct the past and prepare for the future you with a 24/7 optimized metabolism. And four to eight less pounds of fat per year, down the road. I like the sound of that plan. Make it come together, with:

Strength training for each major muscle group twice per week…minimum. (!!)
Daily movement threshold of approximately 22+ minutes of moderate activity.
One weekly session of maximum effort, through heavy resistance training, sprint intervals, or high-intensity circuit work, a group class, etc.
Consider checking, and when indicated, supporting and optimizing your healthy and natural female appropriate androgen hormones. Effort without effective hormone support = fatigue, injury, lack of progress and feeling hopeless. Don’t be that girl!

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