ZOE nutritionist Dr. Federica Amati explains why basal metabolic rate barely changes in perimenopause, but postprandial metabolism does, glucose, fat, insulin, and inflammation stay elevated longer after meals, partly via gut microbiome shifts. She unpacks why “thin” can mask sarcopenic obesity, why calorie labels carry ~20% error, why a nutrient-dense breakfast curbs cravings, and why a 70,000-woman ZOE study saw a 35% symptom drop from diet changes alone.
WHAT YOU’LL LEARN
– Why basal metabolic rate isn’t the problem in perimenopause, but postprandial metabolism is
– What’s actually driving new midsection fat storage as estrogen declines
– Why calorie counting fails as a long-term strategy, from label error to the food matrix effect
– How satiety hormones like GLP-1, PYY, and GIP shift after menopause, and why breakfast is the highest-leverage meal of the day
– Why looking thin doesn’t mean you’re metabolically healthy, and what sarcopenic obesity reveals about muscle as an organ
– What HRT actually changes about your metabolism, muscle mass, and visceral fat, and what it doesn’t
– How a 70,000-woman study found a 35% drop in menopause symptoms from diet changes alone, and why brain fog improved most
TIMESTAMPS
00:00 – Why Perimenopause Changes Body Composition Even When Nothing Else Has Changed
08:00 – Inside ZOE’s Age-Matched Study: Why Postprandial Metabolism Shifts After Menopause
16:00 – Same Meal, Different Response: Satiety Hormones, Carb Cravings & Why Under-Eating Backfires
25:00 – Weight Set Point, Calorie Quality & the Sarcopenic Obesity Trap
34:00 – Why Calorie Counting Fails: Label Error, Nutrient Absorption & the Food Matrix Effect
40:00 – The 70,000-Woman Study: A 35% Symptom Drop From Diet Alone (and Why Breakfast Matters Most)
45:00 – What HRT Actually Does (and Doesn’t Do) for Metabolism, Muscle & Visceral Fat
52:00 – Building Your Metabolic Buffer Before Menopause in an Obesogenic World
VALUABLE RESOURCES
– Dr Federica Amati’s new book: The Appetite Reset
How appetite really works, what GLP-1 medications are actually doing in the body, and how to eat to support your natural appetite signals, on medication or not.
👉
– Follow Dr Federica Amati on Instagram:
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ABOUT THE GUEST
Dr Federica Amati is a medical scientist, Association for Nutrition registered nutritionist, and Head Nutritionist at Zoe, where she leads research on nutrition, gut health and disease prevention across the life course. She holds a PhD in Clinical Medicine Research from Imperial College London, where she also teaches.
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If you want to see how to actually apply Dr. Amati’s nutrition advice into a daily routine to fix your metabolism over 40, check out my step-by-step masterclass on the 7 science backed steps I took to get a flat stomach at 50 here – https://www.youtube.com/watch?v=o5Jg_GMxypc&t=2s
I could listen to Dr Amati all day! She is so full of knowledge and explains things well without being condescending.
You definitely speak my mind! At the end of the day, it is about how you feel in the inside from what you do, rather than just doing what you are “ supposed to do” just for the sake of doing it because the “ experts” say so! I am now far more skeptical about experts advice and so- called “ science”. Wait another 10 years, and probably 50% advices now would be incorrect and the scince will state something completely opposite!
When I hear this vegetarian and low fat dogma I really wonder if these researches have been under stone during the last 10 years! Educate yourselves already!listen to Nick Norwitz for example!
I was eating a lot
Of nut butter since i dont eat meat a lot. But i dont know if that contributes to my weight gain in menopause . I used to eat a lot of nut butter when i was younger. So now i measure my nut butter
I was fasting a lot but i dont think it works for me. I think im going to eat earlier.
Why can't you talk to the point..unnecessary long talks.
Not everybody can eat in the morning, because I myself had no appetite in the morning actually
Lots of things were said. But I don't know what was said
I like the reminder that food quality provides nutrients or lack of – Not just calories – well help regulate appetite, what you crave etc
Now a days everything known and common are labeled as a researched studies
I’m a professional video editor and YouTube thumbnail designer. I really liked how you discussed why eating less makes perimenopause weight gain worse and how nutrition affects metabolic health in such a clear and engaging way. I’ve created an alternative professional thumbnail specifically for this video that I’d love to share with you. What would be the easiest way to send it for your review?
I'm 44 this December and think I'm just back and forth with premenopause right now …. Just gained 7 lbs in a month …no fair but I'm putting effort in till I absolutely can NoT ne more
Not true. I look fine as ever.
Why is it so complicated to listen to women’s podcast. I find it that male doctors are straight forward when explaining things. Always direct to the point to where the problem and then provide the solution.
Thank you!!
I can't. My stomach looks like I'm pregnant. So I look great from top to bottom except my damn stomach. I can't wear anything I used to wear coz I look like shit. Help like someone plz give me advice. It's not about losing weight it's just that damn stomach
Sharing! Thank you ! The six pillars! I’m on to this!
Honestly iv been skinny almost all my life and even after my kid it's been 24yrs I still lose weight at the drop of a hat due to high metabolism but I don't smoke drink once in a while and don't eat meat the basic things make all the difference and walk a lot and do yoga and breathing excercise I'm perimeno now no weight gain just keep the basics clean
I’m a professional video editor and thumbnail designer. Loved High Performance Health’s conversation with Dr. Federica Amati on why severe caloric restriction makes perimenopause weight gain worse—especially unpacking ZOE’s research on postprandial metabolism and gut microbiome shifts, explaining how estrogen decline impacts fat distribution and blood sugar/lipid clearance, highlighting the danger of losing lean muscle mass versus visceral fat, and emphasizing nutrient-dense whole foods, robust breakfasts, and the six foundational pillars of lifestyle medicine. I actually created a custom-made thumbnail specifically for your video to help it stand out and get more clicks. What would be the best or easiest way to send it over to you for review?
Just a question for the ladies saying the lift weights but keep gaining weight….what are the pounds of weights you’re lifting?…and how many reps?…I am a fitness instructor that’s 45 and I see women over 40 using 5lb or 7lbs…
I started at age 35 years old storing fat and began changes
My mother's genetics is a very strong reason of why I stored fat from my abdomen to my hips. At 41 I lift weights, eat within my deficit, move everyday and adequate sleep. No matter what I do, the genes are unbeatable. I notice some changes but everytime I look at my mid section, I know it is genetics. It's going to take years before I could achieve the look that I aim for. For now I just have to live with it and train consistently. Genetics plays a huge part, no matter what the experts say.
I did the eat less thing for months 😩 smaller portions, skipped meals, still gained around my belly like crazy. Felt like my body was fighting me no matter what. Dr said it was normal, gave me nothing. Then a woman in a hormonal group mentioned the Menopause Transition Playbook by (Lisa.Grant) and it just clicked, it wasn’t about eating less but timing food right. 27 lbs down, bloating gone, energy back. Weird how quiet this info is kept.
THIS is one of the BEST interviews I've watched. Data backed information shared with such clarity and compassion. Made me quite emotional at the end, because Dr Amati's understanding of the real world struggles we face and highlighting all the things that can be done to help maintain and build health during such a destabilising change, has given me some much needed hope. This is the first time I don't feel doomed to deteriorate. Thank you Xx
Why do i feel like this at 35😫😣
Bs.
Stress!
Yeah I put on weight my boobs even Katie price be jealous ridiculously big they are
Set point is a disproven pseudoscience
I'm 44 and have been the same size since I was 15yrs old. Maybe it's my genetics but I have never really fluctuated in weight. My whole family are similar. The only time in my life I started having health issues was getting sucked into the wellbeing industry. Now I prefer to eat normal home-cooked good quality food. Like in the Blue Zones. I like their attitude towards life.
For me as an MCAS patiënt, skipping breakfast when I feel the power to do so, is the easiest option for balancing my insulin and grelin levels throughout the day. This even has a positive impact the day after. Insufficient sleep is the biggest driver of overheating. Whatever happens in terms of sports and activity, losing weight will not happen. Not without hormone medication at least.
I think it’s a mistake to dismiss what women are saying about weight gain after 40. So many of my friends say that losing weight since turning 40 is harder. I had 3 kids. The baby weight was so easy to lose for the first two. A couple of long distance runs a week, no change in (my vegetarian whole food) diet and the weight melted off. However after my 3rd child I ran, I weight trained and did yoga and NOTHING. The weight stayed on. That is not in my head. Things changed. I was not eating more junk, it’s patronising to say so.
I haven’t gained a pound through perimenopause nor now in menopause. Gained not a pound and still slim.
So women are eager to get married in their 20's-30's, so that they may have extra responsibilities in their 40's? Something is not right.
Breakfast is the most pointless and needless meal of the day. I lost almost 14 pounds by skipping it for the last 5 weeks. I could eat what I wanted just not in the morninga, and a small option before 6:30. Mental clarity in proved as has my sleep.also ladies you must go for a long walk at least a few times a week
Over 40 here. My weight has not adjusted back to its 'normal' weight of 75KG in a long time now……
Soon to be 46. I don't even know if I'm perimenopausal 😅. But I've changed my diet and do weights at home. I've lost 6 kg since. I just gained weight over the winter and wanted to lose that annoying fat.
Sleep
Nutrition
Movement
Social circle
Stress Mgmt Toolkit
Avoiding smoking drugs alcohol
ok
yes
ok
I literally starved myself on 1200 calories and still gained weight 😩 my belly kept expanding no matter how little I ate, and my doctor just told me to "try harder." I was so exhausted and hopeless. Then in a hormonal group someone mentioned the Menopause Transition Playbook by (Lisa.Grant). Gave it a shot and 29 lbs melted off naturally, sleep restored, and no more starving. Crazy how hidden this is, more should know about it.
I feel like it is mostly related to stress. Menopause seems like it would be stressful.
It is true. I improved my diet and began excersise again at 44 after neglecting my physical health for several years. At 47 I have never felt better. I was not overweight before. I looked ok, uk size 10-12 but felt rubbish. Perimenopause symptoms improved massively since making small changes. I lost 4kg but have a lot more muscle. Still wear size 10.
This is complete bullshit. I have lost a ton of weight since perimenopause and now menopause. I also have kept it off. I look WAY better than I ever have. It’s the same old thing, work out everyday, eat clean. ♥️
If I eat breakfast I continue to eat on the day. If I skip breakfast o am more disciplined. So, no breakfast for me.
Are post menopausal women also less active and less likely to lift weights? If they’re eating more ultra processed and sweet things, despite not admitting to changing their diet.