If you've ever felt the shock of standing in front of the mirror and not recognising the body staring back at you, you already know that doing battle with middle-age spread is as much psychological as physical.
Changes to our bodies in our middle years can trigger a real bereavement process for the loss of youth. Once upon a time, realising that you had put on a few pounds was a catalyst for getting fit and healthy, but later in life, when the weight gain feels inevitable regardless of what you do, doing nothing becomes all too easy.
Dee Johnson, a psychotherapist at the Priory Hospital Chelmsford in the United Kingdom, explains that so-called "psychological blocks" to weight loss in midlife can involve - consciously or unconsciously - giving up on ourselves.
"A common response to that fear and anxiety is to avoid what is happening and so the self-neglect slips in," she says. "Motivation goes, and often at this time of life the pressures of looking after others mean we fall to the bottom of the list."
So it can become "normal" not to pay attention to our own welfare. This can then lead to a misconception that it is simply "too late for self-care".
Johnson believes that we need to ditch the negative notion that reaching your 50s means giving up caring for your appearance and health - and most importantly, staying active. "Weight loss - or maintaining a healthy weight for you - should always go hand in hand with our emotional wellbeing," she says. "Whatever our age."
Yet, there are unavoidable physiological changes that need to be considered with middle-age. But forewarned is forearmed.
In our 40s the levels of hormones that maintain muscle mass tend to decrease. Age-related muscle loss, called sarcopenia, is a natural part of ageing, with most men losing about 30 per cent of their muscle mass during their lifetime.
Since muscle is highly active tissue that burns a lot of energy (even when we are just lying around), losing muscle as we age makes it much more likely that we will gain weight. As Dr Michael Mosley explains: "Unless we do resistance exercises we typically lose three to five per cent of our muscles every decade after the age of 30."
Mosley - who has presented health-related TV programmes and is credited with popularising the 5:2 diet, which involves intermittent fasting - says these changes are most obvious in women, where going through the menopause leads to a fall in oestrogen levels and a build-up of fat, particularly around the tummy.
Estradiol is the form of oestrogen that regulates metabolism and weight. A decrease can change how fat is distributed around the body, causing a woman to gain more in the belly as opposed to the hips, thighs and buttocks - though Mosley adds: "Men also see hormonal changes, with a fall in testosterone levels leading to more belly fat."
Some of us are blessed with genes that make us less likely to succumb to middle-age spread. But consume more energy than you burn and you're likely to see increased belly fat, no matter what.
Your first reaction might be to put on your trainers and head out to pound off the pounds, but, says Mosley: "It will be a lot easier if most of the heavy lifting is done through dieting. You would have to do a huge amount of exercise to burn through enough calories to lose that much weight." Yes, you can tone up - you will look better and feel good - but you probably won't drop a significant amount of weight.
This is something that he attempted to demonstrate in his 2020 television series Lose a Stone in 21 Days with Michael Mosley. His conclusion was that it really is possible to lose a lot of weight in a short period of time with a rapid weight-loss keto diet - not that a keto diet, with its emphasis on low carbs and high fat, will be to everyone's taste.
Mosley says that the most effective approach, at least in the short term, is to significantly cut back on carbs. "If you reduce the carbs you eat to less than 50g a day then you will go into a state of ketosis, where you start burning through your fat stores," says Mosley. "One of the big advantages of ketosis is that it suppresses production of the hunger hormone, ghrelin, so you don't feel ravenous."
This includes all carbs, including the healthy fibrous ones such as vegetables, legumes - chickpeas and lentils - and wholegrains, such as barley, oats, buckwheat, and rye.
Such a strict approach won't suit everyone but if you're determined to lose a stone, Mosley says research shows that the best way to do so, and keep it off, is to start with a low-calorie, low-carb diet, and then gradually increase the carbs and calories until you are no longer losing weight.
And while extremely restrictive diets will help you to lose weight quickly, the risks to wider health cannot be ignored. Cricketer Shane Warne recently died from a suspected heart attack, days after completing a strict detox diet.
Take a Mediterranean approach
"After you have lost the weight, I recommend sticking to a lowish carb Mediterranean-style diet, rich in oily fish, nuts, vegetables and legumes, and with occasional treats, as this has been shown to be the best diet for long-term mental and physical health," says Mosley.
For nutritionist Rhiannon Lambert, a Mediterranean diet has an added effect that can get lost in the conversation about weight loss. How happy you are.
Sitting down to a regular Sunday roast with family, where you enjoy social interaction - the kind that goes hand in hand with a Mediterranean lifestyle - could be more effective than staying at home on the gruel. "We have good research that says more social interaction around meal times is healthy for you as well."
In contrast to Mosley's exacting approach, Lambert favours a holistic one that looks at sleep, gut health and how you eat. When it comes to weight loss, she prefers slow and steady, without affecting your set point weight - the level at which your body decides whether to hang on to or burn fat.
"Remember you're an individual. Have you lost a lot of weight to get to this point? Have you put on a stone? What is your job? What is your relationship with food like?"
Lambert's concern is that if you're not in a good place with food, then how can you lose the weight and keep it off?
Sometimes it's about being realistic regarding your goals.
"It can be easy to pick the number that's the lowest you've been in your life and then aspire to that. The problem is that you were younger then and now have less muscle mass. Then there are hormonal fluctuations. Your body is meant to change."
Maintaining a calorie deficit is one of the most ubiquitous pieces of advice when it comes to weight loss. However, Lambert says that the calorie content of food labelling is about 30 per cent inaccurate. "And based on a calculator that's 120 years old."
We don't all absorb calories in the same way. "We're unique human beings, so someone might absorb all 100 calories of a pack of crisps. Someone else might absorb 70 per cent."
Count calorie quality
In her book The Science of Nutrition, she explains that it's about the quality of the food, not just the amount of energy it contains. "Avocado toast is more nutritious than a cheese sandwich, but it has more calories," she says as an example. So make sure the calories you take in come in the form of healthy whole foods.
Try changing the carbs you eat from white to brown. "Try bulgur wheat and quinoa, or different rices." Lambert recommends incorporating more pulses and legumes, which contain iron, fibre and protein. "Aim for 30g a day, the recommended amount. In the UK we're only hitting around 17 grams."
A higher fibre intake has been linked to a lower risk of belly fat. Although it's not understood why entirely, studies show that people who consume more fibre have a greater variety of gut bacteria, which can impact how we process food, as well as other biochemical reactions, thereby influencing weight loss.
But, warns Lambert, don't do it overnight. Build your way up slowly so that your stomach gets used to the amount of fibre. "Try having porridge in the morning instead of white toast. Weetabix, or overnight oats are great if you're time-poor."
Hydration is also key. Lambert recommends six to eight glasses of water a day - this will curb cravings. But take care to avoid the extra calories of fruit juices and milky drinks.
"If your aim is body-fat loss, you're better off having a black coffee with a dash of milk than a latte."
Similarly, cutting back on alcohol will affect your waistline. Men and women aged 55 to 64 are the most likely age group to drink more than the recommended maximum of 14 units of alcohol a week. That routine half-bottle with dinner is doing midlifers no favours.
"You could easily consume 250-350 calories extra a meal depending on whether it's a small, medium or large glass of wine," says Lambert. "Many of my clients use it as a stress-relieving tool every night. So encouraging them to drink moderately and only at the weekend is still a huge achievement."
Saving your favourite tipple for Friday and Saturday night will mean better weeknight sleep, improved digestion and better metabolising of food.
A lack of sleep may also affect the body's regulation of the hormones ghrelin and leptin, which are thought to be central to appetite. Ghrelin promotes hunger, and leptin contributes to feeling full. In one study, men who got four hours of sleep had increased ghrelin and decreased leptin compared to those who got 10 hours. This might explain why sleep-deprived people also tend to reach for high-fat, high-calorie foods. Most adults should aim for at least seven hours of uninterrupted sleep per night.
Adopt healthy routines
Take time to check in on your habits and look at whether they are helping or hindering you to lose the weight you want to. Are you frequently eating while also consuming TV or other media? Mindless eating can easily lead to overeating.
One quality Lambert recognises in people with stable weight is that they have set meal times. "They're often breakfast eaters, and they probably sit down at a dinner table, or are opting for the right things when they're on the go. They probably stay hydrated and maintain good gut health. They are a lot less stressed and sleep well."
So while it can be tempting to think that restriction is the only way to shift those unwanted kilos , rethinking the big questions can make the difference.
"Ask yourself how you feel when you eat food. Are you satisfied versus feeling full? Once you master that it can be life changing."
The best exercise for midlifers with five kilos to lose
"Evidence suggests that people who regularly exercise are able to maintain weight loss. This is partly because increased muscle ratio boosts your metabolism and increases your calorie burn, but it's also because exercise also lifts the mood, which means less binge-eating and feeling low," says physiotherapist Katie Knapton, founder of PhysioFast online physiotherapy.
"Fat in itself can cause inflammation and joint pain (not just due to the increased load, but also because it releases cytokines, the body's inflammation response). Losing fat could eventually help to ease joint pain, allowing you to exercise with more ease. Putting in the work now means you will be fitter, more active and more able to maintain a healthy weight in years to come."
We lose muscle strength, mobility in the joints and bone density as we head into our 40s. Women are especially susceptible to these changes due to the reduction of oestrogen (a hormone that directly affects the function of musculoskeletal tissues) associated with the menopause.
However, regular resistance training helps to mitigate the loss of the muscle we need in order to boost our metabolism and burn calories. It needs to be done at least two to three times a week and does not necessarily require gym equipment - think body-weight exercises, such as squats and press-ups. As you get fitter and stronger over time, more advanced load-bearing exercises with barbells or dumb-bells can be introduced. Be aware you may not see your weight tumbling: muscle weighs more than the fat it replaces.
Change it up
Try alternating your cardio exercise, and gradually increasing reps and weights in your resistance training. Variety helps your body to be able to respond to different demands requiring endurance, resistance and flexibility. Bodies adapt, so if you run 5km twice a week and do nothing else, you'll plateau. With variety, you're also less likely to either injure yourself by overloading one area or become bored and lose motivation.
Mix up muscle-building resistance training with cardio to efficiently burn fat. Cardio alone burns calories by boosting your heart rate, but to really see a significant difference needs to be paired with two to three strength-training sessions for the reasons outlined above.
Your cardio exercise could involve running, dancing, tennis or brisk walking. This activity needs to get you out of breath, increase your heart rate and engage your muscles in order to burn calories and shift extra weight. A gentle stroll won't wash.
Start slowly and take your time
If you're starting out from no exercise at all, start slowly to avoid tissue overload, injury and pain. Soft tissues, muscles and joints need to be given the chance to adapt to increasing loads and demands gradually. Be realistic - some change can occur in six weeks but you'll notice more of a difference after 12 weeks. Every extra 10 minutes being active can make a difference, so setting achievable actions and goals is sensible.
Go easy on the joints
If you suffer with joint pain, swimming is a great low-impact exercise to introduce into your regular routine. The water helps to support your weight and provides gentle yet consistent resistance for your efforts. However, as with any form of exercise, for a really effective calorie burn you need to put some honest effort in. If you are not naturally a confident swimmer, invest in swimming lessons, or try aqua aerobics - which can be done in shallow water for maximum reassurance.
How that extra stone could affect your health
Over-50s are more likely to put on weight. This is because lower levels of oestrogen lead to loss of muscle, which leads to a lower metabolic rate. As a result, in midlife, we need to pay attention to both diet and physical activity. Here are some of the health implications:
There is a strong link between weight and blood pressure. More blood is required to circulate through the body, putting more pressure on the arterial walls. In addition, adipose tissue (body fat) releases hormones and inflammatory compounds, which lead to salt retention and stimulation of the "sympathetic nervous system" (the system involved with our stress response).
Obesity is linked with high cholesterol and unhealthy blood fats called "low density lipoproteins", particularly if the fat is deposited around the waist. A high-calorie intake, with too much saturated fat and refined carbohydrate (sugar and starch), increases the level of circulating insulin, and thereby contributes to both obesity and raised cholesterol.
Some people, due to a combination of genetics, unhealthy diet, and/or lack of exercise, are prone to carry fat around their organs, known as visceral fat. This is particularly unhealthy as it is readily metabolised by the liver, causing unhealthy fats to circulate in the blood. Unhealthy fats have a lower density than healthy ones, meaning that they are more likely to adhere to the lining of arteries, causing narrowing and potentially leading to blockage. This increases the risk of heart disease, strokes, and peripheral arterial disease. Ideally one should have a waist/height ratio of less than 50 per cent. This is easier for those with a "pear" rather than "apple" shaped body.
Other health considerations
Carrying excess weight increases the risk of insulin resistance, potentially leading to type 2 diabetes. Being overweight also increases the risk of many types of cancer (notably breast, bowel, womb, and pancreas), heart disease, strokes, gall stones, gout and sleep apnoea. The increased risk of cancer is due to the fact that fat cells produce growth hormones and inflammatory chemicals, which cause cells to divide more often. Fat cells also produce oestrogen, potentially increasing the risk of cancer in hormone-sensitive organs, such as breast and uterus.
The Telegraph UK