Visceral fat

Visceral fat is fat stored deep inside your tummy, packed around the liver, the gut and the other organs.

Doctors rarely say visceral. They say central adiposity, central obesity or weight around the middle.

You cannot feel visceral fat itself. You see it in a waist that thickens while the rest of you stays the same, and in clothes that close everywhere except the middle.

The British Menopause Society suggests measuring your bust, waist and hips and noticing how clothes fit, not just using the scales.

Women's Health Concern says that before perimenopause weight gain tends to spread more evenly, and that as estrogen falls the body becomes more prone to laying down fat inside the abdomen. The British Menopause Society's clinician tool puts numbers on it: visceral fat rises from 5 to 8 percent of body weight to 10 to 15 percent as estrogen drops.

Muscle goes too. Women's Health Concern and the British Menopause Society both say lean muscle falls with age, and metabolic rate slows with it.

Then comes the part that matters for us. The NHS website says people from a South Asian background are at risk of health problems at a slightly lower BMI. The British Menopause Society notes that South Asian women have a higher rate of central obesity, insulin resistance, diabetes and high blood pressure during the menopause transition. A woman who is "not fat" by the chart can still be carrying the fat that counts.

• The NHS website: "You should try to keep your waist size to less than half your height." It suggests the NHS waist to height calculator if your BMI is under 35.
• The Pakistan Menopause Society asks doctors to record weight and, preferably, waist size at the menopause visit (Table 2), and to consider blood sugar and cholesterol tests according to age, risk and cost (Table 4).
• For food, it names sweetened drinks and colas as drivers of central obesity, and encourages dals, legumes, fish, eggs, saag, methi and makkai ki roti (Table 5). Women's Health Concern says refined starches such as white rice and white bread can be part of a healthy diet and need not be avoided, though more wholegrain is the aim. More in nutrition.
• For movement, it lists regular aerobic activity such as brisk walking, plus strength exercise using body weight, free weights or bands (Table 6).

The British Menopause Society says there is high-quality evidence for eating fewer calories with more exercise, including strength exercise, which reduced waist size and body fat in perimenopausal and menopausal women. It calls strength exercise almost non-negotiable for women who want to change their body shape. Strength training explains how to start.

On HRT, Women's Health Concern says there is no evidence it causes weight gain. The Menopause Society says HRT may help limit the fat and weight that build up around the menopause transition, but rates the evidence as limited and the effect as small. Weight management covers diets, fasting and the NHS weight programmes; weight loss medicines are a conversation for your doctor.

The NHS website suggests seeing a GP if your BMI is in the overweight range and your waist is more than half your height. With the lower BMI bands for South Asian people, that can include a woman nobody would call overweight.

Ask for blood pressure, blood sugar and cholesterol checks if your waist has grown, especially with diabetes or heart disease in the family. The NHS website also lists fatty liver disease among the health risks of carrying too much weight.

Comments about a growing stomach come free at every family gathering, and most get the cause wrong. This is a change in where your body stores fat, not a failure of discipline.

Women's Health Concern does not recommend fasting diets for menopause weight gain, but that is about diets, not worship. Ramadan and fasting covers fasting through this stage, and questions about the fast itself belong with a qualified scholar.