"No matter what I do, I keep gaining weight” is the phrase I hear most often in my office from my 40-plus patients. This midlife weight struggle is common, and it happened to me.

I hit my late 40s and suddenly my consistent exercise routine and healthy diet weren’t working. When the scale registered 5kg over my ideal weight, I did what any sane person would do: I bought a new scale. But it didn’t lie, and neither did the big new lump around my middle. And in spite of my doing all the things I’d been telling my patients to do for years (avoid soft drink, count kilojoules, watch portion sizes, eliminate bread), the new scale was stuck.

The fact is, midlife women gain, on average, 700g per year. It picks up when they hit menopause: Ninety percent of women gain at least 2kg within a year of hitting that milestone. A few extra grams a year doesn’t seem like a lot, but if you gain 1-2kg a year starting at age 45, by 55 you’re looking at as many as 20 extra kilos.

Sometimes midlife weight gain can be attributed to eating out more, a nightly chardonnay with dinner, or, occasionally, an underactive thyroid. But more often than not, changes in two key hormones are the culprit:

Stress causes cortisol levels to surge

And midlife is hardly a Zen-like time, with kids’ school tuition, ageing parents, and possibly a big life change like death or divorce. Then add in perimenopausal hot flushes, insomnia, and unpredictable periods. Yikes! All that cortisol increases your appetite and cravings for sugar and, yup, brings on weight gain and an accumulation of abdominal fat cells.

A dive in oestrogen affects the distribution of weight

This typically starts in the mid- to late 40s and doesn’t change metabolism, but it does explain why you might have a new muffin top even if you haven’t gained a kilo. But a fall in oestrogen indirectly affects weight gain for one important reason: It has a strong impact on the ability to get a decent night’s sleep.

The solution: Get more sleep

Disrupted sleep is about more than hot flushes-even women who aren’t awakened by these heat waves may end up tossing and turning. The metabolic changes that result from inadequate sleep are, more than anything else, what sabotage midlife efforts to lose the weight. It leads to changes in weight regulation hormones: Disrupted sleep causes ghrelin, the hunger hormone, to increase, and leptin, the “stop eating” hormone, to decrease. Ghrelin doesn’t just increase your appetite; it makes you crave high-carb, high-kJ foods. Increased ghrelin plus decreased leptin equals weight gain. Also, when you’re exhausted, deep-dish pizza is much more appealing than steamed veggies-and exercise is less enticing than hitting the snooze button.

The magic number is seven hours of shut-eye, but roughly 35 percent of adults routinely get less than that. A recent study showed that even one night of sleep loss can have a negative impact on metabolism. The bottom line: Make getting a good night’s rest a priority.

In case you’re wondering: When I made some life changes to decrease stress and started sleeping again, I lost the extra weight. And I’ve learned to embrace my muffin top.

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