Best Weight-Loss Programs for Women Over 40

For most women over 40 carrying extra weight, the weight-loss program worth paying for is one that can prescribe a GLP-1 medication such as tirzepatide (Zepbound) or semaglutide (Wegovy), has a clinical team following you, and pairs the medication with protein and strength training to protect your muscle. In an analysis of the SURMOUNT tirzepatide trials, women in perimenopause and after menopause lost 23% of their body weight on tirzepatide, vs 3% on placebo. If you don't qualify for medication or don't want it, a well-studied diet program such as WW is the better fit.

Do weight-loss shots still work after 40 and through menopause?

Yes. In the SURMOUNT-1 analysis by reproductive stage, women with obesity or overweight and no diabetes lost 23% of their body weight on tirzepatide in perimenopause and after menopause, vs 3% on placebo. Women before menopause lost 26% vs 2%. Menopause didn't stop the medication from working.

The belly fat that tends to pile on around menopause came off too. In perimenopause and after menopause, waists shrank by 20 cm (close to 8 inches) on tirzepatide, vs 4 to 5 cm on placebo. Women before menopause lost 22 cm vs 4 cm.

Nearly every woman on tirzepatide lost a meaningful amount. Across the menopause stages, 97% to 98% lost at least 5% of their weight, vs 29% to 33% on placebo. Between 69% and 73% lost at least 20%.

The medication adds to what diet and exercise can do. In one study in the Zepbound prescribing information, people first completed a 12-week intensive diet and exercise program. Those who lost at least 5% on it then lost significantly more weight over the next 72 weeks when they added Zepbound (brand-name tirzepatide) than when they added placebo.

The menopause analysis has limits. Eli Lilly, which makes tirzepatide, funded it. The researchers looked back at an older trial and sorted most women into menopause stages by age, so some women in the perimenopause group may have been placed in the wrong stage.

How do the main types of weight-loss programs compare?

Compare what you'll pay in month four, not the intro price. First-month deals and quarterly billing make programs look cheaper than they are. Brand-name prices also rise as your dose goes up, so look at the price for the dose you're likely to stay on.

Which weight-loss program fits me?

• Check whether you qualify for medication. Zepbound is approved for adults with obesity (a BMI of 30 or higher), or with overweight (a BMI of 27 to 29.9) plus at least one weight-related problem such as high blood pressure, high cholesterol, sleep apnea or heart disease. It's meant to be used alongside eating fewer calories and moving more.
• Rule medication out if it isn't safe for you. You can't use tirzepatide if you or a family member has had medullary thyroid cancer (MTC) or MEN 2, a rare inherited condition that causes tumors in hormone glands. The label also says to stop once you know you're pregnant, and to tell your clinical team if you're pregnant or planning to be.
• If medication is out, or you'd rather not take a shot, pick a diet program with published evidence behind it. WW and Jenny Craig are the two best-studied.
• Expect your stomach to complain at first. On Zepbound, most nausea, vomiting and diarrhea happened while the dose was going up and eased over time. Between 4.8% and 6.7% of people on Zepbound (at 5 mg, 10 mg and 15 mg) stopped because of side effects, vs 3.4% on placebo, mostly in the first few months (Zepbound prescribing information).
• Plan to stay on it. In one study, everyone took Zepbound for 36 weeks. From week 36 to week 88, people who kept taking it lost significantly more weight than people switched to placebo (Zepbound prescribing information). Pick a program you can afford past the intro month.

How do I keep muscle while losing weight on a GLP-1?

Some of the weight you lose on a GLP-1 is muscle. In the main tirzepatide trial, a group of participants had body scans, and people on tirzepatide lost 10.9% of their lean mass over 72 weeks.

Experts estimate that the muscle lost in the big semaglutide and tirzepatide trials (10% or more over 68 to 72 weeks) roughly matches what about 20 years of aging takes from adults over 30, who lose an estimated 3% to 5% per decade. After 40 that matters more, because your muscle is already slipping, and muscle is what keeps you strong and your body firm as the weight comes off.

Experts name two ways to keep it: eat enough protein, and do resistance training such as weights or bands. A GLP-1 shrinks your appetite, so getting enough protein takes some planning. Ask your clinical team for a protein target that fits how much you can eat now.

One 38-year-old woman in r/Zepbound, who posted "One year difference - 264 to 190," went from 264 to 190 pounds in a year at 12.5 mg. She added lifting as her loss slowed: "Weight loss slowed to about 4-6 lbs a month for the last 5 or so months, but I upped my strength training at that time as well." Her goal wasn't a number on the scale: "I am pretty comfortably in a size 14 and am willing to stop losing weight as soon as I feel good and capable of moving my body and keeping up with my toddlers."

Does hormone therapy help you lose more weight on tirzepatide?

Early real-world data point that way. A study followed 120 postmenopausal women on tirzepatide for a median of 18 months. The 40 women who also used menopause hormone therapy (estrogen as a patch or pill, with or without progesterone) lost 17% of their body weight, vs 14% for the 80 women who didn't. In the hormone therapy group, 45% lost at least 20% of their weight, vs 18% in the other group.

The study was small and looked back at medical records, so it shows a link, not proof that the hormones caused the extra loss. The authors called for larger studies to confirm it.

Hot or Nothing also offers bioidentical estrogen, so your clinical team can look at your weight and your menopause symptoms together in one plan.

If you want your jeans to fit again and your waist back after 40, take the quiz. Our clinical team will review your answers and see whether a GLP-1 plan fits your body, your goals and where you are in menopause.