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If you’ve entered your 40s and suddenly found that the same diet and exercise routine that worked in your 20s and 30s no longer delivers results, you’re not alone. Most women gain weight steadily after the age of 40, with the average increase being approximately 1 to 1.5 pounds per year during midlife, particularly between the ages of 40 and 60.

The frustrating reality is that your body is undergoing significant hormonal changes that can make weight loss harder than ever before. While it’s tempting to blame aging, lack of willpower, or a slower metabolism, the truth is far more complicated. The hormonal shifts involving your thyroid, reproductive hormones, insulin sensitivity, and appetite regulation are creating the perfect storm for weight gain and stubborn fat retention.

Hormonal changes shift how your body responds to food, exercise, and even sleep. Yet, most weight loss advice still centers around “eat less and move more” without acknowledging the powerful hormonal factors that influence everything about weight loss after 40!

Let’s break the silence and talk about the hormonal truths behind weight gain—and what you can do to tip the scale in your favor after 40.

As you enter your 40s, your body begins a gradual but significant transformation that affects virtually every aspect of metabolism and weight regulation. One of the most significant changes is the loss of lean muscle mass, known as sarcopenia. You typically lose 1 to 2% of muscle mass each year, starting as early as age 35, with the rate accelerating after age 60. This muscle loss is particularly problematic because muscle tissue burns more calories at rest than fat tissue, meaning that as you lose muscle, your metabolic rate naturally decreases.

Beyond muscle loss, your body’s hormonal landscape begins shifting dramatically. For many women, perimenopause is in progress, and estrogen levels are fluctuating wildly. For both men and women, thyroid function may become less efficient, insulin sensitivity can decrease, and the delicate balance of appetite-regulating hormones, such as leptin, becomes disrupted. These changes don’t happen overnight, which is why you, like many people, may find yourself gradually gaining weight despite maintaining the same lifestyle habits that previously kept you lean.

The metabolic slowdown isn’t just about burning fewer calories—it’s also about how your body processes and stores the calories you consume. Your cells may become less responsive to insulin, leading to more efficient fat storage. Your brain may become resistant to leptin, the hormone that signals fullness, causing you to eat more than your body needs. Meanwhile, declining thyroid function can make every bodily process, from digestion to temperature regulation, less efficient.

These changes can begin subtly, but they eventually can snowball into major roadblocks. Let’s take a closer look at each one.

Your thyroid gland acts as your body’s metabolic thermostat, controlling how efficiently your cells convert food into energy. When thyroid function declines—a condition known as hypothyroidism—your metabolism slows significantly, making weight gain almost inevitable and weight loss more difficult. What makes this particularly challenging is that thyroid problems often develop gradually and can go undiagnosed for years.

Signs of hypothyroidism

If your thyroid slows down—even slightly—you may experience the following hypothyroidism symptoms:

• Fatigue
• Brain fog
• Constipation
• Feeling cold
• Depression
• And yes, weight gain or resistance to weight loss

The relationship between thyroid function and weight is more complex than many people realize. While severe hypothyroidism can lead to significant weight gain, even subclinical hypothyroidism—where your thyroid hormone levels are just slightly below optimal—can make weight management challenging.

If you’re going through perimenopause or in menopause, the thyroid connection becomes even more pronounced. The decline in estrogen slows thyroid function, creating a double impact on metabolism. This is one of the key reasons why so many women experience unexplained weight gain during their 40s and 50s, particularly around the midsection, where thyroid-related weight gain tends to accumulate.

Subclinical hypothyroidism presents a particularly insidious challenge because the symptoms are often subtle and easily attributed to normal aging or stress. You may experience fatigue, difficulty losing weight, and feeling cold more often. However, because these symptoms develop gradually, they may not prompt a visit to the doctor. Many people struggle for years with unexplained weight gain before discovering that their thyroid function is suboptimal.

Testing thyroid levels

Conventional medicine often falls short when testing for thyroid function. Many doctors only test TSH (thyroid-stimulating hormone), but a comprehensive thyroid panel should include free T4 and free T3 to obtain a complete picture of thyroid function. T4 is the inactive form of thyroid hormone that must be converted to T3, the active form that interacts with your cells. Some people have difficulty with this conversion process, leading to symptoms of hypothyroidism even when the TSH level appears normal. You should also be checked for thyroid peroxidase (TPO) antibodies, which typically elevate when you have Hashimoto’s thyroiditis. This autoimmune disease is the most common cause of hypothyroidism in the U.S.

There are two ways to test your thyroid :

• A standard blood draw can be done at your doctor’s office or a lab.
• Blood spot testing, such as the Paloma Health at-home thyroid test kit, makes it easy to collect a small blood sample from a painless finger prick and mail it to a lab. Paloma’s test kit measures the core thyroid biomarkers—TSH, Free T4, Free T3, and TPO antibodies—making it a convenient and accurate option for those who prefer testing from home.

What you can do

• Ask for a comprehensive thyroid panel, including TSH, Free T3, Free T4, and thyroid antibodies (especially if you suspect Hashimoto’s, an autoimmune thyroid condition).

• Consider treatment beyond T4-only medications, such as levothyroxine. Some people feel better on combination therapy that includes T3.

• Nutritional support: Selenium, zinc, and iodine (in the right amounts) support thyroid health. Always consult a healthcare provider before taking any supplements.

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During perimenopause, progesterone levels are among the first hormones to decline, disrupting the balance between progesterone and estrogen in the body. Progesterone plays a key role in regulating metabolism, appetite, and fat metabolism; when its levels drop, these regulatory effects are diminished. Reduced progesterone may also slow metabolism and increase appetite, making it easier to gain weight even without changes in diet or activity. This hormonal imbalance can also affect insulin sensitivity and thyroid function, further contributing to weight gain and changes in body composition during perimenopause. Finally, lower progesterone levels can lead to a relative excess of estrogen compared to progesterone – a state sometimes referred to as “estrogen dominance” – which can promote fat storage, particularly in the abdomen and thighs.

Signs of low progesterone

Here are some signs that your progesterone might be low:

• A short luteal phase (less than 10 days between ovulation and the start of your menstrual period)
• Heavy or prolonged periods
• Spotting before your period
• Insomnia, anxiety, mood swings
• Breast tenderness
• Difficulty getting or staying pregnant
• Worsening PMS

Testing progesterone levels

There are three ways to test your progesterone levels:

• Blood test for serum progesterone is the most common method for testing progesterone, done via blood draw at your doctor’s office or a lab. This test is typically done about seven days before your period (around day 21 of a 28-day cycle). Timing is crucial since progesterone levels rise only after ovulation. Testing too early or late can give inaccurate results.
• Saliva testing measures free (bioavailable) hormones and is often used by integrative providers; home saliva test kits are also available from direct-to-consumer labs. While less standardized than blood tests, they can reveal daily hormone patterns and chronic deficiencies.
• Urine testing (DUTCH test) is a detailed hormone panel that requires collecting urine samples at home. This test measures progesterone metabolites along with cortisol, estrogen, testosterone, and DHEA. It provides a more comprehensive understanding of hormone balance and metabolism.

What you can do

• Ask for a progesterone test: If you’re in your 40s and struggling to lose weight, low progesterone could be part of the problem—especially if you’re also experiencing mood swings, poor sleep, or irregular periods. Testing your progesterone levels can help identify a hormonal imbalance that may be slowing your metabolism and making fat loss more difficult.
• Follow lifestyle recommendations: Chronic stress raises cortisol, which steals from progesterone production, so it’s important to practice stress management. You should also prioritize getting 7–9 hours of quality sleep per night. And reduce consumption of alcoholic beverages, which can impair hormone metabolism.
• Nutritional support: Eat a balanced diet with healthy fats (e.g., avocado, olive oil, seeds) to support hormone production. Ensure adequate intake of vitamin B6, magnesium, zinc, and vitamin C—key nutrients for progesterone synthesis.
• Consider herbal remedies: Chasteberry (Vitex agnus-castus) may support the pituitary in increasing natural progesterone production. Maca root is an adaptogen that may support hormonal balance in perimenopausal women.
• Consider bioidentical progesterone treatment: Prescription bioidentical progesterone (e.g., Prometrium) is available in capsule, cream, or lozenge form. It’s often prescribed cyclically (e.g., days 14–28) if you’re still cycling, or it may be prescribed along with estrogen as hormone replacement therapy (HRT). (Note: Bioidentical progesterone is safer and better tolerated than synthetic progestins.)

Track your symptoms and cycle, and work with a knowledgeable healthcare provider (e.g., an integrative MD, OB-GYN, or menopause specialist) to interpret your results and create a tailored plan.

During this time, your estrogen levels fluctuate dramatically before eventually declining, creating a cascade of effects that make weight management increasingly complex. The weight gain associated with perimenopause isn’t just about the total number on the scale—it’s also about a fundamental change in how and where your body stores fat.

One of the most significant changes during perimenopause is the redistribution of fat. As estrogen levels decline, women tend to store more fat around their abdomen rather than in their hips and thighs. This abdominal fat, particularly the visceral fat that accumulates around internal organs, is not just cosmetically concerning. This fat significantly increases the risk of cardiovascular disease and type 2 diabetes. The loss of estrogen also worsens muscle mass, further compounding the metabolic slowdown that makes weight loss more challenging.

Contrary to popular belief, hormone replacement therapy (HRT) is not to blame for menopausal weight gain. In fact, research suggests that HRT may actually help prevent abdominal fat accumulation and could have beneficial effects on muscle mass. Estrogen replacement has also been shown to improve cholesterol profiles by increasing good cholesterol and reducing bad cholesterol, which can help mitigate some of the cardiovascular risks associated with menopausal weight gain.

Signs of low estrogen

In addition to weight gain, especially around the abdomen, other signs of low estrogen include:

• Hot flashes and night sweats
• Irregular or missed periods
• Vaginal dryness and discomfort during sex
• Mood swings, irritability, or anxiety
• Difficulty sleeping or insomnia
• Decreased libido
• Fatigue or low energy
• Brain fog or trouble concentrating
• Thinning hair or hair loss
• Dry skin or changes in skin texture
• Joint pain or stiffness

Testing for low estrogen

Women in their 40s can test estrogen levels through blood, saliva, or urine tests, depending on their symptoms and the level of detail needed.

• A blood test for serum estradiol is the most common and reliable method used in conventional medicine. It’s often done on day 3 of the menstrual cycle to check baseline estrogen or around day 12–14 to assess ovulatory peaks.
• Saliva testing measures free, active estrogen and is often used by functional medicine providers. It can help detect daily hormonal fluctuations, especially if you’re experiencing irregular cycles.
• Urine testing (such as the DUTCH test) provides a comprehensive examination of estrogen metabolites, revealing how your body breaks down and clears estrogen. This is useful if you’re dealing with symptoms of estrogen dominance (like weight gain, mood swings, or heavy periods) or want to evaluate your overall hormone balance.

What you can do

• Track your cycle: If you still have a period, irregular cycles may signal perimenopause. Keep a symptom diary to track your symptoms throughout the month.

• Balance blood sugar: Focus on meals rich in fiber, healthy fats, and protein to maintain stable blood sugar levels.

• Talk to a provider about hormone therapy: Bioidentical hormone replacement therapy (BHRT) may help with weight and symptom relief, including hot flashes.

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Insulin is a hormone that helps move glucose from your blood into cells for energy or storage. After the age of 40, insulin resistance becomes a common yet often overlooked cause of weight gain. As cells become less responsive to insulin, the pancreas produces more insulin, leading to chronically high insulin levels that promote fat storage and make weight loss more challenging.

This process can develop gradually and go unnoticed for years. Elevated blood sugar levels after meals trigger even more insulin, creating a cycle where fat is stored and becomes harder to burn. You may gain weight even if your diet hasn’t changed.

Several factors contribute, including age-related muscle loss, which reduces your body’s ability to process glucose. Visceral fat also increases inflammation, interfering with insulin’s effects. As insulin resistance worsens, your body stores more fat—especially around the belly.

Signs of insulin resistance

In addition to difficulty losing weight or unexplained weight gain -- particularly “belly fat” or abdominal obesity -- signs of insulin resistance include:

• Increased hunger and cravings, especially for sugary or carb-rich foods
• Fatigue or low energy, especially after meals
• Brain fog or difficulty concentrating
• Frequent urination and increased thirst
• Darkened patches of skin (acanthosis nigricans), often on the neck, armpits, or groin
• Elevated blood sugar levels or prediabetes diagnosis
• High blood pressure
• Elevated triglycerides and low HDL (“good”) cholesterol
• Skin tags or dark patches of skin (acanthosis nigricans)
• Mood swings or irritability

Testing for insulin resistance

• Fasting insulin and glucose: Measures how your body handles blood sugar after 8–12 hours without food; high insulin with normal glucose can indicate early insulin resistance.
• Hemoglobin A1C: Reflects your average blood sugar over 2–3 months; levels between 5.7–6.4% may signal prediabetes or insulin resistance.
• Oral glucose tolerance test (OGTT) with insulin: Tracks how your glucose and insulin levels respond to a sugar drink over time, revealing hidden insulin spikes.

What you can do

• Prioritize strength training and regular physical activity: Build muscle and boost insulin sensitivity with resistance training, brisk walking, or high-intensity intervals. A daily routine of regular exercise helps your muscles use glucose more effectively, improving insulin response even after a single session.
• Eat balanced meals and manage carbohydrates: Focus on high-fiber, low-glycemic carbs (such as whole grains, fruits, vegetables, and legumes), healthy fats, and protein to stabilize blood sugar levels. Limit added sugars, refined carbs, processed foods, and sweetened drinks. Consider intermittent fasting or time-restricted eating.
• Manage stress and improve sleep: Chronic stress increases cortisol levels, which can make insulin resistance worse. Incorporate deep breathing, yoga, or mindfulness as a daily activity to reduce stress. Aim for 7–9 hours of quality sleep to support balanced blood sugar and hormone levels related to hunger.
• Consider supplements (with your healthcare provider): Berberine, magnesium, inositol, alpha-lipoic acid, chromium, and omega-3 fatty acids may support insulin sensitivity, especially in people with metabolic conditions.
• Limit alcohol intake: Alcohol can spike your blood sugar and impair liver function, affecting insulin control.
• Adopt a Mediterranean-style diet: Emphasize vegetables, healthy fats (such as nuts and olive oil), and whole grains to reduce insulin resistance by preventing insulin spikes commonly associated with refined sugars and grains.
• Medical treatments: Medications such as metformin improve insulin sensitivity and lower blood sugar. Other options include thiazolidinediones (pioglitazone), GLP-1 receptor agonists (liraglutide, semaglutide), which aid weight loss, and SGLT2 inhibitors, which promote glucose excretion.

By combining lifestyle changes, nutrition, stress management, and, if needed, medical support, insulin resistance can often be reversed or significantly improved.

Cortisol, often called the “stress hormone,” naturally rises when you’re under pressure—but for women over 40, it can stay elevated even in those rare moments when life is calm! Why? As estrogen and progesterone levels start to dip during perimenopause and menopause, the body becomes more sensitive to stress. The adrenal glands, which also help produce stress hormones, pick up the slack, often working overtime. Add in busy work and family schedules, poor sleep, and daily life stressors, and you’ve got a perfect recipe for chronically high cortisol levels—even if you don’t “feel” stressed!

The problem? Chronically high cortisol can quietly sabotage your weight. It ramps up hunger, especially for sugary, carb-heavy comfort foods, while signaling your body to store fat—particularly around the belly! At the same time, it can break down muscle, slowing your metabolism and making it even harder to burn calories. That’s why so many women over 40 find themselves gaining weight even when they’re eating well and staying active.

Testing cortisol

There are several ways to test cortisol:

• Saliva test: A saliva cortisol test, sometimes called an “Adrenal Stress Panel,” measures cortisol at 4 to 6 points throughout the day to track your daily pattern. Functional and integrative medicine practitioners commonly use this test.
• Blood test: A traditional serum cortisol test is typically done in the morning for a single cortisol reading. Conventional doctors often use this test, but it doesn’t capture daily fluctuations in cortisol levels.
• 24-hour urine test: This test measures total cortisol output over a whole day. It helps detect adrenal disorders and is often paired with hormone panels like DHEA.
• Urine testing (DUTCH test) measures free and metabolized cortisol and DHEA, as well as other hormones. It provides a more comprehensive understanding of hormone balance and metabolism.

What you can do

• Prioritize rest and recovery: Aim for 7–9 hours of quality sleep and stick to a consistent bedtime routine. Wind down with calming stress-reduction techniques, such as reading, meditation, or savoring herbal tea. Daily mindfulness, breathwork, or brief walks in nature can help lower cortisol levels. Journaling can also reduce mental stress and support emotional balance.
• Balance your workouts: Excessive high-intensity exercise can increase cortisol levels. Include low-impact activities like walking, yoga, or Pilates to support your hormones. Don’t skip rest days—they help your body recover and keep stress hormones in check.
• Eat to support hormone balance: Skipping meals can spike cortisol levels, so eat regularly and include protein and healthy fats in your diet. Choose anti-inflammatory foods, such as leafy greens, berries, and omega-3-rich foods. Limit sugar, processed foods, and caffeine, and stay well-hydrated throughout the day.
• Use targeted supplements & adaptogens (with guidance from a provider): Adaptogens like ashwagandha, rhodiola, and holy basil can help regulate stress hormones. Magnesium supports relaxation and sleep, while phosphatidylserine may help lower evening cortisol levels to enhance rest and recovery.
• Support emotional well-being: Emotional stress can lead to high cortisol levels. Therapy, coaching, or cognitive behavior therapy can help manage it. Journaling, especially when focused on gratitude, helps shift your mindset. Set boundaries and say no when needed to protect your energy and reduce emotional overload.

Leptin, known as the “satiety hormone,” is made by fat cells and tells your brain when you’ve had enough to eat. It signals to the brain that your body has enough energy, helping reduce hunger and increase calorie burn. But in up to 90% of people with obesity, this signaling breaks down, causing leptin resistance.

With leptin resistance, the brain stops responding to leptin’s appetite-suppressing message. Even with plenty of fat stored, your brain thinks you’re starving—leading to constant hunger and reduced energy use. This makes weight loss feel nearly impossible with willpower alone.

Leptin resistance is often triggered by chronic overeating of processed, high-calorie, and fatty foods. These overwhelm your leptin system, and over time, the brain becomes less sensitive, needing higher and higher levels of leptin to produce a feeling of fullness.

Sign of leptin resistance

In addition to unexplained weight gain or difficulty losing weight, other signs of leptin resistance include:

• Constant or excessive hunger despite eating enough
• Difficulty feeling full or satisfied after meals
• Cravings for high-calorie, sugary, or fatty foods
• Fatigue or low energy levels
• Increased fat storage, especially around the belly
• Disrupted sleep or poor sleep quality
• Brain fog or trouble concentrating
• Elevated inflammation or other metabolic issues

Testing for leptin resistance

Testing for leptin resistance is more complex than testing for other hormone imbalances because there is no single standard clinical test for it. It’s usually a functional diagnosis. However, a blood test for leptin is available. When leptin levels are high – combined with symptoms such as obesity or difficulty losing weight – it may indicate leptin resistance, meaning the body isn’t responding properly to leptin’s signals despite its abundance.

What you can do

• Eat a whole-food, anti-inflammatory diet: Focus on plenty of vegetables, lean proteins, and healthy fats while minimizing processed foods, added sugars, fructose, and sugary drinks to support leptin sensitivity.
• Focus on food timing and frequency: Avoid overeating and frequent snacking to regulate leptin signaling. Consider intermittent fasting and time-restricted eating (with medical guidance) to improve leptin sensitivity.
• Adopt healthy lifestyle habits: Get 7–9 hours of quality sleep and manage stress with relaxation techniques like meditation or yoga.
• Exercise regularly: Engage in both aerobic and resistance training to boost leptin sensitivity and help regulate appetite.

Weight loss after 40 isn’t impossible—it just requires a smarter, more personalized approach. As your body changes, so must your strategy. The quick results you may have seen in your 20s or 30s give way to a slower, more deliberate process driven by shifting hormones, thyroid function, and metabolism. Instead of relying solely on willpower or calorie-cutting, success after 40 means targeting the root causes—such as insulin resistance, perimenopausal changes, or leptin resistance—with tailored nutrition, the right type of exercise, stress management, and, when necessary, medical support.

This stage of life calls for a mindset shift: sustainable weight loss is no longer a sprint—it’s a marathon that demands consistency, patience, and a deeper understanding of your physiology. By working with your body rather than against it, you can create long-term systems that support hormonal health and lasting change. The key isn’t doing more—it’s doing what works for you now.

Here are some actions you can take to get started on your journey to a healthier weight.

1. Test, don’t guess

Request comprehensive blood work from a knowledgeable provider who will be your partner in wellness. Go beyond standard labs to uncover hidden roadblocks to weight loss. Include markers like:

• Thyroid function -- TSH, free T4, free T3, TPO antibodies
• Insulin, fasting blood glucose, and hemoglobin A1c
• Cortisol
• Leptin
• Estrogen, progesterone, and DHEA

2. Optimize your nutrition

Nutritional strategies should focus on supporting hormonal balance, maintaining muscle, and promoting satiety.

• Protein is your best friend. Aim for 20–30 grams of protein per meal to preserve muscle mass and stay fuller for longer.
• Ditch the ultra-processed junk. It hijacks hunger signals and fuels inflammation.
• Don’t fear healthy fats: avocados, nuts, seeds, and olive oil support hormone production and satiety.

3. Change your meal timing

The timing of meals can also play a role in optimizing hormonal function and help regulate hormones like insulin and cortisol.

• Consider intermittent fasting or time-restricted eating to improve insulin sensitivity
• Avoid constant grazing, and allow time between meals for hormonal reset

4. Move smarter and get stronger

After 40, it’s time to say goodbye to a sedentary lifestyle. Strength training becomes absolutely critical after the age of 40, not just for appearance but also for metabolic health. Building and maintaining muscle mass helps combat the metabolic slowdown.

• Lift weights. It builds muscle and increases your resting metabolism.

• Walk daily. Walking is often underrated yet powerful for promoting fat loss and regulating hormones.

• Mix intensity: alternate strength, gentle movement, and short cardio bursts.

5. Reduce stress and support sleep

Managing stress and prioritizing sleep are often overlooked but crucial components of hormonal optimization. Chronic stress elevates cortisol levels, which can interfere with insulin sensitivity and promote abdominal fat storage. Sleep deprivation has been linked to virtually every hormone involved in weight regulation, from insulin and leptin to growth hormone and cortisol.

• Practice stress reduction daily, whether it’s meditation, breathwork, or another practice.
• Aim for 7-9 hours of quality sleep per night

6. Focus on progress, not the scale

Success in this stage of life often comes from focusing on small victories and overall health improvements rather than just the number on the scale. Improvements in energy levels, sleep quality, strength, and body composition are more meaningful indicators of progress than weight alone. As you build muscle and lose fat, your weight might not change dramatically, but your body composition and metabolic health can improve significantly! Make it your mindset to celebrate every sign of progress and success, not just the number on the scale!

If you’re over 40 and struggling with weight, it’s not because you’re doing something wrong—it’s because your body is changing. Recognizing the hormonal factors that drive age-related weight gain helps you approach weight loss with compassion and strategy rather than guilt or confusion.

This phase of life can be a powerful time to reclaim your health—not by punishing your body, but by working with it.

This is where Paloma comes in, offering comprehensive, personalized care for thyroid conditions like hypothyroidism and Hashimoto’s, as well as the hormonal shifts of perimenopause and menopause that create barriers to weight loss. Through our virtual care platform, Paloma provides you with access to top practitioners specializing in thyroid and hormonal health, as well as weight loss, including the use of cutting-edge GLP-1 medications. You can take advantage of Paloma’ss convenient at-home lab testing kit, telemedicine appointments, a library of hundreds of in-depth educational articles, and an intuitive smartphone app to track your symptoms and medication.

Paloma’s approach is evidence-based and holistic, recognizing the complex interplay between thyroid function, hormone levels, and your overall well-being. Paloma empowers you with the tools, guidance, and expert care needed to make informed decisions, take control of your health journey, and achieve weight loss success! Find out more about becoming a Paloma member today.

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• Hormonal changes after 40—especially involving thyroid, estrogen, progesterone, insulin, and cortisol—make traditional weight loss methods less effective.
• Declining thyroid function, including subclinical hypothyroidism, slows metabolism and contributes to weight gain, often going undiagnosed.
• Low progesterone and fluctuating estrogen during perimenopause lead to increased abdominal fat, worsened insulin sensitivity, and muscle loss.
• Insulin resistance, often a silent condition, becomes more common with age and promotes fat storage, particularly around the abdomen.
• High cortisol levels from chronic stress can increase cravings, promote fat storage, and reduce muscle mass, further complicating weight loss efforts.
• A personalized, hormone-informed strategy—incorporating lifestyle changes, targeted testing, and medical treatment when appropriate—is essential for successful weight loss after 40.