The first time Ama said it, she said it quietly.
“I am eating less… but I am gaining weight.”
She was not distressed the way patients sometimes are when weight is the obvious issue. Her concern was more precise. Her body felt different heavier in specific places, particularly around the middle. Her clothes fit differently even though her eating habits had not dramatically changed. Her energy had dropped. And despite genuinely trying to make better choices, nothing was shifting in the direction she expected.
This is one of the most common patterns I encounter in clinical practice, and one of the most misunderstood. Women who are not overeating. Women who are, in fact, trying hard. But whose physiology is no longer responding in ways that match conventional nutrition advice. The common thread is rarely willpower or discipline. It is hormonal regulation.
Weight in the body is not a simple mathematics of calories in and calories out though that framing persists stubbornly in popular culture. For women especially, weight is a downstream effect of several interacting hormonal systems. When those systems are functioning well, the body maintains equilibrium relatively easily. When they are disrupted, the body adapts and many of those adaptations favour fat storage, increased appetite, and metabolic slowdown. The four systems most commonly involved are Oestrogen balance, Cortisol regulation, Thyroid function, and Insulin sensitivity.
Oestrogen is not the villain it is sometimes made out to be. It is an essential hormone that supports bone density, cardiovascular health, brain function, mood, and reproductive health. The problem is not oestrogen itself, but imbalance. When oestrogen is not properly balanced by progesterone, or when the liver and gut do not clear used oestrogen efficiently, a condition known as oestrogen dominance can develop (Plottel & Blaser, 2011).
Clinically, this may show up as heavier or more painful menstrual periods, fluid retention especially before menstruation, breast tenderness, and increased fat storage around the hips and lower abdomen. Mood changes, particularly irritability and low mood in the week before menstruation, are also common.
The dietary approach is not about strict restriction, but about supporting the body’s ability to clear oestrogen. Fibre plays a key role. When there is enough fibre in the gut, it binds to excreted oestrogen and helps remove it from the body. Without enough fibre, some of this oestrogen can be reabsorbed back into the bloodstream through a process called enterohepatic recirculation (Plottel & Blaser, 2011). Foods such as oats, wheat, millet, fruits, vegetables, beans, and unripe plantain provide the type of fibre that supports this process. Bitter leaf, fermented dawadawa, ginger, and turmeric also help improve how the liver processes oestrogen.
What became clearer as I worked with Ama was not just what she was eating, but how she was living. Her sleep was poor. She ate irregularly, often skipping breakfast and eating large meals later in the day. She was under constant low-level stress from work, family responsibilities, and the pressure of managing everything. This is not unique to Ama. It reflects the daily reality of many Ghanaian women.
Cortisol is the body’s main stress hormone. When it stays high for a long time, the body shifts into a storage and survival mode. Appetite increases, especially for high-calorie, quick-energy foods. Fat is more likely to be stored around the abdomen because this area has more cortisol receptors than other parts of the body (Incollingo Rodriguez et al., 2015). Muscle can break down, thyroid function can slow, and insulin resistance can worsen. This explains why some women eat the same way as before but gain weight, especially around the waist. It is not random it is a stress response.
Nutritionally, the most effective approach is consistency and balance. Meals that include protein, slow-digesting carbohydrates, and healthy fats such as unripe plantain with garden egg stew and fish, or brown rice with kontomire and eggs help keep blood sugar stable and reduce cortisol spikes that happen after sudden drops in blood sugar. Magnesium-rich foods like groundnuts, legumes, and dark green leafy vegetables help calm the nervous system. Eating at regular times, even during busy periods, sends a stabilizing signal to the body.
Sleep is not just a lifestyle choice it is essential for metabolism. Research shows that sleeping less than six hours per night increases cortisol, raises ghrelin (the hormone that increases hunger), lowers leptin (the hormone that signals fullness), and increases the risk of weight gain and insulin resistance (Spiegel et al., 2004). When sleep is poor, dietary changes alone may not be enough.
In some patients, the main issue is not fat storage but a slower metabolism. The thyroid gland controls how fast the body uses energy. When it is underactive, many body processes slow down.
Common signs include ongoing fatigue even after enough sleep, constipation, feeling unusually cold, dry skin, hair thinning, and steady weight gain that does not improve with dietary changes.
Hypothyroidism is more common in women. Subclinical hypothyroidism where lab values may still appear normal but function is reduced is also common and often missed (Garber et al., 2012). It should be considered, especially in women over 35, postpartum women, or those with a family history.
Severely restricting calories is not a good approach when thyroid issues are suspected. The thyroid responds quickly to low energy intake, and undereating can slow metabolism even further. The focus should be on adequate nutrition. Iodized salt provides iodine needed for thyroid function. Foods like fish, eggs, and legumes provide selenium and zinc, which support proper thyroid hormone activity. The goal is not to “boost” the thyroid artificially, but to support its normal function by removing nutritional gaps.
Among these systems, insulin resistance is often the most important in women with unexplained weight gain. It affects how the body uses and stores energy and in this state, the body tends to store more.
It increases hunger, reduces feelings of fullness, and drives cravings for quick-energy foods. This creates a cycle that is difficult to break through willpower alone.
Ama’s lab results did not show diabetes, but there were early warning signs. Her fasting glucose was slightly elevated. Her waist circumference had increased over two years despite no major change in diet. She often felt tired after eating. This pattern, if not addressed, usually progresses and this is the stage where nutrition can make the biggest difference.
The solution is not to remove carbohydrates completely this is not necessary and not practical culturally. Instead, carbohydrates should be better structured. Foods like millet, oats, brown rice, unripe plantain, and legumes release glucose more slowly and lead to a lower insulin response. Combining carbohydrates with protein and healthy fats at meals such as kenkey with fish and cut vegetables, banku with okra and lean meat, or yam with smoked salmon beans stew helps slow down glucose absorption. Reducing sugary drinks is often the most effective first step (Malik et al., 2010).
| Hormone System | Signs It May Be Disrupted | Key Ghanaian Foods That Help |
| Oestrogen dominance | Heavy periods, bloating, hip and belly fat, breast tenderness | Kontomire, okra, bitter leaf, beans, dawadawa, ginger |
| Cortisol (stress) | Abdominal fat, poor sleep, fatigue, sugar cravings | Groundnuts, legumes, yam with fish, brown rice with eggs |
| Thyroid (sluggish) | Weight gain, fatigue, constipation, cold sensitivity | Iodized salt, fish, eggs, legumes, seafood |
| Insulin resistance | Central fat, fatigue after meals, cravings, elevated fasting glucose | Millet, oats, unripe plantain, kenkey with fish, beans |
What changed for Ama was not a dramatic overhaul. It was alignment matching what she ate to what her body actually needed. Her meals became structured. She stopped skipping breakfast and started eating within an hour of waking. Protein was deliberately included at every meal. Vegetables became non-negotiable. Sugary drinks reduced from daily to occasional. And she began to take her sleep seriously.
Within three weeks, her energy shifted noticeably. The bloating that had become constant reduced. Within two months, her weight began to respond; not rapidly, but steadily and reliably. Her mood improved. She stopped feeling like her body was working against her. That last part matters. When women understand that their body has not been failing them, `it has been responding logically to a disrupted internal environment; the conversation about change shifts completely. They become engaged, not defeated.
If you are experiencing weight gain that does not match your intake, increasing abdominal fat, persistent fatigue, cycle changes, or mood fluctuations that feel disproportionate to circumstances, it is worth exploring the hormonal picture rather than defaulting to more restriction. A personalised approach, grounded in your actual eating habits, your real life, and your specific hormonal pattern, makes a meaningful difference.
I can be of good help Sis!
Garber, J. R. et al. (2012). Clinical practice guidelines for hypothyroidism in adults. Endocrine Practice, 18(6), 988–1028.
Incollingo Rodriguez, A. C. et al. (2015). Hypothalamic-pituitary-adrenal axis dysregulation and cortisol activity in obesity. Psychoneuroendocrinology, 62, 301–318.
Malik, V. S. et al. (2010). Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes. Diabetes Care, 33(11), 2477–2483.
Plottel, C. S. & Blaser, M. J. (2011). Microbiome and malignancy. Cell Host & Microbe, 10(4), 324–335.
Spiegel, K. et al. (2004). Sleep curtailment is associated with decreased leptin, elevated ghrelin, and increased hunger. Annals of Internal Medicine, 141(11), 846–850.
World Health Organization. (2023). Healthy diet guidelines. WHO Press.
Ministry of Health Ghana. (2023). Food-Based Dietary Guidelines for Ghana.
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