The Fit and Fabulous Podcast

Episode 113: Dr. Bill Campbell – Menopause, Fitness, and Weight Loss Resistance

Host: Dr. Jaime Seeman
Guest: Dr. Bill Campbell
Release Date: March 29, 2026

Overview of Episode

In this rich, science-driven conversation, Dr. Jaime Seeman welcomes Dr. Bill Campbell—Professor and Director of the Performance & Physique Enhancement Lab at the University of South Florida—to discuss the complexities of menopause, weight management, fitness, and hormone therapy. Dr. Campbell opens up about his personal motivation stemming from his wife's menopause transition, and the episode weaves together the latest research, clinical anecdotes, and pragmatic advice for women navigating menopause, especially those struggling with weight loss resistance. Together, Dr. Seeman and Dr. Campbell highlight the need for tailored approaches, the role of tracking, exercise, HRT, sleep, and the ongoing search for evidence-based solutions.

Key Discussion Points & Insights

1. Dr. Campbell’s Shift to Menopause Research

• Personal Motivation: Dr. Campbell’s focus shifted dramatically after witnessing his wife’s struggles with menopause. Traditional fat loss approaches no longer worked for her, leading him to question core paradigms in exercise and nutrition science.
  • Quote (Bill Campbell, 02:15):

    “If we were to back up five years from today and somebody were to tell me... you’re going to change your entire research program and focus on menopause. I would have said, there’s no way... In my wife’s case, she had a hard time losing [weight]. Everything we used to do didn’t help.”

2. Why is Weight Loss Harder During Menopause?

• Physiological Shifts: Estrogen (estradiol) and progesterone sharply decline during menopause, affecting energy balance, glucose metabolism, and potentially fat distribution.
• Variability: Responses to hormone therapy or lifestyle interventions vary widely. Anecdotally and in clinical studies, estrogen replacement can help some women lose weight, cause weight gain in others, and make no difference for some.
  • Quote (Bill Campbell, 10:16):

    “Anecdotally what I’m learning is, boy, it’s highly variable... Some women lost 10 pounds on hormone therapy, others gained 8, and for some, no difference.”

3. Does Energy Balance Still Apply in Menopause?

• CICO Still Matters (With Caveats): Caloric intake vs. expenditure remains fundamental, but some menopausal women may require a more aggressive (but short-term) deficit to see results.
• Rapid Fat Loss Protocol: Campbell’s lab tested a 4-day aggressive calorie deficit (3-500 kcal, high protein) with lots of walking (6 hours/day), resulting in fat loss without lean mass loss, and minimal hunger for most.
  • Quote (Campbell, 18:18):

    “What I’m essentially doing is leaning into [aggressive energy deficit], but... for such a short duration that the body only responds by losing fat and not losing any lean mass.”

[15:42-22:43] On Age & Weight Loss Principles

• Standard protocols work well for 20s/30s women; menopausal women may benefit from specific, sharper, and more tightly controlled approaches.
• Importance of tracking: Measuring calories accurately is essential. Over- or underestimation is common and can thwart results.
  • Quote (Seeman, 24:16):

    “I have some patients that come in like, ‘Oh, yeah, doc, I got my app right here... I’m not losing weight.’ But [are] you really tracking accurately?”

4. Exercise Recommendations for Menopausal Women

• Resistance Training: Should be foundational for all, though any form of exercise is better than none.
  • Quote (Campbell, 26:20):

    “Whatever they enjoy... I would really hope and encourage people make resistance training the foundation.”

• On Cardio, HIIT, and Cortisol: Campbell and Seeman agree that most are not over-exercising to the point of pathological cortisol elevations. Listening to one’s body and rest/recovery matter.
  • Quote (Campbell, 29:09):

    “Somewhere they’re getting a message that it’s their cortisol. Maybe it is, maybe it isn’t. It’s not in the research literature.”

5. The Crucial Role of Sleep

[31:05-36:11] Fat Loss Resistance and Sleep

• Gold-Standard Study: A 14-day caloric deficit with sleep deprivation versus adequate sleep showed 2.5x greater fat loss with good sleep. If you’re not sleeping, it’s much harder to lose fat.
  • Quote (Campbell, 33:13):

    “If you’re at a point in life where you can’t sleep, don’t make that a diet phase. You are literally spinning your wheels.”

• Progesterone can aid menopausal sleep issues and improve quality of life.

6. GLP-1 Medications and Menopause

• GLP-1 receptor agonists (like semaglutide) help about 80% of menopausal women with weight loss resistance; about 20% remain non-responders.

7. Hormone Replacement Therapy (HRT) Utilization

• Among fit women, up to 55% are using HRT, versus ~5-10% in the general population. Fit women are more attuned to their bodies, more likely to seek solutions, and may see greater benefits.

8. Muscle, Estrogen, and Anabolic Resistance

• Estradiol is anabolic (muscle-building) or at least anti-catabolic (muscle-preserving). Pre-menopausal women respond better to resistance training than post-menopausal, but even in menopause, muscle can be built and lost lean mass can be minimized—especially with resistance training and optimized protein intake.
  • Quote (Campbell, 45:24):

    “Estrogen, estradiol is anabolic. [But] most studies are not on women who have spent 10–15 years building muscle.”

9. Diet, Protein, and Supplements

[48:21-51:45] Supplements for Menopausal Women

• Creatine: Highly studied, safe, supports strength, lean mass, possibly brain health. Dosing for brain benefits is higher than for muscle (20g/day in some studies).
• Macronutrients:
  • Protein: Should be the anchor—aim for ~0.75g/lb (or 1.6g/kg) ideal bodyweight.
  • Carbs/Fat: Adjust based on personal preference and response. No universal optimal ratio for menopausal women, but higher protein is universally beneficial.
    • Quote (Campbell, 49:53):

      “Just increasing protein... they will gain lean mass and they will lose body fat. No exercise.”

Ketogenic/LCHF:

• Seeman notes personal and clinical success with ketogenic/lower-carb approaches, particularly for women with metabolic risk.

10. Research – Ongoing Studies and How to Get Involved

• Upcoming virtual study for menopausal women with weight loss resistance who already resistance train (comparing with younger controls).
• Measures: Weight (all), composition (optional: DEXA/InBody/BodPod).
• Recruitment via email: B.Campbell@usf.edu
  • Quote (Campbell, 56:03):

    “...unapologetically recruiting... women who claim they cannot lose weight through traditional dieting.”

Notable Quotes & Moments

• On Traditional Advice Failing:
  Campbell (05:37):

  “At first I had no idea because it was new to me.... All my research was in younger, metabolically healthy women... Every time we reduced calories, they would always lose fat. And I... was one of the biggest advocates for calories in, calories out.”

• On HRT Benefits Beyond Weight:
  Seeman (14:47):

  “I’m a fan of HRT for a variety of reasons that have nothing to do with body composition—less diabetes, less cardiovascular disease, less osteoporosis, less colon cancer... a 30% reduction in all cause mortality.”

• On Sleep as a Foundation:
  Seeman (34:39):

  “Sleep is like a skill... I think that’s a puzzle piece that if you’re not sleeping well, you gotta focus on that first.”

• On the Only ‘Magic Drug’:
  Seeman (47:23):

  “Weightlifting is the only non pharmacological intervention that has ever been consistently shown to offset age-related declines in skeletal muscle mass, strength and power. So, if you want a magic drug, weightlifting is the best magic that we have.”

Timestamps for Major Segments

• 00:00-02:15: Introduction to Dr. Campbell and his credentials.
• 02:15-05:37: Dr. Campbell’s personal impetus for menopause research.
• 05:37-11:21: Early theories on estradiol’s role and the variability in outcomes.
• 11:21-15:42: Clinical observations; is menopause a special case?
• 15:42-22:43: Weight loss principles by age; aggressive vs. traditional approaches.
• 24:04-25:22: Importance and pitfalls of calorie tracking.
• 26:20-27:05: Exercise recommendations for menopausal women.
• 29:27-31:37: Exercise volume, overtraining, and cortisol.
• 31:05-36:11: The role of sleep in fat loss and resistance.
• 36:11-37:59: Progesterone and sleep; benefits in perimenopause.
• 37:59-39:00: GLP-1s and menopausal weight loss resistance.
• 39:00-42:27: HRT usage in fit vs. general populations.
• 42:27-46:32: Estrogen, muscle mass, and bodybuilding principles.
• 48:21-51:45: Supplements (creatine/protein) and macro guidance.
• 53:33-54:33: Seeman’s ketogenic bodybuilding prep experience.
• 55:11-58:18: Ongoing virtual research studies and recruitment.
• 58:18-61:00: Study logistics, limitations, and recruitment email.
• 61:00-end: Outro and thanks.

Final Thoughts

This episode delivers a nuanced, evidence-based, empathetic take on the challenges women face during menopause—particularly those living a fitness lifestyle and feeling the sting of “doing everything right” yet not seeing results. Dr. Campbell and Dr. Seeman argue for foundational lifestyle change, individualized responses, maintaining optimism, and above all, never undervaluing the power of resistance training, protein intake, and good sleep. Their ongoing research—and invitations for listener participation—signal that the science is far from settled, but help for women feeling overlooked is on the way.

For more information, you can connect with Dr. Campbell on Instagram @billcampbellphd or via email at B.Campbell@usf.edu.
Dr. Seeman’s clinic—a resource for DEXA scans—is in Omaha, NE at Upgrade Performance Institute.