During the International Congress on Obesity (ICO) 2026, held in Mexico City, Mexico, and organized by the World Obesity Federation, speakers discussed the link between obesity and menopause. Specialists highlighted the importance of recognizing this interaction early in order to develop individualized interventions and treatments that address each patient’s needs, with an emphasis on empathetic, stigma-free care.

Menopause alters body composition, leading to increased fat accumulation in the abdomen. Symptoms during this stage can be exacerbated in women with obesity, requiring comprehensive care that addresses hormonal factors, weight loss, physical activity, and psychological support.

The panelists agreed that treatment for menopause should not begin only when menstruation ceases but rather in the years leading up to this transition, when interventions during perimenopause may help prevent muscle loss, visceral fat gain, and metabolic changes — all of which are more difficult to reverse once established.

However, they cautioned that it can be difficult to identify the onset of perimenopause, which hinders early treatment initiation. They also highlighted barriers to adherence to obesity treatment during this stage.

Therefore, they recommended avoiding one-size-fits-all advice and instead adopting a clinical approach to menopause and obesity that is tailored to each woman’s metabolic condition, symptoms, financial circumstances, and daily life, with gradual goals that can be sustained over time.

Changes in Body Composition During Menopause

Changes associated with menopause can begin several years before the permanent cessation of menstruation. Ada Cuevas, MD, director of the Center for Advanced Metabolic Medicine and Nutrition in Santiago, Chile, explained that symptoms can appear up to 4 years earlier and that one of the most significant changes occurs in fat distribution. Fat begins to accumulate in the torso, abdomen, arms, and breasts, whereas muscle mass is lost, primarily in the buttocks and lower extremities.

Otilia Perichart, PhD, nutritionist and medical sciences researcher, Instituto Nacional de Perinatología, Mexico City, noted that the decline in estrogen and progesterone promotes fat gain and a reduction in lean body mass. In addition, adipose tissue shifts away from the hips and buttocks and starts to accumulate in the abdominal area.

“This abdominal fat — visceral fat — behaves differently: It promotes inflammation and metabolic disturbances,” she explained. Over time, it can infiltrate muscle and liver tissue, increasing cardiometabolic risk. “All women will go through this change in body composition. The key is how to mitigate it.”

Cuevas added that during this stage, resting energy expenditure decreases, which, combined with the loss of muscle mass, can make it more difficult to maintain or lose weight. “We enter a conservation phase: We function the same, but the caloric intake we used to consume may now be excessive.”

Obesity can exacerbate menopausal symptoms, such as sweating, sleep disturbances, mood changes, and urinary incontinence. Cuevas warned that the two conditions can act synergistically and increase the risk for chronic disease.

For this reason, she recommended that women with obesity undergo screening for cholesterol, glucose, and insulin before or during menopause. Early intervention would allow clinicians to identify metabolic abnormalities and begin treatment before visceral fat increases.

Hormone Therapy

Hormone therapy during menopause is primarily used to relieve vasomotor symptoms and mood changes. However, the specialists emphasized that it should not be considered a treatment for weight loss.

“Hormone therapy does not reduce body weight, but it does not increase it either,” Cuevas said. Its main effect on body composition is to help ensure that the redistribution of adipose tissue toward the abdominal area is not as pronounced.

She explained that studies show hormone therapy does not reduce weight or total body fat compared with placebo, but it can mitigate central and visceral fat accumulation, especially when started early. It may also preserve lean body mass and improve insulin sensitivity and lipid profile, although oral formulations may moderately raise triglyceride levels.

Perichart agreed that this therapy is aimed primarily at managing symptoms and risks associated with menopause. “It can help alleviate this distribution of fat mass in the abdomen, but what we really need are lifestyle changes.”

Cuevas presented recent results on the combined use of hormone therapy with semaglutide or tirzepatide in postmenopausal women with overweight or obesity. Studies showed greater weight loss among those who received both therapies than among those who used only the obesity drug. However, she stressed that the choice of treatment must be individualized and take into account medical history and comorbidities.

Cuevas noted that GLP-1 receptor agonists have been shown to reduce weight and body fat and improve glucose, insulin, and lipid levels. However, she acknowledged that their cost limits access and continuity of care.

“There are patients who tell me, ‘I could afford it for 2 months.’ I’d prefer that we look at another option — perhaps a more affordable one — but one that can be sustained over time,” she said.

Healthy Lifestyle and Stigma-Free Care

Perichart emphasized that the goal of obesity treatment should not simply be weight loss but preservation of muscle mass. “More than reducing weight, I’m concerned with reducing fat and preserving muscle mass; interventions are aimed at that.”

To achieve this goal, she said, the Mediterranean diet or the Dietary Approaches to Stop Hypertension diet may be appropriate. These approaches include vegetables, fruits, legumes, whole grains, healthy fats, fish, and eggs, while reducing consumption of meat and ultraprocessed foods. Replacing high-energy-density products with natural foods allows for a moderate reduction in caloric intake without an excessively restrictive diet.

She also advised ensuring adequate protein intake. At this stage, a goal of 20-30 g per meal is recommended because insufficient protein can affect satiety and hinder muscle preservation. However, she cautioned that increasing protein intake without exercise does not build muscle on its own.

Perichart emphasized that diet must be accompanied by aerobic exercise and strength training. She recommended starting physical activity gradually, aiming for 150 min/wk, whether through walking, dancing, swimming, or cycling.

To preserve muscle mass, she advised doing resistance exercises two or three times a week, adding that it is not necessary to lift heavy weights but rather to perform routines with resistance bands or body weight exercises.

Both specialists advised that these lifestyle changes should be gradual and adapted to patients’ daily routines to support long-term adherence. “You can’t follow a textbook diet from day 1; you have to assess what a woman is capable of, what comes easily to her, and what she finds difficult,” Perichart said.

She added that when caring for patients going through menopause, psychological support must also be considered because of the emotional changes experienced during this stage, as well as the stress or anxiety that changing habits can cause.

Cuevas urged healthcare professionals to recognize that fatigue, weight gain, and reduced activity are not simply a matter of willpower. “It’s important to treat patients with kindness and understanding.”

She recommended explaining that these changes are not the woman’s fault and offering realistic alternatives, such as starting with walks, free exercise tutorials, resistance bands, or small dumbbells. “We have to be very approachable and understand the patient,” she said.

The experts emphasized that comprehensive management requires coordination among gynecologists, endocrinologists, nutritionists, psychologists, and physical activity professionals. They agreed that menopause is a stage at which quality of life should be improved and a sustainable, long-term, stigma-free treatment plan should be developed.

Cuevas and Perichart disclosed having no relevant financial relationships.

This story was translated from Medscape’s Spanish edition.