TOPLINE

A narrative review found that obesity-related health risks evolved at different stages of life in women. Newer weight-loss medications, especially GLP-1 drugs, showed promising results for weight and metabolic health, but experts called for more research on their safety and effectiveness at each specific life stage.

METHODOLOGY

• Nearly 42% of women in the US aged 25 years or older were living with obesity in 2021 — a figure projected to climb to almost 59% by 2050 — yet major gaps remain in understanding how obesity medications affect women's health throughout the reproductive years, pregnancy, menopause, and older age.
• Researchers conducted a narrative clinical review to examine how obesity-related risk factors, comorbidities, and treatment considerations affected women across four life stages (puberty, reproductive age, perimenopause, and postmenopause).
• They also evaluated how obesity medications (nonincretin agents, GLP-1 receptor agonists [GLP-1 RAs], and dual GIP/GLP-1 RAs) affected health outcomes at each life stage.
• The review covered English-language peer-reviewed studies published between 2015 and 2025, with sources selected based on how well they matched the review's broad scope.
• Findings were supplemented by expert perspectives from a virtual, asynchronous Women's Health and Weight Management advisory board whose physician members collectively specialized in endocrinology, infertility, women's health, obesity medicine, and obstetrics/gynecology.

TAKEAWAY

• Obesity in childhood is linked to earlier and prolonged pubertal transition; in adolescence, it is tied to several comorbidities, including metabolic dysfunction-associated steatotic liver disease, hypertension, type 2 diabetes, dyslipidemia, and more severe polyendocrine metabolic ovarian syndrome (PMOS; the recently renamed term for polycystic ovary syndrome).
• During reproductive years, obesity is associated with infertility, PMOS, menstrual irregularities, and pregnancy complications, including miscarriage, preeclampsia, gestational diabetes, stillbirth, venous thromboembolism, postpartum hemorrhage, cesarean delivery, and congenital birth defects.
• Obesity-related complications in women going through perimenopause include cardiometabolic problems, hot flashes and night sweats, poor sleep, and mental health symptoms. In postmenopause and older age, obesity has been linked to higher rates of several cancers (esophageal, renal, endometrial, breast, and ovarian), osteoarthritis, declining physical function, and loss of bladder control.
• Obesity medications were effective for weight loss across all life stages. Drugs such as phentermine, phentermine-topiramate, and certain GLP-1s were approved for adolescents. Obesity medications reduced PMOS symptoms and improved menstrual regularity; however, data were mixed. None were approved in pregnancy or during breastfeeding, and discontinuation was required before conception. Later in life, semaglutide reduced major cardiovascular events and tirzepatide improved sleep apnea outcomes; however, the effects of obesity medications on bone health, the risk for cancer, physical function, frailty, and bladder control remained largely understudied.

IN PRACTICE

"Obesity management is most effective when treatment is individualized to patients and when culturally sensitive interventions are considered," the authors wrote.

"Considerations should include the patient's life stage. During childhood and puberty, additional focus on addressing obesity during preventive health visits is needed, and obesity medications (OMs) should be considered. For women in menopause, midlife changes significantly impact weight gain trajectories. Large trials are needed to demonstrate OM-mediated improvements in menopausal weight issues, cardiometabolic risk, fertility and PMOS, and cancer. Obesity and overweight should be treated as chronic diseases and education on newer OMs and their use should be prioritized," they added.

SOURCE

This study was led by Melanie G. Cree, University of Colorado School of Medicine, Aurora, Colorado. It was published online in Obesity Pillars.

LIMITATIONS

No limitations were explicitly mentioned in the study.

DISCLOSURES

Novo Nordisk Inc. provided financial support for medical writing and the open access fee. Novo Nordisk also sponsored the advisory board, which included three of the review's own authors among its participating experts. The authors reported receiving fees, grants, or research support, serving as consultants, speakers, or advisors, holding equity in a women's health company, having board memberships, and holding other ties with various pharmaceutical companies, including the funding agency.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.