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Obesity Care in Obstetrics and Gynecology

CE / CME

Obesity Management During Women’s Reproductive Years: Expert Insights to Your Clinical Queries

Physician Assistants/Physician Associates: 1.00 AAPA Category 1 CME credit

Nurse Practitioners/Nurses: 1.00 Nursing contact hour

Physicians: maximum of 1.00 AMA PRA Category 1 Credit™

Released: October 29, 2025

Expiration: October 28, 2026

Kimberley Sampson-Paine
Kimberley Sampson-Paine, MD, MSc, FACOG, DipABLM, DipABOM, MSCP, FOMA
CME/CE Information

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Course Completed

Patient Case 2: Raychel, 28-Yr-Old Woman, G1P1

Raychel is a 28-year-old woman who is 1 year postpartum after her first child. She has gained significant weight since her delivery. Her BMI is 36 kg/m2, which is up from 28 kg/m2 pre pregnancy. She had gestational diabetes with her first pregnancy and is concerned about recurrence in her next. She hopes to conceive her second child in the next 2-3 years. 

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“Weigh-In”: How confident are you in discussing weight management in a well woman visit?

Patient Case 2 Discussion

Raychel is typical of patients who OB/GYN HCPs see every day. It is certainly important to reduce the risk of gestational diabetes and optimize Raychel’s weight so she feels healthier before her next pregnancy.

Raychel may be facing several barriers to weight loss. Because she has a child at home, childcare demands may affect what Raychel is able to do regarding lifestyle approaches. She may not feel she has enough time for herself, let alone the time needed to participate in a structured lifestyle intervention. Fatigue is another barrier. In addition to caring for a child, maybe Raychel is working. Many of these additional demands can play a part in overweight and obesity after pregnancy. One approach is to optimize lifestyle components first, then consider AOMs.

The situation can be complicated. Is she still nursing? Is she able to sleep? Is she back at work? What does her support system look like? Does she have access to fruits and vegetables? If OB/GYN HCPs take the time to ask these questions and understand the patient, they can better provide personalized care.

It takes time, but without asking these questions, HCPs cannot meet patients where they are in their care. Because time is often a limitation, it may be necessary to use other approaches to get these answers like developing questionnaires or partnering with colleagues on other teams (eg, social workers, lactation specialists, dietitians). This is a team sport. Patients may even provide different information to individual team members (eg, physician, medical assistant, medical student), and then it can be helpful to collectively consider and address the pieces of the puzzle.

There are additional considerations for Raychel if she is currently nursing. What treatments are approved for patients who are breastfeeding? What nutrition should the patient get?41 What is a safe rate for weight loss during breastfeeding?42 These are all topics that HCPs should be talking about in discussions with patients about treatment goals in order to provide tailored treatment.

There are also questions regarding the use of supplements. For example, myo-inositol supplementation is generally used for patients with PCOS. There is some evidence that myo-inositol supplementation may reduce incidence of gestational diabetes in pregnant women with or without PCOS.43 But certainly with the use of supplements, HCPs must ensure patients understand what is safe, regulated, and approved. These things are also often very expensive. How do we integrate that into patients' care plan? Specifically with infertility, supplements are raising our hopes and expectations and providing indications of research needs. 

Starting the Discussion

What is the best way to start discussions about weight management during well-woman visits, particularly between pregnancies? The key message here is that interpregnancy intervals are a critical time for obesity intervention, and everyone on the healthcare team plays a part. But it is not about perfection; it is about meeting patients where they are in their care.

It also is about progress and planning. Going back to the 5A’s of shared decision-making, it is important to ask permission to discuss weight, which signals respect and helps to avoid stigma.

The next step is getting a weight-specific history. What factors have influenced the patient’s weight? When you partner with patients, they often will tell you stories from their life. They may tell their entire story. OB/GYN HCPs are actually the perfect people to hear these personal stories because it is what they do in many other contexts.

It is worthwhile to take the time to learn about patients’ weight-specific history, because HCPs should not make assumptions about patients’ weight status. Just because a patient is sitting in front of you and has a flag on their record for increased BMI, it does not mean that your discussion should focus on the patient’s relationship with food. Just because the BMI says one thing, HCPs do not know the full truth until they ask the right questions about patients’ histories. For example, a patient may be restricting their calories and actively trying to lose weight. So dig in and be curious.33,44

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Avoiding Stigma When Discussing Weight Management

The language used in discussing weight and obesity makes a huge difference. As OB/GYN HCPs, we have a responsibility for how we use language. Specifically, we must avoid negative terms like “morbidly obese.”

This concept extends to codes that are selected in a patient’s EHR. OB/GYN HCPs should use codes that specify obesity class. This is something that can be readily implemented in practice. In addition, HCPs should explain to patients what these codes mean. Do not just write in the medical note that a patient has class I obesity; explain to the patient what that means and why it has been noted.

OB/GYN offices also must create an environment that is safe for all patients. Ensure you provide privacy and the appropriate equipment for all patients.45 How many times have you or a colleague shouted down the hall asking for a bigger gown or cuff? This is not okay. Take a good look at your office and/or clinics. Ask yourself, "Is this a safe place? Is this an inclusive environment?" You can make a huge difference in patients’ experience by providing safe environments with privacy and appropriate equipment. We can all do better, I promise.

These small steps will change the dynamic from judgment to partnership. I have had patients cry in my office because we gave them the correct gown or asked them the appropriate questions. They say, "Nobody has done this for me." These upgrades are so simple and go a long way.

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Managing Patient Expectations

HCPs also must manage patients' expectations. This is highly relevant, especially in the patient case about Raychel. What were her postpartum goals? Was she hoping to return to her prepregnancy weight within a year? Were we continuing to encourage her to breastfeed using a multimodal approach? In this preconception window, we can educate patients about obesity as a chronic disease and counsel them about its associated risks with fertility and pregnancy, and we can help set realistic goals. This is our golden opportunity.

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Obesity Management Considerations for Interpregnancy Intervals

Obesity management must be individualized. HCPs should choose AOMs or other weight loss strategies based on patients’ goals and comorbidities. With Raychel, we can choose AOMs or another strategy to help her lose weight before she conceives her next child.

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Considerations for Addressing Multiple Health Issues

When selecting an AOM for a patient, consider the agent characteristics in the context of the patient’s comorbidities and conditions. For example, an incretin-based therapy may be an especially good option for a patient with T2D and/or cardiovascular disease.26-28,46-48 If a patient’s primary issue is binge eating, there is a medication specifically (lisdexamfetamine) approved for that indication.49 If food cravings are a patient’s biggest problem, then naltrexone/bupropion may be the most appropriate treatment.50 Personalization is key; OB/GYN HCPs must individualize and tailor patient care.

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