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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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Patient Case 3: Taylor, 40-Yr-Old Woman, G3P2

Taylor is a 40-year-old woman who is 2 years postpartum. Her prepregnancy BMI was 30 kg/m2, and her current BMI is 37 kg/m2. She has a history of preeclampsia, which required cesarean delivery. She has tried multiple diets and exercise routines over the years, all of which have failed her. She is juggling work and raising 2 young children. She says, "It is so hard to lose weight. I work all day, and I have 2 kids under 5." Taylor wants something that will actually help her with long-term weight loss.

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“Weigh-In”: How confident are you in considering comorbid conditions when managing obesity?

Patient Case 3 Discussion

Taylor represents the patients who have tried lifestyle modifications repeatedly without success. Now she needs to step up her treatment. With evidence-based tools, her OB/GYN HCP should talk with her about options like incretin-based therapies or surgery. These may be a turning point in her care. 

This conversation will be about moving away from "try harder" to "try differently" with the right support, the right treatment, and realistic long-term goals. This is where OB/GYN HCPs can make a big difference for patients by partnering with them. An OB/GYN HCP may be the only person that patients are seeing regularly. It cannot be assumed that they are following up with endocrinology, primary care, or other subspecialty HCPs or that these conversations are happening with other HCPs.

However, patients want to have these conversations, and they want to feel safe when they are having these conversations, so discussions should move away from blame and shame and meet the patient where they are in their care. Conversations about physical activity do not have to be about a 5K run. Rather, HCPs can partner with patients in looking at their nutrition, sleep, and physical activity to help identify ways they could incorporate more activity into their routine. For example, patients who typically sit at a desk for work could use a standing desk, or a patient could do something active with their kids instead of going to an exercise class. Once lifestyle pillars have been addressed, HCPs can introduce other options like incretin-case therapy or metabolic/bariatric surgery.

SURMOUNT Program Post Hoc Analysis: Tirzepatide in Overweight or Obesity by Reproductive Stage

Considering incretin-based therapies, a post-hoc analysis of SURMOUNT program data looked at tirzepatide vs placebo across the reproductive stages (ie, premenopause, perimenopause, and postmenopause). More than 2500 women who participated in the SURMOUNT-1, -3, or -4 clinical trials were included in the post-hoc analysis. Treatment duration was approximtely 72 weeks.51 Of note, the post-hoc analysis demonstrated not only weight loss, but metabolic benefits associated with tirzepatide use.

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SURMOUNT Program Post Hoc Analysis: Outcomes

The SURMOUNT post-hoc analysis demonstrated consistent weight loss with tirzepatide, regardless of reproductive stage. On average, women lost 23.6% to 26.2% of their body weight with tirzepatide 15 mg vs 2.4% to 3.3% with placebo. Waist circumference also significantly dropped with tirzepatide vs placebo. Of more importance, the proportion of patients achieving 20% weight loss or more was striking: 73% in the premenopause group, 69% in the perimenopause group, and 71% in postmenopause group.51 The outcomes revealed in this post-hoc analysis approach some metabolic/bariatric surgery outcomes, and this is a critical point for our patients in midlife.

The post-hoc analysis of these data shows promising results, provides insights on the potential benefits for patients in peri- or postmenopause, and highlights a beautiful opportunity to partner with our patients.

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Metabolic Outcomes With AOMs

Beyond weight loss, it is helpful to understand how AOMs affect metabolic health. Data from a systematic review of 154 randomized, controlled trials with more than 112,000 patients show that virtually all AOMs improve metabolic markers, but the degrees to which they do so vary. The incretin-based therapies stand out, and considering reductions in A1C and triglycerides, it is understandable how these effects could translate to lower cardiovascular and diabetes risk.52

Most of us are familiar with some of these agents from a diabetes standpoint. I hope you are already familiar with the recent tirzepatide indication for treating moderate to severe obstructive sleep apnea in adults with obesity.28 Semaglutide also has indications beyond weight reduction; it is indicated to reduce the risk of major adverse cardiovascular events in adults with obesity or overweight and established cardiovascular disease and to treat noncirrhotic metabolic dysfunction–associated steatohepatitis with moderate to advanced fibrosis in adults.27

There are likely to be more indications for incretin-based therapies. In working with these agents every day, it is clear that an overwhelming number of patients say they feel better. Furthermore, their inflammation is down, and they are participating in life in a slightly different way. These agents are not magic. They support lifestyle changes, and that is really what we come back to. 

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AOMs and Metabolic Conditions

Individual AOMs are associated with improvement in specific metabolic conditions. In particular, liraglutide, semaglutide, and tirzepatide provide broad metabolic benefits that should be very useful in women’s health. They have been associated with benefits in T2D and MASLD.5,26-28 Liraglutide and semaglutide have also been associated with benefits in atherosclerotic cardiovascular disease, and evidence for tirzepatide is pending.

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Optimizing Changes in Body Composition During Weight Loss

Coming back to nutrition and physical activity, it is critical to counsel patients on the key importance of these interventions. OB/GYN HCPs must counsel patients that obesity management is not just about the number on the scale. It is about preserving muscle, reducing visceral fat, and improving metabolic health. This means that patients need to hear about the importance of high-protein intake and promoting fat loss while preserving lean muscle mass. Patients need to feel fuller, lose more fat, and maintain better satiety, and this is where protein has an important role. With regard to physical activity, moderate resistance and endurance exercise are important.53,54 And these are all the different pieces that we should be looking at.

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Key Takeaways

What are the key takeaways? First OB/GYN HCPs are in a unique position to support women with obesity management across their lifespan. This includes obesity management in patients with PCOS, patients who are pregnant, patients between pregnancies, and beyond into midlife. OB/GYN HCPs have important roles in obesity management, and they may be the only HCP addressing the issue for any given patient.

The way weight is discussed matters. OB/GYN HCPs should be respectful, use patient-first language, and set the tone for shared decision-making that will build trust. 

Further, ensure that treatment options for each patient are clearly explained. OB/GYN HCPs should be aware of available AOMs and what is coming down the pipeline because these therapies are not going away. Whether you are going to be prescribing AOMs yourself or you are seeing patients who are already on AOMs, you must know about them. Ask patients the questions needed to understand where they are in their life plan and health care and how obesity management, including AOMs, fits in the picture.

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