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Obesity Management During Reproductive Years
Clinical Queries: Expert Insights to Improve Obesity Management During Reproductive Years 

Released: January 20, 2026

Celia Egan
Celia Egan, MD, MSCP, DABOM
Kimberley Sampson-Paine
Kimberley Sampson-Paine, MD, MSc, FACOG, DipABLM, DipABOM, MSCP, FOMA
Samantha B. Schon
Samantha B. Schon, MD, MSTR
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Michelle (24-year-old, G0P0) is in your office for a well visit. She was diagnosed with PCOS 8 years ago and continues to have irregular menses. She has been overweight (BMI 28-29 kg/m2) since her teens, but she was able to prevent further weight gain with brisk walking 30-45 minutes 3-4 days/week, strength training 2 days/week, and a diet with limited carbohydrate intake until about 2 years ago, when she went through some life changes. As she finished her education degree, got married, and started a teaching position, she gained weight. Although she continued with the diet and activity regimens that had helped her maintain weight in the past, her BMI increased to 33 kg/m2. She has experienced negative impacts on blood pressure, lipid levels, and blood glucose levels, and she has been diagnosed with moderate obstructive sleep apnea (OSA). Her waist circumference and cardiometabolic markers indicate metabolic syndrome in addition to PCOS. Michelle and her partner plan to have children, although not for several years. Her older sister, who also has PCOS and obesity, had trouble conceiving and was advised to achieve a 20% weight loss to improve her chances of getting pregnant. Based on her sister’s experience, Michelle wants to lose 20% of her current weight (approximately 40 lb [18 kg]) so she can minimize her chances of fertility problems. She would also like to lose the weight to improve her cardiometabolic health (blood pressure, lipids, blood glucose) and possibly regulate her menstrual cycle. Because she was able to maintain her weight with lifestyle management in the past, she thinks she should be able to reach this goal if she participates in an intensive lifestyle-based program.

Examination:

  • Height: 65 in (165 cm)
  • Weight: 199 lb (90 kg)
  • BMI: 33.1 kg/m2
  • Waist circumference: 49 in (124 cm)
  • Blood pressure: 131/81 mm Hg

Laboratory results:

  • A1C: 6.1%
  • Total cholesterol: 225 mg/dL
  • Low-density lipoprotein cholesterol (LDL-C): 146 mg/dL
  • High-density lipoprotein cholesterol (HDL-C): 44 mg/dL
  • Triglycerides: 175 mg/dL

Medications (example):

  • Metformin: 850 mg QD

Which of the following would you provide to Michelle as the best advice for identifying reasonable treatment goals?