Tailoring Weight Management Conversations Across a Woman’s Lifespan

In her presentation Anti-Obesity Medications: What Obstetrician-Gynecologists Need to Know, at the 2025 American College of Obstetricians and Gynecologists Annual Clinical and Scientific Meeting, Johanna Finkle, MD, from the University of Kansas Health System, discussed obesity as a chronic disease that impacts women from adolescence to menopause. How can clinicians tailor weight management conversations to women at different life stages? In the video above, Dr Finkle shares practical strategies for tailoring weight-related counseling in the context of polycystic ovary syndrome (PCOS), pregnancy, the postpartum period, and menopause. From preconception fertility to midlife hormonal changes, Dr Finkle highlighted the importance of timely education and personalized guidance to support long-term health.

The following transcript has been edited for clarity, style, and length.

Patient Care: How should clinicians tailor weight management conversations at different stages of a woman's life?

Dr Finkle: During my presentation, I focused on 3 key stages in a woman’s life, but weight concerns can arise across the entire lifespan.

PCOS, for example, affects about 10% of women of reproductive age, and 60% to 80% of those women have pre-obesity or obesity. At this stage, many women may be thinking about conception. PCOS can cause menstrual irregularities, and even a modest weight loss—just 5% to 7%—can restore menstrual regularity and improve the chances of spontaneous pregnancy. So, preconception counseling should include education about the link between PCOS and weight, and how weight loss can support fertility.

During pregnancy, obesity increases the risk for complications like gestational diabetes, hypertensive disorders, and the need for cesarean delivery. It's important to educate patients on these risks and counsel them on appropriate weight gain. For those with obesity, the Institute of Medicine recommends gaining only 11 to 20 pounds during pregnancy.¹ Counseling should also address healthy eating, physical activity, and sleep—lifestyle modifications that are safe and beneficial during pregnancy.

In the postpartum period, breastfeeding requires only about 500 extra calories per day. This is a good time to reinforce healthy eating habits, resume physical activity, and, once breastfeeding is complete, potentially consider anti-obesity medications—especially before the next pregnancy.

Then there's perimenopause and menopause, when hormonal changes impact sleep, appetite, mobility, and joint pain. Estrogen decline also leads to fat redistribution, especially in the central and visceral regions. Weight gain is common during this transition, so early counseling is critical. I start discussing it before women reach their 40s. By the time they’re in perimenopause, symptoms and weight gain have often already begun. So, I recommend addressing these issues in their 30s—talking about what to expect in their 40s and beyond. It’s a great opportunity to help patients prepare for a healthy next phase of life.

Reference:

1. American College of Obstetricians and Gynecologists. ACOG Committee opinion no. 548: weight gain during pregnancy. Obstet Gynecol. 2013;121:210-2. doi: 10.1097/01.aog.0000425668.87506.4c