As part of the ENDO 2025 session, “Obesity Management Across the Lifespan: Special Considerations,” Lisa Morselli, MD, PhD, talks about the unique challenges in obesity management in women during their reproductive years.
On Tuesday, July 15, ENDO 2025 here in San Francisco will feature a session titled, “Obesity Management Across the Lifespan: Special Considerations.” As the title suggests, the session will cover obesity management in special situations and age groups – promoting lifelong healthy behaviors in children and adolescents, addressing the challenges faced by women who have obesity during their reproductive years, and understanding the unique considerations of obesity management in the elderly.
For her part of the session, Lisa L. Morselli, MD, PhD, DABOM, of the Medical College of Wisconsin in Milwaukee, will deliver the talk on obesity management in women in their reproductive years, especially how obesity affects fertility, pregnancy itself, and overall wellness. “I will give an overview of issues specific to women of reproductive age when it comes to obesity and weight loss.”
More than 40% of women in the U.S. live with obesity and many countries have rates of over 20%, so this talk is not just clinically relevant to many in the endocrine field, it comes at the right time as new popular weight loss drugs may offer the chance to slim down but pregnancy and fertility need to be taken into consideration as well.
Drugs like tirzepatide can interfere with the absorption of oral contraceptives, says Morselli, and women should be counseled about the risk of unexpected pregnancy. At the same time, some forms of birth control can promote weight gain. Funambulism to be sure, but Morselli and her colleagues working in this area hope to at least provide a safety net.
Contraindications
Morselli tells Endocrine News that women living with obesity should ideally lose weight before conceiving and limit their weight gain during pregnancy to decrease the risk of harmful consequences for themselves and their offspring.
However, all anti-obesity medications (AOM) are contraindicated in pregnancy. “Then, an important question is: How do we balance the benefits of weight loss induced by AOM with the risk of significant weight regain due to stopping these drugs in preparation for pregnancy?” Morselli says. “We know that significant weight gain during pregnancy increases the risk of harmful consequences for the mother herself (gestational diabetes, pregnancy-induced hypertension, need for C-section, postpartum weight retention) and for the offspring (macrosomia, childhood obesity).”
The other side of this issue is that obesity is associated with decreased fertility. Morselli says that some of that is related to polycystic ovary syndrome (PCOS), but severe obesity can also impair the function of the hypothalamus-pituitary-gonadal axis.
“The literature on this topic consistently suggests that weight loss can improve fertility, i.e. the ability to become pregnant,” Morselli says. “Unfortunately, data about the rate of live birth or miscarriage is not as clear. Again, if using AOM in women of reproductive age, we need to understand the risk of weight regain when stopping medications in preparation for pregnancy.”
Saboteurs
Balancing weight and wellness is another seemingly high-flying act that Morselli works to support. Morselli says that for her, wellness should be a holistic approach to general well-being and health. “However, nowadays, we are exposed to a lot of marketing from ‘wellness’ centers or companies offering weight loss treatments that are not necessarily evidence-based,” she says.
Then there’s social media: It can be a useful tool to help people lose weight. There can be great information on there, or even just inspiring posts to help people keep going. But these platforms are rife with misinformation regarding wellness and weight loss methods. The Endocrine Society had to host an entire webinar about how the TikTok trend of “hormone balancing” isn’t a real thing and, as Morselli says, it can be difficult to discern the good from the bad. “We as medical providers also have to be careful about our messaging around weight loss: weight loss should be attempted to improve health or prevent future complications of excess weight, rather than to look good/conform to society pressure,” she says. “We do not want to trigger eating disorders or other mental health issues related to fat-shaming or bias, which are more prevalent in women.”
No One Path to Obesity
When young women come to her with the goal of losing weight to improve fertility, Morselli discusses the option of AOM, but also starts conversations about bariatric surgery, since, she says, that may be a more sustainable weight loss intervention and there is ample evidence for its long-term safety. “Bariatric surgery does carry a risk for small- for-gestational-age fetus but lower risk of other complications,” she says.
These conversations speak to the importance of individualized medicine, since, according to Morselli, the path to obesity is different for every person. “As a consequence, while there is a general consensus to approach weight loss, there is no one-size-fits-all intervention,” she says. “Weight-related comorbidities also need to be considered as they may impact ability to be physically active or which medications are more likely vs less likely to be useful.”
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