Obesity continues to increase in the U.S., and while there are no significant differences between men and women when it comes to obesity rates, women experience different effects of their obesity. Hormonal differences, like Polycystic Ovary Syndrome (PCOS), and the implications of obesity for fertility illustrate some of the ways in which women’s experiences with obesity diverge from those of men.
Obesity can lead to hormonal fluctuations in women, including hypoestrogenism. Estrogen, the primary female sex hormone, influences fat distribution and metabolism. During different life stages, such as puberty, pregnancy, and menopause, estrogen levels change significantly, impacting body weight and fat distribution. For example, during menopause, declining estrogen levels are associated with an increase in abdominal fat, which is linked to higher risks of cardiovascular disease.
Polycystic ovary syndrome is a common endocrine disorder affecting 6 to 10% of women of reproductive age and is closely linked to obesity. This condition includes insulin resistance, which can lead to weight gain and slower weight loss rates. The relationship between PCOS and obesity is bidirectional; obesity exacerbates the symptoms of PCOS, and the hormonal imbalances associated with PCOS contribute to obesity.
Subfertility, or the failure to conceive after one year, is a side effect of PCOS and obesity more broadly. Excess body weight can disrupt hormonal balance, leading to irregular ovulation or anovulation (lack of ovulation), which can hinder conception. Additionally, obesity is associated with increased levels of insulin and inflammation, both of which can adversely affect reproductive health. Women with PCOS can experience a more pronounced effect on their fertility because insulin resistance can lead to a more extreme hormone imbalance.
A provocative headline associated with the increase in press coverage of obesity medications is the concept of “Ozempic Babies.” Women who previously had fertility issues were experiencing surprise pregnancies after starting semaglutide treatment. These pregnancies likely reflect the effects of weight loss on excess estrogen levels and ovulation.
Hormonal imbalances and fertility struggles are not distributed evenly across all women. Disparities exist between racial groups, as revealed by a study of IVF outcomes among women with overweight and obesity. Failure to achieve pregnancy was higher among women with obesity as a whole, but particularly for Black and Asian women with obesity. Rates of live births are lower among Black, Asian, and Hispanic women with obesity. Both of these outcomes emphasize the importance of access to obesity care for women to improve their reproductive health.
The need for improved access to care is aptly illustrated by a recent article that described marked disparities in the need for care; almost 62% of adult Black women were eligible for obesity care. Access to health care and coverage of obesity treatment are essential for the women who need it. To promote health equity, advocacy should begin by expanding care for those who face the highest rates of complications from their obesity.