Johanna Finkle, MD, on weight loss management in reproductive-aged patients

Effective weight loss counseling and medication management for reproductive-aged women requires ob-gyns to be familiar with clinical obesity definitions, contraceptive considerations, and both short- and long-term pharmacologic treatments, according to Johanna Finkle, MD, weight loss specialist and ob-gyn at The University of Kansas Health System, in her presentation at the 2025 ACOG Annual Clinical and Scientific Meeting held in Minneapolis Minnesota from May 16 to 18, 2025.

Johanna Finkle, MD, weight loss specialist, OB/GYN, The University of Kansas Health System.

Clinical eligibility and reproductive intent

In an interview with Contemporary OB/GYN, Finkle emphasized that the initial assessment should follow guideline-based criteria. “You need to see if the patient has a BMI greater than 30 or has a BMI between 27 and 29.9 with a comorbidity related to their weight,” she said. Comorbidities include hypertension, diabetes, polycystic ovary syndrome, and sleep apnea.

Once eligibility is determined, Finkle advised that clinicians evaluate the patient’s reproductive goals. “Are they trying to conceive at this point? Are they going through fertility treatments, or are they on contraception?” she asked.

For patients on contraception, GLP-1 receptor agonists can reduce the effectiveness of oral contraceptives. “You need to make sure that they’re using backup if they’re on an oral contraception…because it becomes less effective and they can have a pregnancy,” Finkle said.

Weight loss medications and contraceptive implications

Finkle categorized weight loss medications into short- and long-term use. Short-term options include sympathomimetic amines such as phentermine, generally prescribed for up to 12 weeks, though duration may vary by state regulations.

Long-term oral medications include orlistat, phentermine/topiramate, and naltrexone/bupropion. Phentermine/topiramate is a combination of a stimulant and an anti-seizure medication, and Finkle noted a critical risk: “It can cause cleft lip and palate. And so you really need to counsel about birth control.” Topiramate may also decrease the effectiveness of oral contraceptives.

Given these risks, Finkle counsels patients on long-acting reversible contraception (LARC). “For example, an IUD would be the best. It would interfere with their weight gain and would protect them while…on a medication like phentermine/topiramate,” she said.

Injectable GLP-1 receptor agonists include liraglutide (daily), semaglutide (weekly), and tirzepatide (weekly). Effectiveness ranges from 7%–10% weight loss with liraglutide, to 15% with semaglutide, and approximately 20% with tirzepatide. “Tirzepatide has the least amount of side effects,” Finkle noted, but cautioned about cost, as these medications can exceed $1,000 without insurance coverage.

Surgical considerations and updated anesthesiology guidance

Finkle addressed updated guidelines regarding the use of GLP-1s prior to surgery. “Before, the guidelines stated that you had to be off the GLP-1s for a week,” she said. “But now it’s changed to just be on a full clear liquid diet for 24 hours, and then they do an ultrasound to see how much residual is left.”

Because these medications slow gastric motility and increase satiety, residual stomach contents can elevate aspiration risk during surgery.

Shifting to a non-stigmatizing, evidence-based model

Newer definitions of obesity as a disease state, including one recently published in The Lancet in 2025, reflect a shift in medical framing. “It looks at it as an illness that causes systemic issues and organ damage,” Finkle said. Clinicians are now encouraged to assess “clinical adiposity and preclinical adiposity” to evaluate whether fat mass is contributing to medical complications.

Finkle recommended beginning patient conversations by asking, “Is weight an issue…you’re interested in discussing today?” From there, she advised focusing on cardiometabolic markers such as lipid panels, blood glucose, and signs of sleep apnea.

“Noticing that you only have to reduce someone’s weight by 10% to make a clinical impact…is important,” she said, citing benefits such as reduced hypertension and diabetes risk.

Overcoming clinical barriers

Finkle acknowledged the challenge ob-gyns face in integrating obesity medicine into already compressed clinical visits. “How am I going to integrate, you know, obesity medications into my practice?” she said. “I only have 15 minutes to see someone and talk about perhaps birth control or perimenopause…Pap smear…clinical breast exams…order mammography.”

To address this, Finkle dedicates a specific day in her schedule for weight management visits. “My built out for my schedule is different…those patients require a lot more time than a 15-minute visit,” she explained. These visits involve “a lot of counseling and a lot of motivational interviewing techniques.”

She encouraged her colleagues to approach obesity care through the full “pillars of obesity medicine,” which she defined as “nutrition, exercise, and lifestyle modification”—alongside appropriate medication use.

Disclosure:

Finkle reports no relevant disclosures.

Reference:

Finkle J. Anti-Obesity Medications: What Obstetrician-Gynecologists Need to Know. Presentation. Presented at: 2025 American College of Obstetricians and Gynecologists (ACOG) Annual Clinical and Scientific Meeting. May 16-18, 2025. Minneapolis, Minnesota.