Background Obesity is increasingly recognized as a risk factor for several malignancies, including cervical cancer. Women with obesity participate less frequently in screening and may have higher rates of unsatisfactory cytology, potentially affecting cervical lesion detection. This study evaluated the association between BMI and high-grade cervical intraepithelial neoplasia (CIN) in a referral cohort. Methods In this single-center retrospective study, clinical and histopathological data from 257 women referred to the dysplasia unit clinic of Hannover Medical School (Germany) between January 2021 and December 2025 were analyzed. BMI was categorized as normal (<25 kg/m²), overweight (25–29.9 kg/m²), and obese (≥30 kg/m²). The primary outcome was high-grade cervical lesions (CIN 2/3/AIS). Logistic regression assessed associations between BMI and high-grade lesions, adjusting for age, gravidity, and smoking. Results Overall, the distribution of histological findings showed numerically higher proportions of CIN 3 with increasing BMI, although this difference did not reach statistical significance (p = 0.055). Increasing BMI was significantly associated with high-grade lesions (OR 1.61, 95% CI 1.02–2.52, p = 0.040), remaining significant after adjustment (OR 1.74, 95% CI 1.01–3.00, p = 0.048). HPV genotype distribution (p = 0.784) and cytological findings (p = 0.34) were comparable across BMI groups. Conclusion Higher BMI was associated with an increased likelihood of high-grade cervical intraepithelial neoplasia in women referred for dysplasia evaluation. Similar HPV and cytology distributions suggest that this association may reflect differences in timing of diagnosis or clinical detection rather than underlying HPV patterns.
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