Beyond medication: rethinking postpartum obesity management in the era of increasing GLP-1 receptor agonist use

Obesity remains one of the most pressing public health challenges worldwide and is increasingly prevalent among women of reproductive age. 17 Beyond pregnancy and childbirth, the postpartum period offers an important opportunity for obesity prevention and health promotion because it influences women's long-term cardiometabolic health. 8 Persistent postpartum weight retention is common and is recognised as an important contributor to longterm obesity, cardiometabolic disease, and adverse outcomes in subsequent pregnancies. 2,6,10 Improving postpartum weight management has therefore become an important component of strategies to reduce the long-term burden of chronic disease among women. 8 In this context, glucagon-like peptide-1 receptor agonists (GLP-1 RAs), originally developed for the treatment of type 2 diabetes, have rapidly emerged as effective pharmacological therapies for obesity management. 14,15 Their expanding use has generated considerable interest alongside concerns regarding medication shortages, equitable access, and appropriate prescribing. 3,9 Recent evidence indicates that the use of GLP-1 receptor agonists is increasing during the postpartum period, with weight reduction appearing to be the primary indication for use. 4 Given that obesity is an established indication for GLP-1 receptor agonists, this trend is not inherently unexpected. 15 It is also occurring within a broader social context in which many women experience societal expectations to regain their pre-pregnancy body weight while simultaneously navigating the physical recovery of childbirth, infant caregiving, sleep disruption, breastfeeding, and changing family roles. 5 Together, these biological, social, and environmental factors make postpartum obesity management particularly complex .Because the postpartum period represents a critical window for improving long-term maternal health, the increasing use of pharmacological therapy provides an opportunity to reconsider how these treatments can be integrated within comprehensive approaches to postpartum obesity management. 8 This opinion paper examines the public health implications of the increasing use of GLP-1 receptor agonists during the postpartum period. For the purposes of this Opinion, the postpartum period refers broadly to the first 12 months after childbirth, while recognising that individual studies use different postpartum observation periods and that obesity management initiated during this period should transition into longer-term care across the reproductive life course. Instead of focusing solely on pharmacological therapy, it also considers what this emerging trend means for postpartum obesity management from a public health perspective.The discussion examines the evolving evidence on postpartum GLP-1 receptor agonist use, the importance of long-term obesity management across the life course, the structural and equity challenges influencing women's ability to engage in comprehensive care, and the policy actions needed to strengthen postpartum obesity management beyond medication alone.Published evidence on the use of GLP-1 receptor agonists during the postpartum period remains limited. Recent reviews have highlighted growing interest in the potential role of GLP-1 receptor agonists across the reproductive continuum, from preconception through the postpartum period. 14 However, primary evidence describing postpartum prescribing remains scarce and is currently informed largely by the Danish cohort reported by Bliddal et al. 4 Using national registry data from 382,277 pregnancies between January 2018 and June 2024, the study identified 1,549 mothers who filled a GLP-1 receptor agonist prescription within 182 days after delivery. Postpartum use increased from 34 per 10,000 deliveries in the second quarter of 2022 to 173 per 10,000 in the second quarter of 2024. 4 Although these findings are derived from a single national cohort, they provide an important sentinel signal that postpartum prescribing of GLP-1 receptor agonists may be changing. 4 It is still uncertain whether this emerging prescribing pattern reflects trends in other healthcare systems. This highlights the need for surveillance and real-world evidence from diverse settings. As obesity is an established indication for these medications, the observed trend is not unexpected. Furthermore, it provides an opportunity to consider how pharmacological therapy can be integrated within comprehensive models of postpartum obesity management.The postpartum period is increasingly recognized as a critical window for improving women's long-term health. 2 Although clinical care traditionally focuses on pregnancy and the first six weeks after birth 2 , physiological, metabolic, and behavioural adaptations initiated during pregnancy often extend well beyond the immediate postpartum period. 2,6 The International Federation of Gynecology and Obstetrics (FIGO) recommends viewing obesity as a chronic disease requiring continuous management across the reproductive life course rather than episodic care confined to pregnancy. 8 Consequently, postpartum care should extend beyond short-term recovery to support sustained weight management and long-term maternal health.Persistent postpartum weight retention is common and has been associated with an increased risk of long-term obesity. 11 It is also associated with an increased risk of hypertension, type 2 diabetes, and cardiovascular disease. 6,10 Women who enter subsequent pregnancies with persistent obesity or excess weight are also more likely to experience adverse maternal and neonatal outcomes, reinforcing the importance of achieving optimal health between pregnancies. 2 Given that obesity is a major risk factor for noncommunicable diseases, addressing postpartum weight retention offers an important opportunity for primary prevention across the life course. 8,17 Beyond its physical health consequences, postpartum obesity may also affect psychological well-being during the transition to motherhood. Women may experience body dissatisfaction and depressive symptoms during the postpartum period. 5,12,13 These interconnected physical and psychological challenges further support the need for comprehensive postpartum obesity management that addresses both physical and mental health after childbirth.Lifestyle interventions, particularly regular physical activity, contribute to healthy weight maintenance while also improving mental health and reducing long-term disease risk, underscoring the interconnected nature of maternal health across the life course 1,18 These long-term approaches are particularly important within a broader social context where many women experience expectations to rapidly return to their pre-pregnancy body weight while simultaneously navigating childbirth recovery, infant caregiving, breastfeeding, sleep disruption, and changing family responsibilities. 5 Supporting women through this period therefore requires sustainable, comprehensive postpartum obesity management that promotes long-term health as opposed to focusing solely on short-term weight reduction.The challenge is therefore no longer whether postpartum weight management is important, but how best to deliver comprehensive and sustainable postpartum obesity management.Comprehensive postpartum obesity management extends beyond achieving weight loss alone. 8 Consistent with the recognition of obesity as a chronic disease, it requires a long-term, multidisciplinary approach that addresses the biological, behavioural, psychological, and social factors influencing maternal health. 8,17 Such care should integrate evidence-based nutritional counselling, regular physical activity, behavioural interventions, ongoing clinical follow-up, and, where clinically indicated, pharmacological treatment. 8,10 Rather than representing competing strategies, these components should be viewed as complementary elements of care that support sustained maternal health across the postpartum period and beyond Within this multidisciplinary framework, lifestyle interventions remain the foundation of postpartum obesity management. 8 Healthy dietary patterns, regular physical activity, adequate sleep, and behavioural support contribute not only to weight management but also to improved cardiometabolic health, physical function, psychological well-being, and overall quality of life. 17,18 These benefits extend beyond weight reduction and remain relevant regardless of whether pharmacological treatment is prescribed, underscoring the importance of supporting healthy behaviours throughout the postpartum period. 8,17 Pharmacological therapies, including GLP-1 receptor agonists, should complement, instead of replacing, comprehensive postpartum obesity management. 8 Current obesity management guidelines recommend combining pharmacotherapy with lifestyle interventions to optimise treatment outcomes, recognising that these approaches are complementary rather than mutually exclusive. 8,10 From a public health perspective, the priority is not to choose between pharmacological therapy and lifestyle interventions, but to ensure that women have access to the multidisciplinary support needed to initiate, adopt, and sustain healthy behaviours throughout the postpartum period.However, translating comprehensive postpartum obesity management into routine practice also requires consideration of the structural and health system factors that influence women's ability to access and sustain these interventions.Defining comprehensive postpartum obesity management is only one step towards improving maternal health; delivering it consistently in routine practice presents a different challenge.operating at the individual, community, and health system levels. 7,16 Contemporary public health frameworks recognise that sustained behaviour change is shaped by interactions between individuals and the environments in which they live, work, and care for their families, highlighting the importance of supportive health systems and health-promoting environments alongside evidence-based clinical care. 16 The transition to motherhood introduces substantial changes that influence participation in long-term health promotion. 1,5 Recovery from childbirth, infant caregiving, breastfeeding, sleep disruption, return to employment, household responsibilities, and changing patterns of healthcare use all compete for women's time and attention during the months following birth. 1,5,7 As recognised by the World Health Organization (WHO), health behaviours are shaped by the social, environmental, and organisational conditions in which people live, work, and care for their families. 17 These competing demands can therefore influence the extent to which healthy nutrition, physical activity, behavioural support, and clinical followup are initiated and sustained during the postpartum period. Effective postpartum obesity management requires not only the availability of evidence-based interventions but also women's ability to access and sustain them across the life course, beginning in the postpartum period. 8,17 Achick-Muyu (2025) proposed that postpartum obesity management should move beyond recommendations directed solely at individual women and instead promote mother-friendly health-promoting environments that support healthy behaviours within the realities of family life. 1 Rather than expecting women to adapt to services that may not reflect the practical demands of the postpartum period, health systems should adapt services to better meet women's needs by integrating health promotion into settings they already access and designing care that accommodates caregiving responsibilities. Such approaches align with contemporary public health strategies that recognise supportive environments and responsive health system design as essential components of sustainable behaviour change. 16,17 Viewing postpartum obesity management through a structural and health systems lens shifts the focus from treatment alone to the conditions that enable long-term health. 16 Although pharmacological therapy, lifestyle interventions, behavioural support, and clinical follow-up remain essential components of care, their effectiveness depends on whether women can access the services and environments needed to sustain healthy behaviours over time. 8,17 Access to these resources varies according to socioeconomic circumstances, geography, healthcare organisation, and the availability of community-based support. 17These differences also influence who is most able to benefit from emerging obesity therapies, making equity a central consideration in the expanding use of GLP-1 receptor agonists during the postpartum period.The increasing use of GLP-1 receptor agonists during the postpartum period has important implications for equity in obesity care. 4,14 While these medications have expanded therapeutic options for women living with obesity, equitable access to GLP-1 receptor agonists depends on prescribing policies, reimbursement mechanisms, affordability, health knowledge and health system capacity. However, medication access alone is unlikely to address postpartum obesity unless it is integrated within comprehensive models of care that also support nutrition, physical activity, behavioural interventions, and long-term follow-up.Contemporary clinical guidance supports this approach. During recent GLP-1 receptor agonist shortages, UK health authorities advised clinicians to prioritise prescribing for licensed indications, reinforcing the importance of appropriate patient selection and evidence-based prescribing. 3,9 Similarly, The National Institute for Health and Care Excellence (NICE) recommends that pharmacological therapy for obesity be delivered within a structured weight management pathway that incorporates dietary modification, physical activity, behavioural support, and regular clinical review rather than as a standalone intervention. 10 However, opportunities to benefit from comprehensive postpartum obesity management are not equally distributed. 17 Women living in socioeconomically disadvantaged communities, rural settings, or other underserved populations may face greater barriers to accessing specialist obesity services, structured lifestyle programmes, transportation, childcare, and ongoing follow-up. 1,5,16 These structural barriers can limit access to both pharmacological treatment and the multidisciplinary care needed to support sustained weight management. 16 Ensuring equity therefore requires more than expanding access to medication alone; it requires equitable access to comprehensive postpartum obesity management that integrates evidence-based pharmacological treatment with nutritional support, physical activity, behavioural interventions, long-term follow-up, and supportive health-promoting environments. 10,16 Such an approach is more likely to ensure that advances in obesity treatment reduce, rather than widen, existing health inequalities. 17With evidence of increasing postpartum use of GLP-1 receptor agonists, there is an opportunity to strengthen postpartum obesity management beyond pharmacological treatment alone. 4 Rather than focusing solely on pharmacological treatment, health systems should adopt comprehensive models of care that extend beyond the traditional postpartum care model, which often focuses on the first 4-6 weeks after birth. 2 This could be delivered through stronger continuity between maternity services, primary care, and existing weightmanagement services, allowing nutritional counselling, physical activity, behavioural support, long-term follow-up, and pharmacotherapy where appropriate to continue beyond early postpartum care. 8,10 Health systems and community health services could strengthen access by integrating health promotion into services women already use after childbirth and expanding community-based opportunities for healthy behaviours. 16 , 17 Building on this broader health-promotion approach, I further propose mother-friendly interventions, including family-centred and childcaresupported opportunities for physical activity, to reduce the caregiving barriers discussed earlier.¹ Policies should also promote supportive social environments by addressing weight stigma, encouraging realistic expectations of postpartum recovery, and recognising that maternal health extends beyond returning to pre-pregnancy weight. 5As the use of GLP-1 receptor agonists continues to expand, 4 policy development should also ensure that pharmacological therapy is integrated within equitable and evidence-based models of care. Future research should evaluate not only the effectiveness and long-term safety of GLP-1 receptor agonists in postpartum populations but also the implementation of integrated care models, their impact on maternal health outcomes and health equity, and the effectiveness of structural interventions that enable women to sustain healthy behaviours over time.Given the importance of postpartum obesity management across the life course, the evolving role of GLP-1 receptor agonists provides an opportunity to rethink how health systems deliver comprehensive, equitable, and sustainable postpartum care. Although evidence on postpartum GLP-1 receptor agonist use remains limited, this emerging field highlights the need to move beyond a medication-centred approach towards models of care that address the biological, behavioural, social, and structural factors influencing maternal health.Pharmacological therapy should complement, rather than replace, comprehensive postpartum obesity management. Integrating evidence-based pharmacological treatment with nutritional support, regular physical activity, behavioural interventions, long-term follow-up, and mother-friendly health-promoting environments offers an opportunity to strengthen long-term maternal health and reduce the burden of obesity across the life course.