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