This edition covers:
- Why body composition matters for women’s long‑term health
- How women’s body composition and cardiometabolic risk evolve through life
- The role of GLP‑1 medications and lifestyle support in women’s health
Around this time last year, a colleague shared a newly published research study titled “Sex Differences in the Efficacy of Glucagon‐Like Peptide‐1 Receptor Agonists for Weight Reduction: A Systematic Review and Meta‐Analysis.” I rolled my eyes. Great, another weight loss study that shows that males lose more weight due to their higher levels of testosterone, faster metabolisms due to having more muscle, etc. Do we really have to keep doing research on this topic?
Yet to my surprise, the results said just the opposite. In fact, when researchers looked across 13 different GLP-1 studies, they found that females achieved more weight loss than males.
It brings up a good point. Men and women’s bodies are different; we tend to gain weight differently and lose weight differently. We also experience different external factors and pressures to look or move a certain way. For these reasons, I wanted to explore what GLP-1s can mean for women’s health, starting with their effect on body composition.
Body Composition vs. BMI vs. Body Shape
Before we continue, let’s ground ourselves on three important terms: body composition, BMI and body shape.
Body composition refers to the ratios of body fat, muscle, organs, bone, and water within the body, which play a crucial role in assessing health and fitness. When stepping on a standard weight scale, we're presented with a single figure—our total body weight, which fails to differentiate between the aforementioned muscle, fat, organs, bone and water weight. This is where body composition comes in, offering insight into clinically significant proportions: body fat and muscle mass.
A healthy body composition is often characterized by a lower percentage of body fat and a higher percentage of muscle, with women naturally carrying higher body fat than men. Higher body fat—especially around the abdomen—is clinically linked to insulin resistance, high cholesterol, and inflammation, even in people who are “normal weight” or have a “healthy body mass index (BMI).”
That’s why it's important to distinguish body composition from BMI. Although BMI is a widely used metric in healthcare, it only looks at weight relative to height, without considering the muscle:fat ratio. Two people could have the same BMI but vastly different body compositions, and vastly different risk factors. For example, Uar Bernard, a defensive tackle for the Philadelphia Eagles, is 6’4’’, weighs 306 pounds, and would be considered obese with a BMI of 37.2, yet he only has 6% body fat.
Body composition and BMI are also separate from body shape. Women commonly identify as having an apple, pear, hourglass, or rectangle shape based on the Body Shape Assessment Scale, but body shape is largely determined by genetics and cannot be changed (despite what your favorite fitness influencer might have you believe). However, body composition can be influenced by adjustments to exercise, diet, and overall lifestyle.
The Evolution of Women’s Body Composition and Cardiometabolic Risk
Throughout life, women's bodies undergo several transitions that impact how we feel and function, and it’s no secret that as we age, our disease risk increases. Heart disease is the leading cause of death in women, and nearly 80% of women ages 40 to 60 have one or more risk factors for coronary heart disease; multiple risk factors further increase that risk.
From a clinical standpoint, significant body composition changes start at puberty, setting the stage for long-term cardiovascular and metabolic health. But at the same time, during the pre-teen and teenage years, most of us aren’t thinking about our ratio of muscle to fat. I know I wasn’t. At that age, my focus was largely on playing sports and looking slender, as that was what was fed to me in the media.
20s to 40s: Gradual Shifts Breed Long-Term Risk
Women gain the most amount of weight in their 20s through 40s (approximately 37 pounds on average) due to career, child care, and lifestyle habits. This weight gain paired with slow decline in muscle mass after age 30 impacts our body composition, leading to a heightened risk of cardiovascular disease and diabetes. For women who go through pregnancy, hormonal conditions like gestational diabetes and preeclampsia can add another layer of long-term cardiometabolic risk.
When I look at my own life, it’s no wonder why this era, especially the early 20s, are a breeding ground for weight gain. For me, early adulthood meant moving out of my parent’s home and leaving my mom’s home-cooked Nigerian food, no longer setting scheduled time for sports and movement, and spending most of my days and nights at a desk or in front of a screen.
For me and my friends, we focused on graduating from pharmacy school and entering the workforce, and less about our health and wellness. It’s almost funny to think about how healthcare workers and students are so focused on learning and caring for others, that they often forget about themselves.
Luckily for me, even though I am one of the millions of women with a sedentary desk job, I am fortunate to work at Omada—a company dedicated to health and wellness that supports me in building healthy habits. I even have a walking pad at my desk that allows me to get my steps in and still have dedicated time to strength train.
I often hear people say “the things you thought you were getting away with in your 20s and 30s will catch up to you in your 40s,” and it’s true. The 20s through 40s are a crucial era for influencing our overall health and setting the stage for the next significant cardiometabolic phase: menopause.
50s and Beyond: As Estrogen Drops, Risk Rises
Menopause is official once a woman has missed 12 consecutive months of their period, generally occurring around the age of 50. It’s marked by a significant decline in estrogen, triggering a cascade of changes throughout the body, especially body composition. Body fat that once settled around the hips and thighs begins to migrate to the abdomen, visceral fat (fat around the vital organs) accumulates, and holding onto muscle mass and bone density becomes an even greater challenge. If you’ve read this far, you won’t be surprised to learn that post-menopause brings the highest disease risk, with women commonly being diagnosed with cardiometabolic disease in their mid-50s to 60s.
Menopausal hormone therapy (MHT, formally known as HRT) is currently the most effective medical treatment for specific menopausal symptoms like hot flashes and night sweats. It also helps maintain bone and muscle and may reduce menopause‑related increases in body fat. However, MHT is only taken by 5% of menopausal women, possibly due to earlier reports that suggested a link to increased cancer risk. In addition, MHT may not be appropriate for every woman, and isn’t a primary fat loss treatment for women experiencing significant body composition changes.
While these stats are informative, I’ll admit they’re not the most uplifting. But here’s the good news: innovations like GLP-1s for weight loss and lifestyle support programs are giving women more control over their body composition and disease risk.
How GLP-1s and Strength Training are Changing Women’s Health
GLP-1 medications have shown meaningful benefits in weight loss and metabolic health, with clinical trials demonstrating up to 21% weight loss over 72 weeks. For many women, particularly those in pre and post-menopause, this level of weight loss can recalibrate cardiometabolic risk by lowering visceral fat levels, boosting insulin sensitivity, and reducing inflammation.
Increasingly, GLP-1s are used by both younger and older women across the working-age spectrum to meet varied goals including improved glycemic control, weight loss and body fat reduction, improved mobility and avoiding disability in aging.
However, it's important to recognize a specific risk: some GLP-1s are associated with a higher proportion of lean mass loss, a particularly significant concern for menopausal women already facing muscle and bone density challenges. While GLP-1s make fat loss more accessible, muscle mass must be preserved intentionally.
Skeletal muscle plays an essential role in women's health by improving blood sugar control and metabolism and acting as a key determinant of mobility, balance, and overall independence.
