**Background:** Obesity is defined by the WHO as abnormal or excessive adipose accumulation that puts health at risk, and by the Obesity Medicine Association (2021) as 'a chronic, progressive, relapsing and treatable multi-factorial, neurobehavioural disease.' According to WHO population statistics for 2016, 40% of women had overweight and 15% had obesity globally. Low- and lower-middle-income countries also demonstrate significant obesity rates, facing a double burden of malnutrition where obesity increases in urban settings while undernutrition persists in rural areas. The paper notes that more deaths occur globally from overweight and obesity than from underweight, with exceptions in Sub-Saharan Africa and Asia. Weight bias, stigma, and discrimination disproportionately affect women, particularly those who self-identify as visible minorities including Black and Asian women in North America.
**Methods:** This is a FIGO (International Federation of Gynecology and Obstetrics) Best Practice Advice paper, representing a narrative review and expert consensus guideline. The authors synthesized existing evidence across multiple domains of women's health affected by obesity, including pregnancy outcomes, gastrointestinal and liver diseases, kidney health, respiratory health, venous thromboembolism, gynecologic and reproductive health, mental wellness, and cognition. The paper incorporates WHO BMI classification categories (underweight <19, normal 20–24.9, overweight 25–29.9, obesity class I 30–34.9, class II 35–39.9, class III >40) and the Edmonton Obesity Staging System as assessment tools.
**Key Results:** The paper reports that weight loss achieved with health behavioral changes is usually 3%–5% of body weight, which can result in meaningful improvement in obesity-related comorbidities. For NAFLD, prevalence increases with increasing BMI, and a higher incidence of gestational diabetes and early pregnancy miscarriages exists among women with NAFLD. NAFLD can develop into nonalcoholic steatohepatitis over 5–7 years, leading to fibrosis and hepatocellular carcinoma. Regarding micronutrient deficiencies after malabsorptive weight loss surgery, key deficiencies include folate (15%–38%), vitamin B12 (37%–50%), iron (47%–66%), vitamin D (20%–80%), and vitamin E (5%–12%). The risk of osteoporotic fractures is increased 3–5 years following surgery. For VTE, women with BMI ≥30 in the postpartum period had a four-fold increased risk of deep vein thrombosis, with a dose-dependent effect of BMI on postpartum VTE risk. DVT prophylaxis is recommended starting day 1 after vaginal birth for up to 3 weeks postpartum and after cesarean birth for up to 6 weeks postpartum. The risk of VTE was two times higher in the obesity group among users of combined hormonal contraception compared with women of normal weight. Obesity is associated with increased incidence of endometrial, renal, esophageal, ovarian, and breast cancers in postmenopausal women and colorectal cancer in premenopausal women.
**Clinical Implications:** The paper recommends a 'people first approach' to avoid stigmatizing labeling (e.g., 'a pregnant woman living with obesity' rather than 'a morbidly obese pregnant woman'). The focus of care should be on improving health outcomes rather than focusing on weight loss. Key recommendations include: screening for obesity at routine visits using BMI; using the Edmonton obesity staging system for comprehensive assessment; providing individualized treatment including nutritional therapy, exercise, psychological interventions, pharmacotherapy, and surgery; screening women with class III obesity for cholelithiasis following weight loss interventions; dietary and blood screening of micronutrient levels with appropriate supplementation; early referral of women with obesity and abnormal uterine bleeding for pelvic ultrasound and endometrial sampling; considering early mammogram screening for individuals with obesity and gigantomastia; DVT prophylaxis in the immediate postpartum period; using appropriately sized examination equipment and considering the lateral decubitus position for pelvic examination; doubling the dose of levonorgestrel-based emergency contraception to improve effectiveness; and co-managing patients with a weight loss support team. The paper emphasizes that public health interventions have thus far failed to achieve significant decreases in population obesity prevalence, and future research should focus on interprofessional care, root causes of obesity, and system- and country-specific interventions.