Presentation (CTI)

OBJECTIVES: Menopause is associated with increased weight gain, adverse fat redistribution, and rising prevalence of cardiometabolic/psychosocial comorbidities. Concurrent behavioural and psychological changes - emotional eating, reduced activity, sleep disruption, and challenges sustaining lifestyle interventions - may further compound these risks. This study aimed to characterise the interplay between menopause, behavioural drivers, and comorbidity burden in obesity, identifying patterns of heterogeneity and lived experience needs across subgroups.
METHODS: Cross-sectional data were drawn from the Adelphi Real World Obesity Disease Specific Programme™ (US, October 2023-April 2024). Physicians reported clinical characteristics. People living with obesity (PLwO) completed questionnaires on behaviours/outcomes, including reasons for stopping therapy, sleep (JSEQ; 0-20), and work productivity (WPAI: absenteeism, presenteeism, overall and activity impairment). Analyses were descriptive.
RESULTS: Of 1,155 PLwO (pre-menopausal: n=333; peri-menopausal: n=83; post-menopausal: n=283; other: n=27; male comparator group: n=429)., comorbidity burden increased across menopause, with post-menopausal women showing elevated cardiometabolic risk (hypertension 57%, type 2 diabetes 20%), comparable to males. Mental health-related comorbidities were more frequent in women than males, including anxiety (~17% vs 7%) and depression (~15-19% vs 12%). Behavioural drivers were common: 53% reported emotional eating, 43% loss of control, and 28% persistent hunger; depression was identified by 21% of PLwO and 15% by physicians. These behaviours coincided with adherence challenges, including discontinuation of weight loss efforts due to insufficient results (60%), difficulty sustaining lifestyle changes (49%), and emotional triggers (27%). Sleep disturbance increased across menopause (JSEQ 7.2 post- vs 4.9 pre-menopause vs 6.5 males) and was associated with greater activity impairment (37.6% vs 27.7% vs 27.3%), highlighting distinct behavioural/ clinical profiles across menopausal stages.
CONCLUSIONS: Menopause is characterised by converging cardiometabolic, psychological, and behavioural drivers of obesity aligning with challenges in sustaining weight management efforts. These findings highlight the importance of recognising heterogeneous lived experiences and behavioural drivers within obesity care to better reflect patient need.