The Journal of Nutrition · Nov 10, 2026

Nutrition Care Strategies at the Intersection of Menopause and Obesity Pharmacotherapy

By Christensen S, Hurtado Andrade MD, Sampson-Paine K et al.

The premenopause to menopause transition, known as perimenopause, is a critical period of metabolic vulnerability, characterized by hormonal changes, shifts in body composition, and increased cardiometabolic risk. Concurrently, incretin mimetic pharmacotherapies have emerged as highly effective treatments for obesity, achieving weight reductions that are approximating those previously observed only after bariatric surgery. While these agents confer substantial benefits, their mechanisms—appetite suppression, delayed gastric emptying, and enhanced satiety—introduce nutritional risks that intersect with pre-existing vulnerabilities of women experiencing this transition. Reduced energy intake and inadequate micronutrient intake, combined with estrogen deficiency, heighten the risk for osteoporosis and sarcopenic obesity. Likewise, gastrointestinal adverse events further compromise dietary quality and hydration, while aging physiology amplifies susceptibility to malnutrition. This narrative review synthesizes current evidence on nutritional risks during perimenopause in the context of incretin mimetic pharmacotherapy, highlighting overlapping pathways that influence musculoskeletal health, metabolic resilience, and quality of life. Clinical strategies to mitigate these risks, including protein optimization, micronutrient monitoring, menopausal hormone therapy (osteoporosis/musculoskeletal health), and multidisciplinary care, are discussed alongside research priorities to inform targeted nutrition frameworks. Addressing these gaps is essential to ensure safe, effective, and sustainable obesity management for women in midlife and beyond.

doi.org/10.1016/j.tjnut.2026.101936PubMed 43009103Interventions