Key takeaways:

• Men with obesity have more visceral adipose tissue than women, whereas women have more subcutaneous adipose tissue.
• Obesity increases risk for different types of cancers in men compared with women.

PHILADELPHIA — Body composition and obesity-related complications differ between men and women, but incretin-based medications confer benefits among all adults, according to a speaker at the Heart in Diabetes CME Conference.

Samuel Klein, MD, division chief of nutritional science and obesity medicine at Washington University in St. Louis, outlined some of the biggest differences in how obesity presents itself among women compared with men and discussed some of the key risk factors health care professionals need to be aware of when managing obesity. Despite the differences between the sexes, Klein also discussed how GLP-1 receptor agonists and SGLT2 inhibitors are linked to benefits among both men and women with obesity.

Infographic content were derived from Klein S. Session 2: Women’s health. Presented at: Heart in Diabetes CME Conference; June 19-21, 2026; Philadelphia. Body composition

One area where men and women differ is with body fat and muscle mass. Klein said men have greater muscle mass content than women as measured through whole body MRI. Data published in Obesity in 2023 showed men have a greater proportion of weight loss consisting of muscle mass compared with women.

“Some of the concern about women with low muscle mass losing weight, it could be a problem because they’re already starting with low muscle mass,” Klein said during a presentation. “But women tend to lose less [muscle mass] than men with any kind of weight loss.”

Body fat also tends to be distributed differently among men and women, according to Klein. He said women have a higher percentage of body weight as fat than men, but men have more visceral adipose tissue. Conversely, subcutaneous adipose tissue is higher in women than men.

“This is presumably driven by sex hormones,” Klein said. “When women become postmenopausal, some of these body composition changes revert toward a male. Also, this is driven by differences in regional lipolytic activity and lipogenesis.”

Klein said insulin sensitivity is a pathogenic factor contributing to cardiometabolic disease for people with obesity. Data from 350 adults without diabetes showed women have greater insulin sensitivity than men, despite having more body fat.

“Some [women with obesity] have normal insulin sensitivity and are not different from people who are lean,” Klein said. “This is important because there’s a subgroup of people with obesity that are considered metabolically healthy and do not develop the metabolic diseases typically associated with obesity.”

Klein said some women with metabolically health obesity may not experience a change in metrics such as triglycerides or fasting glucose even after they gain weight. He said some women “are really resistant to the adverse effects of excess body fat,” which is something that is rarely observed in men.

Clinical aspects

There are several differences in obesity-related complications between men and women, Klein said. Both men and women with obesity have increased risk for cardiovascular disease. Among women, Klein said, CVD risk is elevated further for those with early menarche, early menopause, irregular menstrual cycles, polyendocrine metabolic ovarian syndrome, breast cancer or autoimmune diseases.

Obesity raises risks for different types of cancer, according to Klein. Men with obesity have increased risk for colorectal, kidney and esophageal cancers, whereas women with obesity have higher risk for endometrial, ovarian and postmenopausal breast cancers.

“Type 2 diabetes is also different in men than women,” Klein said. “Type 2 diabetes in men occurs with a lower BMI at diagnosis and earlier onset in men than women. In mental health, there’s greater depression and anxiety in women with obesity than men with obesity.”

Klein said most trials assessing incretin-based medications have found women lose more weight than men. In a meta-analysis of four trials assessing GLP-1-based drugs, women lost about 2% more body weight than men.

Though women lose more weight than men with incretin-based medications, both men and women with obesity can derive benefits from the drugs, Klein said.

“The decreased [risk] in CV death, nonfatal [myocardial infarction] and stroke in males is the same as females,” Klein said. “The decrease in adverse kidney outcomes, such as renal failure requiring dialysis, is the same in men as they are in women.”