Obesity health risks differ significantly between men and women

New research being presented at this year's European Congress on Obesity (ECO) in Istanbul, Turkey (12-15 May), reveals distinct patterns of heart, metabolic, and inflammatory health risks between men and women living with obesity, providing an insight into how clinicians may be able to tailor management approaches.

The study led by researchers at Dokuz Eylul University in Turkey found that men with obesity appear more susceptible to developing abdominal (visceral) fat, a key factor in developing leading heart and metabolic health risks, as well as elevated levels of liver enzymes, an indicator of liver damage. In contrast, women with obesity appear more likely to develop systemic inflammation and high cholesterol that can lead to heart disease and type 2 diabetes.

"Our findings reveal intriguing differences in the way men and women respond to obesity," said lead author Dr Zeynep Pekel, from Dokuz Eylul University, Izmir, Turkey. "They show just how important gender-specific research is. Not only are sex differences a powerful player in the pathology and course of obesity, but our results indicate that such differences could be a stepping stone toward finding targeted, sex-based therapies to help in the management of people living with obesity."

In 2023, an estimated 1.54 billion adults (around 1 in 3 women and 1 in 4 men) were living with metabolic syndrome worldwide-a cluster of the most dangerous risk factors for cardiovascular disease and type 2 diabetes, including abdominal obesity, high cholesterol, high blood pressure, and raised fasting plasma glucose.

Obesity is a complex chronic disease characterised by varied metabolic and inflammatory responses. Biological sex influences adipose (fat) tissue distribution, hepatic (liver) metabolism, and systemic inflammatory activity. However, sex-based profiling of cardiometabolic and inflammatory markers among adults living with obesity is lacking.

To address this knowledge gap, researchers analysed data from 886 women (average age 45 years) and 248 men (average age 41 years) with obesity attending the Obesity Clinic at the Department of Internal Medicine, Dokuz Eylul University Faculty of Medicine between 2024 and 2025, to compare anthropometric, metabolic, and inflammatory parameters and identify sex-specific patterns.

All participants underwent physical measurements (e.g., height, weight, body mass index [BMI], blood pressure) and extensive evaluations of blood lipid profiles to quantify cardiovascular risk factors (i.e., total cholesterol, low-density lipoprotein [LDL], or "bad" cholesterol, high-density lipoprotein [HDL], or "good" cholesterol, triglycerides, fasting blood glucose).

Biochemical markers of liver (alanine aminotransferase [ALT] and gamma-glutamyl transferase [GGT] levels) and kidney function (creatinine levels) as well as inflammatory parameters (C-reactive protein, erythrocyte sedimentation rate, white blood cell count, and platelet count) were also assessed.

The analysis found that, on average, men had slightly higher body mass index (BMI) than women (37.5 vs 36 kg/m²), but their waist circumference was significantly greater (120 vs 108cm), while systolic blood pressure tended to be higher (128 vs 122 mmHg)-both factors associated with a range of health problems including cardiovascular disease and diabetes (see table in notes to editors).

Additionally, liver enzymes (ALT and GGT) and triglyceride levels were significantly elevated in men, as were creatinine levels, which can lead to a range of complications, including liver disease.

In contrast, women had significantly higher total cholesterol (215 vs 203 mg/dL) and LDL or "bad" cholesterol (130 vs 123 mg/dL) than men. Additionally, inflammatory markers including erythrocyte sedimentation rate, C-reactive protein, and platelet count, were also significantly higher in women (see table in notes to editors).

Pekel explained that sex differences in hormones, immune response, and fat distribution help explain the patterns observed. For example, hormones (especially oestrogen) affect how fat is stored and how the body responds to inflammation. Women tend to store more fat under the skin and show a different inflammatory profile, which can be seen in higher levels of markers like C-reactive protein and erythrocyte sedimentation rate. Women also generally have a stronger immune response, partly related to genetic factors such as the X chromosome. In contrast, men are more likely to accumulate fat around internal organs, which is more closely linked to metabolic complications.

"It's still early days and these findings need to be confirmed in other patient groups, but they offer important insight into how obesity may affect men and women differently," said Pekel. "These differences are likely influenced by biological factors such as hormones, immune responses, and fat distribution. Our next steps are to validate these findings in larger populations, better understand the biological processes behind these differences, and explore how these patterns relate to clinical risk."

The authors acknowledge several limitations to the study, including that the study is cross-sectional in design and cannot establish causal relationships and is potentially subject to confounding and reverse causation errors. Additionally, they note that the study includes mainly adults of Turkish ethnicity making the generalisability of the findings to other ethnicities less certain, and a larger study could confirm and extend the study results.