Our Founding Physician Dr. Fahimeh Sasan sat down recently with Dr. Finch, Founder and Chief Medical Officer at Knownwell, for a conversation about weight, fertility, and GLP-1 medications, and how to approach pregnancy planning with the best possible health. Here is what we learned.
Understanding Weight and Fertility Risks
For women with a BMI over 30, health risks increase as BMI increases. These risks can include miscarriage, gestational diabetes, high blood pressure, C section, and growth issues with the baby. There is also a higher chance of preterm delivery, surgical complications, infection, and ongoing blood pressure issues.
GLP-1 medications can help reduce these risks by supporting weight loss prior to pregnancy. Studies show about 15 to 20 percent weight loss over roughly 72 weeks, or about a year and a half. The earlier you begin optimizing your health before pregnancy, the better.
It is important to remember that obesity is a chronic disease. It is not just about weight, it is about overall health and impact.
GLP-1 Medications and Pregnancy Timing
GLP-1s have not been around long enough to fully understand their effects on pregnancy. Current recommendations suggest stopping the medication five to seven weeks before trying to conceive.
For IVF, it is recommended to stop at least one month before, with a sweet spot around two months. Because these are often weekly medications, it can take about six weeks to fully leave your system.
The key message is to give yourself time to optimize your health before pregnancy.
Preparing Your Body Before Pregnancy
For women with a higher BMI, GLP-1s can be used before pregnancy alongside nutrition and exercise. The goal is to build sustainable habits so that once you stop the medication, you still have strong routines in place.
Pregnancy does not have to mean excessive weight gain. Working with clinicians and dietitians can help manage healthy weight gain during pregnancy.
Nutrition and Metabolic Health
Whether or not GLP-1s are part of your plan, foundational health habits matter:
- Nutrition: Aim for balanced meals with plants and protein. Focus on adding foods rather than restricting them. The more vegetables, fruits, whole grains, and fiber-rich options, the better. A helpful goal is five servings of fruits and vegetables per day.
- Regular eating patterns: Consistent meals (breakfast, lunch, dinner) help regulate metabolism.
- Physical activity: Movement supports both metabolic health and fertility.
- Sleep and stress management: Often overlooked, but critical for hormonal balance and overall well-being.
An anti-inflammatory approach to eating rich in whole, nutrient-dense foods can support fertility. The mindset shift from “cutting out” to “adding in” is especially powerful and sustainable.
Fertility Without GLP-1s
If you prefer not to use GLP-1s, start with fertility testing. Work with your doctor to create a personalized plan. Fertility is not one size fits all, and decisions should be made on a case by case basis. Questions about age and weight should also be discussed individually with a clinician.
Common Myths About Weight Loss
A major myth is that people should be expected to lose weight on their own through lifestyle changes alone. In reality, studies show it is very difficult to lose weight and keep it off long term.
Like other chronic conditions, there is treatment and medication for a reason. It is there to improve health, longevity, and quality of life.
After Pregnancy and GLP-1s
Restarting GLP-1s after pregnancy depends on individual circumstances. If you are not breastfeeding, it may be possible to restart once you have recovered.
GLP-1s are not recommended during breastfeeding. Weight management during this time should focus on a combination of nutrition, activity, and safe medical guidance.
Considerations for Those at a Normal Weight
There is not enough data on GLP-1 use in people with a lower or normal BMI. Too much weight loss could carry risks such as bone health issues.
This is a highly individualized decision and should be discussed with a clinician.
Key Takeaways from the Professionals
Dr. Sasan
- Obesity should be treated as a disease, not a personal failure
- GLP-1s are a tool to improve health and fertility and should not carry stigma
- Optimizing weight can improve many aspects of health and conception
Dr. Fitch
- Seek comprehensive, evidence based care rather than relying only on internet information
- Talk through risks and benefits with your provider
- Create a long term plan focused on overall health and well being
- Care should be individualized since everyone is different
Overall message
- Focus on long term health
- Give yourself time to prepare for pregnancy
- Use available tools and medical support to optimize outcomes
