Men and women with obesity face very different hidden health risks

A research team from Dokuz Eylul University in Turkey found that men with obesity are more likely to accumulate abdominal (visceral) fat. This type of fat surrounds internal organs and is strongly linked to serious heart and metabolic conditions. Men in the study also showed higher levels of liver enzymes, which may signal liver damage. Women with obesity, on the other hand, were more likely to experience widespread inflammation and elevated cholesterol levels, both of which raise the risk of 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."

A Global Health Challenge With Complex Risks

In 2023, about 1.54 billion adults worldwide were living with metabolic syndrome (around 1 in 3 women and 1 in 4 men). This condition includes a group of major risk factors for cardiovascular disease and type 2 diabetes, such as abdominal obesity, high cholesterol, high blood pressure, and raised fasting plasma glucose.^[1]

Obesity itself is a complex chronic disease that affects the body in many ways. It involves changes in metabolism and inflammation, and these changes can vary widely between individuals. Biological sex plays a role in where fat is stored, how the liver processes nutrients, and how the immune system responds. However, detailed comparisons of these differences between men and women with obesity have been limited.

Study Examines Sex-Based Differences in Obesity

To better understand these patterns, researchers analyzed data from 886 women (average age 45 years) and 248 men (average age 41 years) who were treated at the Obesity Clinic in the Department of Internal Medicine at Dokuz Eylul University Faculty of Medicine between 2024 and 2025.

Participants underwent a range of evaluations. Physical measurements included height, weight, body mass index (BMI), and blood pressure. Blood tests measured lipid levels to assess cardiovascular risk, including total cholesterol, low-density lipoprotein (LDL), or "bad" cholesterol, high-density lipoprotein (HDL), or "good" cholesterol, triglycerides, and fasting blood glucose.

Researchers also examined markers related to liver function (alanine aminotransferase (ALT) and gamma-glutamyl transferase (GGT) levels), kidney function (creatinine levels), and inflammation. Inflammatory indicators included C-reactive protein, erythrocyte sedimentation rate, white blood cell count, and platelet count.

Key Differences in Fat Distribution and Biomarkers

The results showed that men had a slightly higher body mass index (BMI) than women (37.5 vs 36 kg/m²). However, their waist circumference was much larger (120 vs 108cm), and their systolic blood pressure was also higher (128 vs 122 mmHg), both of which are linked to increased risk of cardiovascular disease and diabetes (see table in notes to editors).

Men also had significantly higher levels of liver enzymes (ALT and GGT), triglycerides, and creatinine. These findings point to a greater likelihood of liver-related and metabolic complications.

Women, in contrast, had higher total cholesterol (215 vs 203 mg/dL) and LDL or "bad" cholesterol (130 vs 123 mg/dL). They also showed higher levels of inflammatory markers, including erythrocyte sedimentation rate, C-reactive protein, and platelet count (see table in notes to editors). These patterns suggest a stronger inflammatory response.

Hormones and Biology Help Explain the Differences

According to Pekel, these differences are likely influenced by hormones, immune system activity, and how fat is distributed in the body. Hormones (especially oestrogen) affect fat storage and the body's inflammatory response. Women typically store more fat beneath the skin and tend to show higher levels of inflammation-related markers such as C-reactive protein and erythrocyte sedimentation rate. They also generally have a more active immune response, partly due to genetic factors like the X chromosome.

Men are more likely to store fat around internal organs. This visceral fat is closely associated with metabolic disorders and increases the risk of serious health 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."

Study Limitations and Next Steps

The researchers note several limitations. The study is cross-sectional, which means it cannot determine cause and effect and may be influenced by confounding factors or reverse causation. In addition, most participants were adults of Turkish ethnicity, so the findings may not fully apply to other populations. Larger and more diverse studies will be needed to confirm and expand on these results.

Notes

1. Worldwide trends in metabolic syndrome from 2000 to 2023: a systematic review and modelling analysis | Nature Communications

This research is based on abstract 1854 presented at the European Congress on Obesity (ECO). All abstracts were reviewed by the congress selection committee. A full paper has not yet been published, but the authors are available to answer questions.