Key points

• The recent development of, and access to, incretin drugs is revolutionising the treatment of obesity and type 2 diabetes.
• Menopausal and post-menopausal women experience higher rates of obesity and are therefore potential candidates for incretin therapy.
• The benefits of incretin drugs extend beyond weight loss to include a range of pleiotropic effects, including on the cardiovascular system, kidneys, and brain.
• The optimal mid-life health intervention should decrease fat mass, increase or at least maintain muscle mass and function, and decrease chronic disease risk.
• Incretin drugs have substantial and beneficial effects of reducing body and fat mass but also reduce lean and muscle mass.
• Effective management of diet and exercise can optimise changes in body composition, promoting functional strength into older age.
• To optimise health benefits, obesity care during menopause should integrate the knowledge of general practitioners, exercise physiologists and dieticians.