AbstractObjectivesMenopause contributes to weight gain in women. We explored factors associated with obesity in women with HIV aged 45–60 years.MethodsThe present study is an analysis of cross‐sectional questionnaire and clinic data from the Positive Transitions Through the Menopause (PRIME) Study. We categorized body mass index (BMI) as normal/underweight (< 25 kg/m²), overweight (25–29.9 kg/m²) and obese (> 30 kg/m²). We used logistic regression to explore demographic, social, lifestyle and clinical factors associated with BMI.ResultsWe included 396 women in this analysis. Median age was 49 years [interquartile range (IQR): 47–52]. Most (83.6%) were not UK‐born; the majority (69.4%) were black African (BA). Median (IQR) BMI was 28.6 (24.6–32.6) kg/m²; and 110 (27.8%), 127 (32.1%) and 159 (40.1%) of the women were normal/underweight, overweight and obese, respectively. Median (IQR) BMI did not differ in pre‐, peri‐ and post‐menopausal women (p = 0.90). In univariable analysis, being non‐UK‐born was associated with BMI > 30 kg/m² [odds ratio (OR) = 1.94, 95% confidence interval (CI): 1.07–3.53]. Compared with BA women, women of other black ethnicities were more likely to be obese (OR = 2.37, 95% CI: 1.02–5.50) whereas white British women were less likely to be obese (OR = 0.34, 95% CI: 0.17–0.68). Current smoking and increasing number of comorbid conditions were associated with increased BMI. We found no association between obesity and socioeconomic status. On multivariable analysis, only ethnicity remained associated with obesity (compared with BA: white British, OR = 0.34, 95% CI: 0.17–0.68; other black, OR = 2.50, 95% CI: 1.07–5.82).ConclusionsNearly two‐fifths of women had BMI > 30 kg/m². Obesity was associated with black ethnicities but not with menopausal status. The combination of obesity and HIV may place women at increased risk of co‐morbidities, requiring tailored and culturally appropriate interventions.