Viewing obesity as a disease, rather than something effort alone can fix, changes your treatment options. It also may require testing and iterating to find a plan that works for you.
“One of the things that we don’t know right now is which person needs exactly which treatment and why,” Dr. Gudzune says.
Weight Loss Medications
The most effective weight loss drugs change the chemistry of the hormones that act on your gut and brain. For many users, the result is weight loss that can seem almost effortless, though people who also commit to improved diet and exercise habits will have even better results.
Popular glucagon-like peptide-1 (GLP-1) agonists, for instance, work by mimicking the hormone that helps us feel full after a meal, slowing down digestion. The signals also travel to the brain, where they reduce hunger and quiet cravings for sweet and fatty foods and snacks, and help to lower blood sugar by spurring the release of insulin.
This is why GLP-1s were first developed to treat type 2 diabetes. The U.S. Food and Drug Administration (FDA) has approved the GLP-1s semaglutide (Wegovy), liraglutide (Saxenda), and tirzepatide (Zepbound) to treat obesity and weight management in adults specifically, though weight loss is a known side effect of others.
GLP-1s also reduce the fat around the belly and vital organs, the riskiest type of fat, which is linked to heart disease, stroke, and diabetes, Gudzune says.
They also can improve insulin sensitivity, lowering diabetes risk, and can reduce inflammation.
GLP-1s are not the only medication option. Older weight loss pills such as orlistat (Alli, Xenical), phentermine-topiramate (Qsymia), and naltrexone-bupropion (Contrave) can also alter gut and brain chemistry to deliver durable weight loss benefits.
But an important aspect of viewing obesity as a chronic disease is understanding that it may require lifelong treatment. People who stop using a weight loss drug usually start regaining weight quickly.
To maintain weight loss and other health benefits, you might need to take GLP-1s indefinitely, just as you might expect to take a medication for high blood pressure or high cholesterol, Gudzune says.
Bariatric Surgery
Bariatric surgery is another treatment option that can fundamentally improve the root causes of obesity. These procedures alter the size of your stomach, small intestine, or both, in addition to changing how they function. Types of bariatric surgery include:
- Gastric Sleeve In this procedure, about 80 percent of your stomach is removed to reduce the amount of food you can eat.
- Gastric Bypass A small stomach pouch is created and attached to a part of your small intestine, bypassing parts of your stomach and intestine to reduce their capacity.
- Duodenal Switch This surgery combines a gastric sleeve with an intestinal bypass, rerouting the small intestine, including the duodenum, so food passes through a shorter section of it.
- Gastric Band Also known as lap-band surgery, in this procedure a silicon band is placed around part of your stomach to reduce its capacity.
All are designed to change your digestive system to help you lose weight. Restricting the size of your stomach naturally reduces hunger, and shortening the length of the intestine reduces the amount of energy you absorb from the food you’ve eaten.
But these procedures don’t only change the size and shape of your digestive tract. They also significantly change the chemistry of your gut, changing the behavior of hormones such as GLP-1 and ghrelin, which affects hunger.
“We actually see changes in those hormones that regulate body weight immediately after surgery,” Gudzune says. “It’s through those metabolic hormonal changes that a lot of the benefits from bariatric surgery are derived from.”
Although many bariatric surgeries are permanent, they are not necessarily a permanent fix. Good results may require a lifelong commitment to weight management. Although the initial procedure often sparks a honeymoon period, in which the pounds seem to melt off effortlessly, gradual weight regain is common. Recipients can expect to spend the rest of their lives tweaking their medications, diet, and other lifestyle choices to help keep the weight off. Follow-up surgeries may be necessary.
Not everyone with obesity is eligible for bariatric surgery. Your doctor may consider it only after other treatments are unsuccessful, depending on other health conditions in play. Each procedure also comes with a number of risks.
Lifestyle Changes
Although medications and surgery may be the most immediate ways to address obesity’s root causes, experts still recommend addressing your weight loss goals with lifestyle changes first.
“We will start with lifestyle change because we need to see how you respond — and there are folks that do really well in that regard,” Gudzune says.
Even after acknowledging that obesity is a chronic disease often driven by complex hormonal imbalances, experts still believe that lifestyle changes remain “gold standard” treatments, even for people who have received bariatric surgery or medication.
In this context, diet and exercise are not just about calories consumed and spent but about re-engineering your hormonal response. A healthy diet can improve insulin sensitivity and improve the balance of appetite-regulating hormones such as ghrelin and leptin.
Physical activity helps build lean muscle, which can also improve insulin sensitivity and increase your resting metabolic rate, helping you burn calories even when you’re at rest.
Of course, many people seeking obesity treatment have already tried to lose weight the old-fashioned way, with mixed success. That’s why behavioral therapy — which can include individual therapy and membership in a support group — may be an important part of ongoing obesity treatment.
And it’s not just about diet and exercise. Addressing factors such as mental health and sleep quality can contribute to successful obesity treatment.
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