Amid all the excitement surrounding the new GLP-1-type anti-obesity medications and others in the pipeline, many people, including healthcare providers, are conflating weight loss with obesity treatment. But obesity treatment isn’t just about weight reduction or about one class of medications (no matter how promising!). In the words of a new consensus statement by the International Obesity Collaborative, “Obesity care is about health, not weight.”
Obesity care goes beyond mere body weight reduction in a number of ways, all of which tie back to an unwavering focus on improving patients’ health:
Comprehensive, individualized treatment
Obesity is a complex, multifactorial, relapsing chronic disease that requires a highly individualized treatment approach. Before starting a patient on an anti-obesity medication, we must develop a comprehensive, personalized education and treatment plan that takes into account all the specific factors contributing to that individual’s weight gain and those preventing weight loss (from physical activity and nutrition, to sleep patterns and stress, to previous weight loss experience, to other health conditions and medications). Treatment may include GLP-1 medications, but there’s no one-size-fits-all solution.
We call the medications anti-obesity medications rather than weight-loss drugs for a reason: they’re designed for long-term treatment of the chronic disease of obesity. We can’t just prescribe Wegovy or Zepbound and send patients on their way. These medications are generally well tolerated when prescribed appropriately, but not all patients with obesity are good candidates. We need to support those who are with dietary strategies and personalized titration schedules to minimize side effects, as well as education to identify early warning signs way before more serious adverse events occur.
Obesity leads to dysregulation in a variety of physiological pathways that can affect virtually every body system. Obesity is associated with more than 200 health conditions, including heart disease, hypertension, type 2 diabetes, osteoarthritis, sleep apnea and certain types of cancer, to name just a few. Treating obesity includes addressing these comorbidities. While it’s true that weight loss itself can lead to improvements in many of these weight-related health conditions, it’s not always a straightforward process. Individuals with obesity often have multiple comorbidities, and many are already taking multiple medications — creating additional variables and potential interactions to manage.
Patients with obesity may present with specific weight goals they’d like to achieve, but as providers, we emphasize instead the importance of health outcomes, such as measurable improvements in metabolic health markers. The healthy lifestyle habits incorporated into the treatment plan underscore this focus, and a patient’s ability to decrease or discontinue other medications — for hypertension or diabetes, for example — often depends not only on the amount of weight lost, but also on these complementary lifestyle changes.
Support for long-term weight maintenance
Patients need to be aware that the initial weight loss period is only the first stage in a lifelong journey. Obesity is a chronic disease — one that we don’t yet have a cure for — which means that weight management requires long-term commitment. As clinicians, our job isn’t finished when our patients bring their weight down; we need to provide ongoing support to help them sustain the healthy behavior changes they’ve made, avoid medication discontinuation, and make adjustments and get back on track when they encounter the inevitable challenges along the way. Weight maintenance is often more difficult than weight loss, and patients frequently underestimate how much ongoing support they’ll need.
We’re thrilled to have so many new anti-obesity medications in our armamentarium — medications that are extraordinarily effective at helping individuals lose weight. But weight reduction is just part of the obesity treatment story. As clinicians, we need to make sure we’re looking beyond the number on the scale and delivering holistic, empathetic, evidence-based care tooptimize our patients’ overall health and well-being.
** I’m honored to be a member of the International Obesity Collaborative (IOC), a global initiative to address obesity internationally. Comprised of 12 leading obesity organizations, the IOC aims to raise awareness, share best practices, and implement effective interventions to treat obesity around the world. We recently published the consensus statement: “Obesity Care vs. Weight Loss.” Stay tuned for more publications by the IOC.