Obesity – A Chronic, Relapsing Disease Requiring Long-Term Treatment

Lifestyle interventions are often insufficient to interrupt these mutually reinforcing processes. This depends to a large extent on age, sex and existing comorbidities. Determining this is therefore a professional clinical responsibility.

In other words, obesity treatment extends beyond lifestyle modification.

Nevertheless, lifestyle modification can neither be omitted nor abandoned. Appropriate treatment always begins with it, not only because it supports professional assessment, but also because pharmacological treatment does not replace it; rather, it complements it.

This is an important factor because, following the discontinuation of pharmacological treatment, lifestyle changes must be maintained in order to avoid the so-called yo-yo effect, which is also an integral part of obesity as a disease.

We are therefore not talking about aesthetics, but about increasing both the number of years lived and their quality.

For individuals with a BMI above 30 kg/m², pharmacological weight loss may be an appropriate treatment option following suitable clinical assessment, even if comorbidities have not yet developed.

Contemporary clinical guidelines do not regard pharmacological treatment of obesity merely as a last resort, but as an important part of comprehensive disease management.

Lifestyle management, dietetic support and, where appropriately indicated, pharmacological treatment are complementary treatment options.

Selecting the appropriate treatment strategy requires an individual clinical assessment.

The American Diabetes Association (ADA) 2026 clinical guidelines represent a significant advance in the assessment of pharmacological treatment for obesity.

According to the guidelines, pharmacotherapy should be considered even in adults living with obesity who have not yet developed obesity-related comorbidities or complications (Recommendation 2.6a).

For patients who already have such comorbidities or complications, or who are at increased risk of developing them, pharmacological treatment is recommended to be offered as part of the initial therapeutic strategy (Recommendation 2.6b).

The latter recommendation has a Grade A level of evidence, meaning that it is supported by high-quality scientific evidence.

This approach reflects a significant shift in perspective: pharmacological treatment of obesity is not exclusively an option following persistently unsuccessful lifestyle management, but, where clinically indicated, may be used from the beginning of treatment as a therapeutic tool complementing dietetic and lifestyle interventions.

In the United Kingdom, the current NICE NG246 clinical guideline continues to emphasise the primary role of lifestyle interventions in the treatment of obesity.

According to the guideline, interventions addressing nutrition, physical activity and behaviour change must be initiated and evaluated before pharmacological treatment is considered.

This approach regards pharmacotherapy as part of comprehensive obesity treatment, which may be used as an adjunct to lifestyle management where clinically indicated.

However, NICE does not prescribe a uniform, mandatory duration of lifestyle intervention for all patients before pharmacological treatment is considered.

This is a matter of professional clinical judgement in each individual case.

The European Association for the Study of Obesity (EASO) 2026 position statement emphasises a personalised approach to pharmacological treatment of obesity based on clinical considerations.

Accordingly, the selection of appropriate pharmacotherapy cannot be based solely on body mass index (BMI), but must also take into account obesity-related comorbidities and complications, the patient's overall clinical condition, individual risk factors and the therapeutic goals established.

This perspective represents a significant shift in emphasis in obesity treatment: the focus of therapeutic decision-making is not solely on the extent of weight loss, but on the clinically relevant health benefits achievable for the individual patient.

The aim of treatment is therefore not exclusively to reduce body weight, but to prevent and treat obesity-related diseases, reduce the risk of complications and improve long-term health.

Excess body fat, particularly when it adversely affects metabolism or organ function, represents a significant health risk.

Type 2 diabetes, high blood pressure, cardiovascular diseases, sleep apnoea and joint problems may all be associated with obesity.

These risks increase over time, which is why the treatment of weight-related problems cannot be postponed indefinitely.

Weight loss is not merely a matter of choice. It is an important condition for maintaining or restoring health.