Overweight and obesity have emerged as two of the most pressing health challenges of the modern world, posing significant threats to individual well-being and public health systems alike. These conditions are no longer limited to affluent societies but have become global epidemics, cutting across geographical, cultural, and socioeconomic boundaries. Obesity is associated with a wide range of chronic illnesses, including type 2 diabetes, hypertension, cardiovascular disease, degenerative joint disorders, sleep apnea, and certain cancers. Beyond the clinical complications, obesity also inflicts psychological and social burdens, as individuals often face stigma, prejudice, and discrimination.
Traditionally, obesity was mistakenly seen as a simple consequence of unhealthy behavior—overeating, inactivity, or lack of self-discipline. This narrow perspective not only failed to capture the biological and environmental complexity of obesity but also perpetuated damaging stereotypes. Fortunately, modern medical science has shifted its understanding. Advances in the study of obesity’s pathophysiology have highlighted that it is a chronic, multifactorial disease influenced by genetics, environment, metabolism, and behavior. These insights are paving the way for innovative pharmacological, surgical, and behavioral interventions that offer hope for more effective management.
Obesity as a Chronic Disease
Obesity must be recognized and managed as a chronic disease, much like hypertension or diabetes. It is not a temporary state to be reversed and forgotten once the desired weight is achieved. Patients who reach their weight goals remain at risk of relapse if support is withdrawn. This underscores the need for long-term management strategies and ongoing clinician-patient partnerships. Just as blood pressure control requires continuous attention, obesity management should not be discontinued but adapted over time as the disease evolves.
The Need for a Multidisciplinary Approach
Effective obesity care is rarely the work of a single physician. It demands a multidisciplinary approach that may include primary care doctors, endocrinologists, bariatric surgeons, dietitians, psychologists, and physiotherapists. Each discipline contributes unique expertise—whether through metabolic evaluation, surgical intervention, nutritional guidance, or behavioral therapy. Tailoring care to individual patients is essential, as obesity presents differently depending on genetics, comorbidities, lifestyle, and psychosocial circumstances. The severity of obesity and the presence of related conditions should guide the intensity of intervention.
Combating Stigma in Obesity Care
Perhaps one of the most overlooked aspects of obesity management is the stigma patients face. Weight-related stigma discourages many individuals from seeking care, leading to delayed diagnosis and poor management of obesity and its associated diseases. Physicians must engage in compassionate, non-judgmental conversations about weight, focusing on health rather than appearance. Importantly, not all symptoms should automatically be attributed to weight. A thoughtful evaluation that considers other possible causes is critical in avoiding misdiagnosis. By reframing obesity as a complex medical condition rather than a personal failing, clinicians can help dismantle stigma and build trust.
Beyond Body Mass Index (BMI)
Body Mass Index (BMI) remains the most widely used measure to classify overweight and obesity. However, it is far from a perfect tool. BMI does not account for differences in body composition, muscle mass, sex, or ethnicity. A muscular athlete and a sedentary individual with excess fat may have the same BMI, yet vastly different health profiles. As such, BMI should be considered a starting point rather than a definitive diagnostic measure. The development of more precise tools to assess obesity—such as body fat distribution, metabolic markers, and genetic factors—will be crucial in advancing care.
The Role of Lifestyle Modification
While lifestyle changes such as diet and exercise remain foundational in obesity management, evidence shows that they alone are often insufficient for long-term success. Less than half of patients in structured lifestyle programs achieve even modest weight loss of 5% or more. The most effective diet, experts emphasize, is the one that a patient can adhere to sustainably while maintaining a calorie deficit. Exercise plays an important role in preserving muscle mass, improving metabolic health, and supporting psychological well-being, but lifestyle modification should be viewed as one component of a broader therapeutic strategy rather than the sole intervention.
Pharmacologic and Surgical Interventions
Recent years have witnessed remarkable progress in pharmacologic therapies for obesity. Drugs such as bupropion–naltrexone, orlistat, phentermine–topiramate, liraglutide, and semaglutide have expanded treatment options, offering meaningful weight reduction when combined with lifestyle interventions. On the surgical front, procedures like sleeve gastrectomy and gastric bypass remain highly effective for severe obesity, with newer, less invasive endoscopic procedures also gaining traction. Choosing among these options requires shared decision-making, where patients and clinicians carefully weigh benefits, risks, and personal preferences.
Toward a New Era of Obesity Care
As we move into an era of increasingly effective therapies, the future of obesity management looks promising. Better understanding of its biological underpinnings not only facilitates the development of targeted preventive and therapeutic strategies but also helps challenge outdated narratives that fuel stigma. Addressing obesity with the same seriousness as other chronic diseases can improve health outcomes and quality of life for millions worldwide.
Conclusion
Overweight and obesity represent one of the defining health challenges of our time. Their management requires a nuanced, long-term, and multidisciplinary approach that integrates medical science with compassion. By embracing new pharmacological and surgical tools, refining diagnostic measures, and, most importantly, dismantling stigma, the medical community can help patients achieve not just weight loss but improved overall health and dignity. The fight against obesity is not about numbers on a scale—it is about empowering individuals to live healthier, longer, and more fulfilling lives.
drtasadukitoo@gmail.com
The writer is a Physician/Public Health Expert, Life member, Research Society For the Study Of Diabetes in India (RSSDI), member- American College of Physicians (USA), Member, Endocrine Society (USA), Nominee, Board of Directors, Endocrine Society (USA).
