Treatments for Obesity

Nutrition

There is no single diet that is best for everyone with obesity. A successful eating plan should be nutritionally adequate, sustainable, affordable, culturally appropriate, and compatible with your preferences and medical needs.

Depending on your preferences, evidence-based approaches may include Mediterranean-style eating, lower-carbohydrate or lower-fat diets, higher-protein diets, plant-forward diets, or structured calorie-reduction programs. The common goal is generally to create a “Calorie deficit.” In other words, to take in fewer calories per day than you use. By making healthy food choices, you can pack all the nutrition your body needs into your daily intake.

Very restrictive diets (such as extreme calorie-restriction or fad diets that deviate markedly from what you and your family normally eat) may produce rapid initial weight loss but can be difficult to maintain. Long-term adherence is usually more important than choosing one particular “lose weight quick” approach.

Physical Activity

Exercise has benefits that extend well beyond the number of calories burned. Regular physical activity can improve cardiovascular fitness, insulin sensitivity, blood pressure, sleep, mobility, mood, and overall health and quality of life.

Aerobic activities may include brisk walking, cycling, swimming, jogging, or other activities that raise the heart rate. Resistance exercise, such as lifting weights or using resistance bands, is also important because it helps preserve muscle mass during weight loss.

Exercise alone typically produces relatively modest weight loss; weight loss occurs more in the kitchen than it does in the gym. However, exercise can enhance the effects of dietary changes and is particularly important for improving health and helping maintain weight loss over time.

People who aren’t currently active don’t need to begin with an intensive exercise program. Gradually increasing walking or other forms of movement can be an appropriate starting point, particularly for people with joint pain, cardiovascular disease, or limited mobility.

Behavioral Treatment

Behavioral therapy (psychotherapy that focuses on changing unhealthy behavioral patterns) helps people identify and change patterns that contribute to overeating or make weight management more difficult. Strategies may include setting realistic goals, monitoring food intake and physical activity, planning meals, identifying triggers for overeating, problem-solving, managing stress, and developing strategies to prevent relapse.

Comprehensive behavioral programs typically combine nutrition, physical activity, and behavioral counseling. Research shows that these interventions can produce meaningful weight loss, although maintaining the lost weight can be challenging.

Psychological support may also be appropriate when depression, anxiety, binge-eating disorder, trauma, or other psychological factors affect eating behavior or obesity treatment.

Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists.

GLP-1 is a naturally occurring hormone involved in appetite regulation, digestion, and blood glucose control. It acts on areas of the brain involved in appetite and satiety, helping people feel fuller and reducing hunger and food intake. It also appears to act on parts of the brain involved in creating food cravings.

GLP-1 receptor agonists are medications that mimic the action of GLP-1, a natural hormone released after eating. They are used in treating diabetes, obesity, and some heart problems, depending on the medication.

Common GLP-1 receptor agonists include:

A related medication, tirzepatide, is sometimes grouped with GLP-1 therapies, although it acts on both GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) receptors. It is sold as Mounjaro® for type 2 diabetes and Zepbound® for chronic weight management and certain obesity-related conditions.

These medications are prescription treatments and are not appropriate for everyone. Common side effects include nausea, vomiting, diarrhea, constipation, and abdominal discomfort.

Naltrexone/Bupropion

Naltrexone/bupropion (commonly branded as Contrave) combines two medications that influence brain pathways involved in appetite and food-reward behavior. The medication may help reduce hunger and cravings in some people. However, it is not appropriate for everyone. For example, naltrexone interferes with opioid medications, and bupropion may increase the risk of seizures in susceptible individuals. Blood pressure should also be considered when determining whether this treatment is appropriate.

Clinical studies show a weight loss of about 5% to 8% of total body weight after one year of consistent use. Treatment is typically evaluated at 12 weeks; if the patient has not lost at least 5% of their body weight, the drug is usually discontinued.

Nausea, constipation, headache, dizziness, dry mouth, and insomnia are the most common side effects.

Orlistat

Orlistat works differently from medications that suppress appetite. It inhibits gastrointestinal enzymes (“lipases”) required to digest dietary fat. As a result, some of the fat consumed in food is not absorbed and is therefore excreted in the stool after it passes through the digestive system.

Side effects can include oily stools, fecal urgency, gas, and increased bowel movements, particularly after high-fat meals. Orlistat can also reduce absorption of fat-soluble vitamins, so supplementation may sometimes be recommended.

Future Medications

Combination medications are in development for treating obesity. For example, maridebart cafraglutide (MariTide) combines a GLP-1 receptor agonist with a GIP agonist (similar to tirzepatide). Cagrilintide-semaglutide (CagriSema) combines a GLP-1 agonist with an amylin and calcitonin receptor agonist, which targets a unique brain pathway that slows stomach emptying, thereby further curbing appetite. Other medications that target other novel pathways are under development.

What Happens If You Stop Obesity Medication?

One of the most important developments in obesity treatment has been the recognition that medication often needs to be continued long-term. Obesity produces biological adaptations that encourage weight regain after weight loss. Appetite can increase, energy expenditure can decrease, and hormonal signals controlling hunger and fullness can change.

This highlights the importance of using weight loss medication together with lifestyle modifications, in the form of a proper diet and regular exercise, so that when the medication is discontinued you can continue with a weight-healthy lifestyle.

Sleeve Gastrectomy

A sleeve gastrectomy involves removing a large portion of the stomach, leaving a smaller, sleeve-shaped stomach. This reduces the amount of food the stomach can hold, but its effects are not purely mechanical. Surgery also alters gastrointestinal hormones and biological pathways involved in hunger, fullness, and metabolism.

Roux-en-Y Gastric Bypass

Gastric bypass creates a small stomach pouch that is connected to a lower portion of the small intestine. Food therefore bypasses much of the stomach and the first portion of the small intestine. Like with a sleeve gastrectomy, gastric bypass changes both food intake and physiological signals involved in appetite and metabolism.

Who May Be Eligible for Bariatric Surgery?

Modern recommendations have expanded eligibility for metabolic and bariatric surgery.

The American Society for Metabolic and Bariatric Surgery and the International Federation for the Surgery of Obesity and Metabolic Disorders recommend metabolic and bariatric surgery for people with a BMI of 35 kg/m² or higher, regardless of whether obesity-related medical conditions are present. Surgery should also be considered for individuals with metabolic disease and a BMI of 30 to 34.9 kg/m².

Eligibility may vary according to national guidelines, healthcare systems, insurance requirements, ethnicity, medical history, and individual circumstances.

Bariatric surgery is not simply a procedure followed by discharge from obesity care. Patients require long-term medical and nutritional follow-up. Vitamin and mineral supplementation is particularly important because nutritional deficiencies may develop after some procedures.