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By Dr Naser Gharaibeh; Email: [email protected]
Endocrinologist& Obesity Medicine Consultant
Valley Health System – New Jersey, USA
Metabolic Medicine and Weight Loss Director
Many people still see obesity as a personal failure. They assume that a person simply eats too much, exercises too little or lacks willpower.
This view is outdated and harmful.
Obesity is a chronic disease influenced by genetics, hormones, sleep, stress, medications, food access and the environment in which we live. Like diabetes or high blood pressure, it often requires long term care. More than 1 billion people worldwide now live with obesity, making it one of today’s greatest public health challenges.
As an endocrinologist and obesity medicine physician with a focus on menopause care, I see its effects every day. I also see what happens when we stop blaming people and start offering proper treatment.
A disease, not a lack of discipline
Our bodies defend their weight more strongly than most people realize.
When a person loses weight, hunger can increase and the body may burn fewer calories. This is not an excuse or a sign of weakness. It is biology.
Genes also affect appetite, fullness, fat storage and the way the body responds to food. Sleep deprivation, stress, certain medications and hormonal conditions may add to the problem.
Where a family lives also matters. Some communities have safe parks, affordable fresh food and easy access to healthcare. Others do not. Work schedules, income, transport and caregiving responsibilities can all affect a person’s ability to manage their health.
Telling someone to “eat less and move more” ignores this reality.
Are we starting to turn the tide?
Obesity rates remain high and continue to rise in many parts of the world. Yet there are early signs of change in some populations.
A large analysis published in 2024 found a small decline in obesity among American adults in 2023, the first recorded decline in more than a decade. However, other national data still show that about four in ten American adults live with obesity. One encouraging change does not mean that the problem has been solved.
It does show that progress may be possible.
Public awareness is improving. Healthcare professionals understand the disease better. Families are talking more openly about weight, food, sleep and mental health. We also have more treatment options than we had a decade ago.
No single medication or public policy will solve obesity. However, changes across schools, workplaces, healthcare systems and communities can add up. When society changes the environment and provides effective treatment, people have a better chance of improving their health.
More than “weight loss medications”
The phrase “weight loss medication” can be misleading. It makes the treatment sound cosmetic, as though its only purpose is to change someone’s appearance.
I prefer the term antiobesity medication.
These medications treat a chronic disease and may improve many of its complications.
Obesity can affect the body in several ways:
Metabolic complications include type 2 diabetes, fatty liver disease, high blood pressure and abnormal cholesterol levels.
Physical complications include sleep apnoea, joint pain, reduced mobility and difficulty completing everyday activities.
Emotional and social complications may include low confidence, anxiety, depression, isolation and the effects of weight related stigma.
Antiobesity medications are not antidepressants, and they do not directly treat every condition on this list. However, treating obesity may improve blood sugar, liver health, breathing during sleep, mobility and overall quality of life. Some medications now have specific approvals for conditions such as obstructive sleep apnoea in adults with obesity.
The goal is not simply to produce a lower number on the scale. The goal is to help the person live a healthier and more active life.
GLP 1 medications are only one option
GLP 1 medications have received enormous attention because they can produce significant weight loss and improve several health conditions.
They are not the only anti-obesity medications. Other medicines work through different pathways, and metabolic surgery remains an important treatment for some people.
GLP 1 medications should not be treated as a desperate last resort. They are evidence based medical treatments for people who meet the appropriate criteria. They should also not be viewed as a quick solution for anyone who wants to lose a few kilograms.
Marketing and social media have created two opposite problems.
Some people use these medications without a clear medical need or proper follow up. Others who have obesity and serious health complications cannot obtain them because of cost, limited insurance coverage or availability. The World Health Organization has warned that access remains unequal, even as production expands.
Buying unapproved products or taking doses without proper guidance also carries real risks. Health authorities have reported dosing mistakes, severe side effects and hospital admissions linked to some compounded GLP 1 products.
Medication does not replace lifestyle
I regularly meet people whose lives have changed after starting an antiobesity medication.
They may sleep better, move with less pain, control their diabetes or take part in family activities they once avoided. These results can be life changing.
However, medication does not replace healthy habits. It can make those habits more achievable by reducing hunger and helping a person feel full sooner.
Nutrition, physical activity, strength training, sleep and stress management remain the foundation of care. This foundation also protects muscle, supports bone health and helps the person maintain progress.
Good treatment requires more than a prescription. Depending on the person’s needs, the care team may include a physician, dietitian, physical therapist, pharmacist and mental health professional.
The team should monitor side effects, blood pressure, blood sugar, nutrition, muscle health and other medications. Regular follow up also helps the person adjust the treatment safely.
Clinical guidelines recommend using antiobesity medications alongside lifestyle treatment, not instead of it.
Families and communities have a role
The words we use matter.
Comments about body size, jokes about weight and constant criticism can push a person away from care. Weight stigma may cause people to avoid medical appointments, exercise in public or discuss their struggles with family members.
Support does not mean policing someone’s plate or repeatedly asking how much weight they have lost.
It means listening without judgement. It may mean preparing balanced meals together, joining a family member for a walk or helping them attend medical appointments. It also means recognising that treatment decisions belong to the patient and the healthcare team.
Parents and caregivers should be especially careful when discussing weight around children and teenagers. The focus should remain on health, energy, strength and healthy routines, not shame or appearance.
What needs to happen next?
We need better public understanding of obesity as a disease.
We need more research into long term treatment, muscle preservation, mental health and the needs of different communities. We also need fair access to evidence based medications for people who are likely to benefit from them.
Most importantly, we must replace blame with proper care.
Obesity is not a simple disease, and it will not have a simple solution. Medications are one part of treatment. Lifestyle, family support, community resources and regular medical care are equally important.
When we treat obesity seriously, safely and without judgement, we give people more than an opportunity to lose weight. We give them a better opportunity to regain their health.
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Sidebar: Before starting an anti-obesity medication
Ask these questions:
• Do I have a medical reason to take this medication?
• Who will monitor my progress and side effects?
• Could it interact with my other medications?
• How will I protect my nutrition, muscles and bone health?
• What is my plan for food, movement, strength training and sleep?
• How often will I have follow up appointments?
• What is the long term plan if the medication works?
Never share medication, use someone else’s prescription or change the dose without guidance from a qualified healthcare professional.
