The treatment of obesity is a highly integrated medical process aimed at safely and effectively reducing weight, minimizing the risk of related complications, and improving the overall quality of life for patients. Treatment strategies are typically customized based on the patient's body mass index (BMI), health status, and individual needs, emphasizing long-term weight maintenance rather than short-term weight loss.
Modern medicine recommends that treatment should combine medical monitoring, behavioral adjustments, and, when necessary, pharmacological or surgical interventions. Physicians assess the risks and benefits based on the patient's specific circumstances, set phased goals, and regularly track progress to adjust the plan. This process requires active collaboration between the patient and the healthcare team to achieve sustainable health improvements.
Today's treatment options for obesity can be categorized into various approaches, including medication, surgery, behavioral therapy, and technology-assisted methods. The main treatment directions include:
Pharmacological treatment is typically used for patients with a BMI ≥ 30 or a BMI ≥ 27 with metabolic diseases (such as diabetes). Currently approved medications are divided into the following categories:
Medications such as Liraglutide mimic the action of incretin hormones, delaying gastric emptying and increasing feelings of fullness. Studies have shown an average weight reduction of 5-10%, along with improved blood sugar control. It is important to note potential side effects such as nausea or gastrointestinal discomfort.
Medications containing coenzyme A derivatives can block appetite-stimulating signals, suppressing overeating. Some medications need to be used in conjunction with a low-calorie diet plan to achieve optimal results. Physicians will assess the suitability based on the patient's liver function status.
Surgical treatment is an important option for severe obesity but must strictly meet specific criteria. The main types of surgery include:
This surgery reduces stomach capacity and alters intestinal structure, decreasing food absorption and lowering ghrelin secretion. Long-term follow-up shows a maintenance of 15-30% weight loss, but it is necessary to evaluate whether the patient has severe metabolic diseases (such as BMI ≥ 40) and the risk of postoperative nutritional deficiencies.
Emerging endoscopic weight loss procedures include gastric balloon placement or intestinal stenting, which are less invasive than traditional surgery but have a narrower range of applicability. Physicians will assess based on the patient's metabolic index, age, and comorbid symptoms.
Behavioral therapy is the foundation of all treatment plans and requires structured programs to change daily habits. Key elements include:
Psychotherapy can help address binge eating or emotional eating issues. Cognitive Behavioral Therapy (CBT) can assist patients in identifying triggers and establishing alternative behavior patterns. Support groups provide a peer interaction platform to enhance treatment motivation.
Emerging research focuses on gene therapy, gut microbiome modulation, and neuromodulation techniques. Genetic studies have found polymorphisms in genes such as FTO associated with obesity, which may lead to the development of targeted medications in the future. Gut microbiome transplantation experiments have shown that specific strains can improve metabolic indicators, but clinical applications are still in the experimental stage.
Wearable devices combined with artificial intelligence are gradually becoming auxiliary tools, capable of monitoring dietary intake and activity levels in real-time, and providing personalized recommendations through algorithms. Additionally, gut nerve stimulation devices are under testing, aiming to regulate hunger signal transmission mechanisms.
When BMI exceeds 30 and is accompanied by hyperlipidemia, sleep apnea, or other metabolic diseases, it is advisable to seek evaluation from a weight management specialist. If non-pharmacological treatments have not achieved targets after 6 months, or complications such as fatty liver arise, treatment intensity needs to be reassessed.
Eligibility for surgical evaluation must meet specific criteria, such as BMI ≥ 35 with cardiovascular disease, or BMI ≥ 40 without complications. Physicians will conduct a comprehensive examination to rule out other metabolic abnormalities and explain the long-term care requirements before and after surgery.
Aerobic exercise can quickly burn calories and is recommended as the main focus in the early stages of weight loss; while weight training helps increase muscle mass to boost basal metabolic rate, maintaining weight in the long term. It is suggested to combine 3 sessions of aerobic exercise (such as jogging or swimming) with 2 sessions of resistance training each week to achieve more stable weight loss results.
Why do some people find it difficult to lose weight even when controlling their diet?This may be due to hidden sources of calories that are not accounted for (such as sauces or processed foods), or a decreased metabolic rate from prolonged low-calorie diets. It is recommended to use dietary tracking apps for precise monitoring and adjust dietary structure and caloric deficit under physician guidance to avoid hitting a "plateau."
How do medications work in obesity treatment? What side effects should be noted?Current medications primarily work by suppressing appetite, delaying gastric emptying, or blocking fat absorption mechanisms. Common side effects include nausea, diarrhea, or gastrointestinal discomfort, and regular monitoring of liver function or blood pressure is required. Prior to use, a physician must assess BMI and comorbidity risks, as not all patients are suitable for pharmacological treatment.
How does long-term stress affect weight control?Stress stimulates cortisol secretion, prompting the body to store abdominal fat while also triggering emotional eating behaviors. It is recommended to use mindfulness meditation, regular sleep, and aerobic exercise to metabolize stress, along with behavioral therapy to adjust eating habits, effectively breaking the vicious cycle between stress and obesity.
Under what circumstances should weight loss surgery be considered?When BMI exceeds 32 with obesity-related diseases (such as diabetes or sleep apnea), or when BMI exceeds 37 but non-surgical treatments have failed, evaluations for surgeries such as gastric bypass or sleeve gastrectomy can be considered. The decision for surgery must be assessed by a multidisciplinary team using the Surgical Risk Score (SRS) and accompanied by long-term nutritional follow-up post-surgery.
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