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Treatment of Overweight and Obesity
Overweight and obesity are chronic conditions that often require long-term treatment. While body mass index, or BMI, is commonly used to define overweight and obesity, BMI is an imperfect measure. It does not account for fat distribution, muscle mass, or the difference between visceral fat and subcutaneous fat.
Even so, BMI remains a useful screening tool because higher BMI is clearly associated with increased risk of many medical problems. Especially for patients with excess visceral fat or obesity-related conditions, effective Overweight and Obesity Treatment can improve health and quality of life.
How overweight and obesity are defined
BMI is calculated from height and weight.
- Overweight: BMI greater than 25
- Overweight in Asians: BMI greater than 23
- Obesity: BMI greater than 30
- Obesity in Asians: BMI greater than 25
Obesity is often further classified as:
- Mild obesity: BMI 30 to 35
- Moderate obesity: BMI 35 to 40
- Severe obesity: BMI greater than 40
Limitations of BMI
BMI is widely used, but it has important limitations:
- It assumes body size increases or decreases in a simple way with height
- It does not distinguish fat from muscle
- It does not show where fat is distributed
- It does not reflect visceral fat directly
Body fat percent may or may not be a better indicator, because it also does not show where fat is distributed, nor does it reflect visceral fat. Therefore, some people with obesity may be metabolically healthy, while others with a lower BMI may have significant health risk due to visceral fat or inflammation in and around the fat cells.
Who should be treated?
Not every patient with overweight or obesity needs the same treatment approach. In general, treatment is most clearly indicated when obesity is associated with medical complications.
Patients who should usually be considered for treatment include those with:
- Sleep apnea
- Hypertension
- Cardiovascular disease
- Atrial fibrillation
- Prediabetes
- Type 2 diabetes
- Dyslipidemia
- Fatty liver disease
At higher BMI levels, treatment is generally appropriate even if complications are not yet obvious. In patients with excess visceral fat and obesity-related comorbidities, treatment may also be appropriate even if BMI is not that high.
Overweight and Obesity Treatment options
Successful long-term treatment usually involves medicines or bariatric surgery, or even both, along with added lifestyle management.
Treatment with medicines
There are several medicines available for weight loss. These differ in how much weight loss they typically produce.
Medicines associated with less than 5% median weight loss
- Orlistat
- Bupropion, used off-label
Medicines associated with about 5% to 10% median weight loss
- Phentermine
- Bupropion/naltrexone
- Liraglutide
Medicines associated with about 10% median weight loss
- Oral semaglutide
- Orforglipron
- Phentermine/topiramate
Medicine associated with about 10% to 15% median weight loss
- Injectable semaglutide
Medicine associated with about 15% to 20% median weight loss
- Tirzepatide
- Cagrilintide + semaglutide, investigational
Medicines associated with about 20% to 25% median weight loss
- Retatrutide, investigational
In general, weight loss medications work best when combined with lifestyle management. Real-world outcomes are often less than clinical trial results, likely because medications are sometimes prescribed without the same level of structured lifestyle management used in studies.
Side effects of medicines
All weight-loss medicines can have side effects. The specific risks depend on the medication used.
Orlistat
Common side effects may include:
- oily stools
- diarrhea
- fecal urgency
- gas with discharge
- reduced absorption of fat-soluble vitamins
Bupropion
Possible side effects include:
- insomnia
- anxiety or jitteriness
- dry mouth
- headache
- increased blood pressure in some patients
- lowered seizure threshold
Naltrexone/bupropion
Possible side effects include:
- nausea
- constipation
- headache
- insomnia
- increased blood pressure
- mood-related side effects in some patients
Phentermine
Possible side effects include:
- increased heart rate
- elevated blood pressure
- insomnia
- dry mouth
- nervousness
- palpitations
Phentermine is a controlled substance and is generally best used carefully and selectively.
Phentermine/topiramate
Possible side effects include:
- dry mouth
- constipation
- tingling
- insomnia
- mood changes
- cognitive slowing or brain fog
Topiramate may also be associated with teratogenic risk, so pregnancy avoidance is important when appropriate.
Liraglutide, orforglipron, semaglutide and tirzepatide
Possible side effects include:
- nausea
- vomiting
- diarrhea
- constipation
- abdominal discomfort
- fatigue
Less commonly, these medicines may contribute to gallbladder issues or pancreatitis in susceptible patients.
General medication considerations
Medication selection should be individualized based on medical history, goals, prior response, and side effect tolerance.
Lifestyle management
Lifestyle management remains an important part of obesity treatment. It works best when it is structured, realistic, and paired with ongoing support.
Effective lifestyle treatment includes three major components:
1. Reduced caloric intake
Weight loss requires fewer calories than the body uses to maintain weight. The body naturally resists weight loss, which is one reason sustained weight loss can be difficult.
A lower-calorie eating plan is needed for meaningful weight reduction. After weight loss is achieved, calorie intake needs to remain lower than before to maintain the new weight.
2. Exercise
Exercise alone usually does not produce major weight loss, but it is still very important. Regular aerobic and resistance exercise improves health in many ways and helps preserve lean body mass during weight loss.
A useful target may be:
- About 180 minutes per week of moderate aerobic exercise
- About 60 minutes per week of resistance exercise
People who are not active should build up gradually.
3. Health-promoting foods
What matters most for weight loss is total calorie intake. Some foods are more filling, including:
- fruits and vegetables
- whole grains
- legumes
- nuts
- vegetable oils
Other foods, especially ultra-processed foods high in sugar, refined carbohydrates, salt, and additives, can encourage overeating and make weight control harder.
Diet patterns such as the Mediterranean diet and DASH diet are often more health-promoting than diets high in red meat, saturated fat, sugar, and refined carbohydrates.
Lifestyle management alone may not produce large or sustained weight loss in many patients, but it can improve results when combined with other treatments.
Maintenance of weight loss
Weight loss is usually easier to achieve than to maintain. Long-term maintenance requires continued treatment. If medications are stopped, much of the lost weight generally returns. For this reason, obesity should be treated as a chronic condition rather than a short-term problem.
Bariatric surgery
Bariatric surgery generally produces greater median weight loss than medication alone, often around 25% to 30% of body weight.
Some patients maintain much of that weight loss long term, while others regain some or most of the lost weight. For patients who regain weight after bariatric surgery, adding medication can be a reasonable option.
How our practice can help
Our self-pay telemedicine practice offers personalized obesity medicine care for patients seeking a medically guided approach to weight loss.
We can help with:
- Evaluation of overweight and obesity
- Medical weight management
- Lifestyle planning
- Medication selection and follow-up
- Discussion of side effects and tolerability
- Long-term weight maintenance planning
Take the next step
If you are struggling with excess weight and want a thoughtful, individualized treatment plan, a telemedicine visit can be a practical first step. Many patients do best with a structured approach that combines lifestyle changes, medication when appropriate, and long-term follow-up.
Schedule a telemedicine visit today to discuss treatment options for overweight and obesity.
Frequently asked questions
Overweight is generally defined as a BMI of 25-30, while obesity is generally defined as a BMI over 30.
No. BMI is useful, but it does not account for muscle mass, fat distribution, or visceral fat.
That depends on the degree of obesity, body fat distribution, and overall health risk. At higher BMI levels, treatment may still be appropriate, while at lower BMI levels, treatment may be optional.
Yes. Several medications can help with weight loss, especially when combined with lifestyle management.
Most of the weight loss is generally regained over time after stopping medication.
Bariatric surgery usually results in greater weight loss, but some patients later need medication to maintain results.
Take the next step
A telemedicine visit with Dr. Sangal can be a practical first step toward answers and a plan.
Self-pay · Telemedicine for residents of California, Massachusetts & Michigan