Obesity is a long-term health condition that can increase the risk of type 2 diabetes, hypertension, coronary heart disease, stroke, and certain cancers.
Estimates suggest that more than 40% of adults in the United States live with obesity. However, expanded obesity definitions, which include waist measurements and fat distribution, raise U.S. adult obesity rates to nearly 70%.
Typically, the main goal of obesity treatment is to achieve and maintain a healthy, sustainable weight. However, a new scientific statement from the Endocrine Society argues that the success of obesity treatment should not be measured by weight loss alone.
Instead, researchers and clinicians should focus increasingly on whether treatment improves overall health, reduces obesity-related complications, and helps people maintain those benefits over the long term.
The statement, published in The Endocrine Society’s journal, Endocrine Reviews, highlights major advances in obesity research, including the emergence of highly effective medications such as semaglutide and tirzepatide.
At the same time, it identifies important unanswered questions about how obesity develops, how people respond differently to treatment, and how safe and effective newer medications are when used for many years.
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Newer medications targeting the glucagon-like peptide-1 (GLP-1) pathway, including semaglutide and tirzepatide, have significantly changed the obesity treatment landscape.
These medications are being used to manage overweight and obesity and may also improve some health problems associated with obesity. Researchers are studying their potential effects in conditions involving the heart, kidneys, liver, and sleep apnea, as well as in areas such as cancer, substance use disorders, arthritis, and infertility.
This broader range of potential benefits raises an important question: Should the amount of weight lost be the primary measure of whether obesity treatment is successful? The Endocrine Society’s statement suggests it should not.
Instead, researchers should increasingly investigate whether treatment improves meaningful health outcomes, such as metabolic health, cardiovascular health, physical function, and obesity-related diseases.
“The major goals for treatment success in the clinic encompass clinically relevant outcomes, not just [the percentage of] weight loss,” Daniel Drucker, MD, of Mount Sinai Hospital in Toronto, Ontario, Canada, and lead author of the Endocrine Society’s Scientific Statement writing group, emphasized to Medical News Today.
“For some outcomes, such as obstructive sleep apnea and osteoarthritis, there is a strong correlation between the extent of weight loss and the improvement in the specific condition,” explained Drucker.
“For other co-morbidities, including reduction of rates of heart attacks, stroke, cardiovascular death, metabolic liver disease, and diabetic kidney disease, there are contributions from both weight loss as well as weight loss-independent mechanisms,” he added.
“Hence, depending on the specific circumstances, improvement in health is not strictly a discussion focused only on weight loss goals.”
– Daniel Drucker, MD
The statement from the Endocrine Society represents a broader shift in how researchers are thinking about obesity treatment.
Weight loss can be an important part of treatment, but the ultimate goal is to improve health. For some people, meaningful treatment success may involve reducing the risk or severity of obesity-related disease, improving physical functioning, or maintaining metabolic health rather than achieving a particular number on the scale.
“Success depends on the goals of the patient — what complications associated with obesity are they trying to prevent or reverse? ‘Success’ will be defined differently depending on the concerns and goals of each patient and will frequently be much more than just a weight loss goal,” Drucker noted.
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“Every patient is different. For each patient, one needs a comprehensive assessment of their health, their concerns and their goals, and then a personalized treatment plan can be formulated, which will include, but not be limited, to a specific weight loss goal.”
As obesity medications become more effective, determining who should receive them, how long they should be used, and which outcomes matter most will become increasingly important.
Improved knowledge in these areas could help to improve the understanding of obesity biology, make treatment more precise, establish clinically meaningful outcomes, and support safer use of emerging therapies.
For individuals living with obesity, that could ultimately mean a treatment approach focused less on weight as an isolated target and more on achieving and maintaining better long-term health.
The scientific statement also identifies six major areas that researchers should focus on:
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Understanding these areas could help researchers move toward more personalized approaches to obesity care.
Despite the potential benefits of newer obesity medications, the Endocrine Society statement emphasizes that important safety questions remain.
Researchers need to better understand the direct effects of these medications, the consequences of rapid weight loss, and the possible risks of long-term treatment.
Because many newer therapies have not yet been studied over the entire period that people may ultimately use them, longer follow-up will be important.
The statement therefore calls for larger, longer, and more diverse clinical studies, alongside greater use of real-world data.
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Another major issue is that obesity generally requires long-term management. Estimates suggest that roughly half of people with obesity taking GLP-1 medications may discontinue the drug within 12 months of initiation.
Research indicates that people who discontinue obesity medication after reaching a target weight can regain weight rapidly. Some associated health measures, including blood pressure, cholesterol, and blood sugar levels, may also worsen.
This suggests a shift in research toward investigating whether people can maintain health improvements at lower doses or by transitioning to other medications after an initial treatment period. Such approaches could eventually help clinicians develop more individualized treatment plans rather than assuming that every person needs the same medication, dose, or duration of treatment.
“As noted above, everyone is different,” Drucker concluded to MNT. “An individual with a BMI of 28 and a history of a recent myocardial infarction would likely benefit from use of a GLP-1 medicine yet not need to target 15 to 20% weight loss to optimize health outcomes.”
“On the other hand, someone with a BMI of 37 and obstructive sleep apnea (OSA) may indeed need to target at least 10 to 15% weight loss to improve their health and decrease the severity of their OSA.”
