- A new statement from The Endocrine Society says that obesity treatment success should include improvements in heart, metabolic, liver, sleep, mental, and physical health, not just the number on the scale.
- Newer drugs, such as semaglutide and tirzepatide, can support weight loss and may improve obesity-related conditions, but researchers still need to understand their long-term effects and optimal use.
- Due to possible complications from stopping treatment, researchers are exploring whether lower doses or alternative medications can help maintain benefits.
- The organization adds that more research is necessary, and has highlighted 6 major areas of research to focus on.
Estimates suggest that
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.
Newer medications targeting the glucagon-like peptide-1 (GLP-1) pathway, including semaglutide and tirzepatide, have significantly changed the obesity treatment landscape.
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
“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.
“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.”
– Daniel Drucker, MD
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.
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.
Another major issue is that obesity generally requires long-term management. Estimates suggest that
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.”