Doctors Still Do Not Recognize Obesity as a Disease!

"Obesity must be recognized and treated as a disease." This was the central message of the 23rd European Congress of Internal Medicine (ECIM 2025), held on March 5-8, 2025.

As a new generation of anti-obesity medications develops rapidly, internists discussed obesity's economic and health burden, recent advances in medication and surgery, effective lifestyle strategies and persistent prejudice toward obesity.

Obesity: A Disease Rather Than a Personal Choice

One of the main reasons obesity medications are not widely prescribed is that obesity is seen as a personal choice rather than a disease.

A workshop titled Adult Obesity Treatment Course for Internists, organized by the European Association for the Study of Obesity, addressed patients' experiences and the important roles of physical activity and nutrition in managing obesity.

Despite strong scientific evidence in these areas, a substantial gap remains between theory and practice.

Today, very few specialists focus on prescribing exercise, but I believe that number will grow over time. This is a gradual process, and we are still at the beginning, but I am confident it will last.

One of our responsibilities is to educate colleagues and give them the knowledge and skills to prescribe exercise.

Obesity, which requires a multidisciplinary approach free from stigma and prejudice, is a complex disease. Treatment should always be sought at specialized centers.

Why Are New-generation Obesity Medications Underused?

Medications such as orlistat, metformin, and liraglutide (Saxenda) have long been used for obesity. Newly developed hormone-based weight-loss injections , including tirzepatide (Mounjaro) and semaglutide (Ozempic), are also highly effective.

New-generation medications are highly effective for weight loss, yet obesity is still not adequately addressed as a disease in its own right. Patients with obesity are generally treated for conditions such as hypertension, diabetes, and hyperlipidemia, but overall health cannot improve comprehensively without treating obesity itself.

Concerns about side effects, doubts about effectiveness, high costs, and access difficulties limit the wider use of obesity injections. However, most of these barriers are based on prejudice rather than scientific evidence.

These medications do have side effects, but what medication does not? What matters is discussing potential side effects thoroughly with patients before treatment and developing strategies to minimize them through appropriate dose adjustments.

The table below lists FDA (United States Food and Drug Administration)-approved medications used as weight-loss injections:

Will Bariatric Surgery Continue Despite New Medications?

As advances in medication and new obesity injections revolutionize weight management, questions arise about the future of bariatric surgery. Will surgery retain a role in this changing approach to obesity treatment?

The answer is "definitely yes."

Although current evidence suggests medications can be effective, particularly for moderate weight loss, the dramatic, long-term weight loss provided by bariatric surgery remains indispensable for many patients. Surgery continues to be the most effective and lasting solution, particularly for people with a body mass index (BMI) above 40 or serious obesity-related health problems.

Related topic: Are Weight-loss Injections Replacing Bariatric Surgery?

The most common weight-loss operation, sleeve gastrectomy, continues to lead obesity surgery, followed by Roux-en-Y gastric bypass and one-anastomosis gastric bypass procedures.

Differences Between Bariatric Surgery and Medication

1. Effectiveness: Bariatric surgery may provide lasting weight loss of 25-35%, whereas obesity medications generally produce weight loss of around 25%.
2. Metabolic Effects: Surgery contributes not only to weight loss but also to improvements in metabolic conditions such as type 2 diabetes, hypertension, and sleep apnea.
3. Side Effects and Risks: Obesity medications are generally well tolerated, but questions remain about their long-term effects. Bariatric surgery carries anesthesia and operative risks, although modern surgical techniques are reducing them.

What Should the Approach to Obesity Treatment Be?

For patients with a body mass index (BMI) below 35, the first approach should be diet and exercise therapy . If these measures are insufficient, medication may be considered next, with surgery reserved as a last resort. In particular, for people carrying 10-20 excess kilograms, surgery as an initial treatment is not appropriate.

In conclusion, surgery and medication will advance together. Cooperation between surgeons and internists will continue to strengthen. Treating obesity as a disease requires a comprehensive approach grounded in scientific evidence.