What Is the Best Method for Long-Term Weight Loss: Diet, Medication, or Obesity Surgery?

Hunger and equitable access to food remain major problems worldwide. Today, however, an even greater problem is excessive consumption, inactivity, and the resulting overweight and obesity.

Obesity, which reduces the quality of life of billions of people worldwide and brings numerous serious health problems, has become an epidemic . This article examines in detail the various methods used to combat obesity.

1. How common is obesity worldwide and in Turkey?

• Worldwide: According to the World Health Organization (WHO), 650 million adults worldwide are obese and more than 1.9 billion people are overweight.

• Turkey: According to the Turkey Nutrition and Health Survey, approximately 30% of adults in Turkey are obese and 35% are overweight.

2. What health problems does obesity cause, and which cancers is it associated with?

• Metabolic Diseases: Type 2 diabetes, hypertension, and insulin resistance.

• Cardiovascular Diseases: Coronary artery disease, stroke and heart failure.

• Respiratory Problems: Increased risk of sleep apnea and asthma.

• Orthopedic Problems: Joint inflammation, osteoarthritis, and limited mobility.

• Cancers: Research has shown that obesity is strongly associated with the following cancers:

  • Stomach and esophageal cancer

  • Breast cancer (particularly after menopause)

  • Colorectal cancer

  • Uterine cancer

  • Pancreatic and kidney cancer

  • Liver cancer

  • Prostate cancer (aggressive types)

3. What are the treatment options?

• Lifestyle Changes: Diet, exercise, and generally healthy lifestyle habits.

• Anti-Obesity Medications (AOMs): Recently approved weight-loss injections help suppress appetite and support weight loss.

• Bariatric Surgery: Surgically reducing the volume of the stomach.

4. Have these methods been compared?

• So far, no study has directly compared these methods.

• It is important to explain the advantages and disadvantages of these options to patients to help them make informed decisions.

5. What do guidelines say about obesity treatment?

• According to the American Heart Association and the American Association of Endocrinologists, body mass index (BMI) guides the following approaches to treating overweight and obesity:

  • BMI 25-29.9: Lifestyle changes.

  • BMI 27-29.9 + Comorbidity: Lifestyle changes and anti-obesity medications (AOMs).

  • BMI ≥ 30: Lifestyle changes and AOMs.

  • BMI ≥ 30 + Multiple Comorbidities: Lifestyle changes, AOMs, and bariatric surgery.

6. Why are lifestyle changes fundamental?

• Lifestyle changes form the foundation of every treatment method.

• Lack of physical activity affects sleep quality, appetite, and metabolism.

7. Is weight regained after bariatric surgery?

• Weight-loss operations are effective for weight loss, but 49% of patients may regain some weight after surgery.

• Average weight loss after Roux-en-Y gastric bypass:

  • Year 1: 31.2%

  • Year 5: 25.5%

• Similar rates of weight regain have also been observed after sleeve gastrectomy and adjustable gastric banding.

8. Are anti-obesity medications effective?

• Semaglutide: Average weight loss of 17.3%, but regain of up to 11.6% has been observed after discontinuation.

• Tirzepatide:

  • 36 weeks: 20.9% weight loss.

  • 52-week follow-up: Patients who stopped treatment regained 14%, while those who continued the medication lost an additional 5.5%.

Below, we examine medications approved by the FDA (US Food and Drug Administration) and administered by injection for weight loss: