Not all obesity treatments are equally effective, a new study finds.
Obesity affects more than 40% of adults and 19% of children in the United States.
National Institute of Diabetes and Digestive and Kidney Diseases. Obesity. Treatment options for obesity have changed and expanded rapidly—to the point where it can be confusing to keep up with what options are available.
These treatment options include popular prescription medications like Ozempic (semaglutide), Wegovy (semaglutide), and Mounjaro (tirzepatide).
A new analysis published last month in JAMA pared down the best obesity treatments currently on the market.
“It’s been really surprising—over the past four, five years—how many medications are coming out,” Melanie Jay, MD, one of the report’s authors, told Health.
“The purpose of this review was to summarize the data in an accessible place, to synthesize the things we know,” she said.
To determine which treatments work best, Jay and her team reviewed more than 100 studies, randomized control trials (RCTs), and other articles.
Given the toll obesity takes on the U.S., advanced research on the condition is important.
Obesity has been linked to higher rates of heart disease—the leading cause of death in the U.S.—type 2 diabetes, hypertension, osteoarthritis, and premature death.
The new study also underscores the fact that obesity is a medical condition and should be studied as such.
“All this knowledge about obesity highlights how obesity really is a disease—it’s not about willpower; it’s not a moral failing,” said Jay, who is also an associate professor in the Department of Medicine and Department of Population Health at NYU Grossman School of Medicine.
Here’s how obesity treatments compare, as well as what other aspects of obesity still need to be studied.
Recent research identifies behavioral changes, medications, and surgery as the most effective treatments for obesity.
For the new review, Jay and her team analyzed 126 articles to gather data on available obesity treatments.
“There were tens of thousands of articles on obesity,” she explained.
The authors of the report wrote that they chose only the highest-quality papers to include in their review. Among these articles were:
- 26 randomized control trials (RCTs)
- 29 meta-analyses and systematic reviews
- 14 longitudinal/population-based studies
- 15 clinical practice guidelines
- Four policy guidelines
- Two cross-sectional studies
- Two study/intervention descriptions
- 34 narrative reviews
The researchers found that the most effective obesity treatments are: bariatric surgery, behavioral interventions, and the use of certain medications—glucagon-like peptide receptor 1 (GLP-1) agonists and glucose-dependent insulinotropic polypeptide/GLP-1 receptor agonists.
GLP-1 agonists include medications with active ingredients semaglutide, (like Ozempic and Wegovy), and liraglutide. Tirzepatide is a glucose-dependent insulinotropic polypeptide/GLP-1 agonist, found in medications like Mounjaro and Zepbound.
The authors of the review found the effective treatments differed in how much weight they helped people with obesity lose:
- Bariatric surgery: 25% to 30% weight loss
- GLP-1 agonists and glucose-dependent insulinotropic polypeptide/GLP-1 receptor agonists: eight to 21% weight loss
- Behavioral interventions: five to 10% weight loss
Among the medications analyzed for the review, tirzepatide (Mounjaro and Zepbound) had the “greatest effect,” with an average weight loss of 21% after 72 weeks of use.1
The new review provides an accurate analysis of the field of obesity treatment right now, Benjamin O’Donnell, MD, an endocrinologist and weight management expert at The Ohio State University Wexner Medical Center, told Health.
“Having read this report, what the authors describe aligns very well with my own experience and practice in treating obesity,” he said. “There’s nothing very surprising here.”
It’s worth noting, O’Donnell added, that what works for one person with obesity may not work for the next.
“Each person should be provided [an] individualized treatment plan with a focus on lifestyle changes and finding a long-term approach,” he explained.
Obesity Treatments Aim to Impact Hunger Levels
O’Donnell notes that the effectiveness of various treatments varies based on their impact on an individual’s feelings of fullness or hunger.
Bariatric surgery, typically recommended for individuals with a body mass index (BMI) of at least 35 or those with a BMI of 30 to 34.9 with concurrent metabolic disease, comes in multiple types. These procedures generally restrict food intake and may also modify nutrient absorption and food digestion. Bariatric surgery becomes a consideration when lifestyle interventions, such as diet and exercise, prove ineffective.
For individuals with a BMI of 30 or higher, or a BMI of at least 27 with obesity-related comorbidities like hypertension, type 2 diabetes, cardiovascular disease, or sleep apnea, medications like Semaglutide, Liraglutide, and Tirzepatide are recommended. These medications work by suppressing appetite and delaying gastric emptying, leading to extended periods of food retention in the stomach.
Behavioral interventions are suggested for individuals dealing with obesity or being overweight. These interventions encompass dietary changes, exercise, stress management techniques, and guidance for those experiencing insufficient sleep.
The Future of Obesity Treatment in the US
While the report acknowledges the effectiveness of multiple treatments currently available, Jay highlights several challenges in the field of obesity treatment.
A significant concern is the shortage of obesity specialists in the U.S., especially considering the anticipated rise in the number of people affected by obesity. Despite the benefits of new medications, they introduce fresh challenges, particularly in terms of accessibility.
Jay emphasizes the existing access issues, stating that the supply is not meeting the demand. The critical question of who can access these medications also remains unanswered, raising concerns about potential widening health disparities if better treatments are not made universally accessible.
The introduction of new medications prompts the need for more studies to address questions about eligibility criteria and insurance coverage. Despite the comprehensive overview provided by the new review on current obesity treatments, continuous studies are essential to stay abreast of the evolving market.
According to Jay, the review may become slightly outdated within a year due to the constant emergence of new medications.
