Difficulty controlling body weight, overweight, and obesity should motivate seeking medical attention; Obesity is a chronic disease associated with various complications and has a significant impact on public health; There are currently several treatment options, and the medicines that have emerged in recent years have a good safety profile and good results; It is essential that they are used under medical guidance and with follow-up throughout the treatment, which is prolonged. What is obesity? Obesity is a complex chronic disease characterized by an excessive accumulation of body fat. It compromises health, increases the risk of multiple complications, and can reduce life expectancy. For many years obesity was simplistically viewed as an exclusive consequence of personal choices and often summarized by the expression "eat less and move more" to be resolved. Today we know that this view is reductionist and does not reflect current scientific evidence . Obesity has a well-established neurobiological basis: it involves changes in the central mechanisms of appetite regulation, satiety, and energy balance. There is also a significant genetic contribution , which influences individual susceptibility to weight gain. It also has a strong interaction with the contemporary environment, characterized by high food availability, sedentary lifestyle, sleep deprivation, and high stress levels. Furthermore, obesity is a relapsing disease . After weight loss, the body activates adaptive mechanisms that increase hunger and reduce energy expenditure, favoring the recovery of lost weight. These mechanisms do not represent a lack of willpower , they are related to the disease pathophysiology. This also helps explain why many people experience repeated cycles of weight loss and regain , even when following structured diets and exercise programs. What are the goals of obesity treatment? Like other chronic diseases, such as high blood pressure or diabetes, obesity treatment is often prolonged and requires long-term medical follow-up . The goal of treatment is not only to reduce weight, but above all to improve overall health , preventing or treating associated complications such as: Type 2 diabetes; Hypertension; Cardiovascular disease; Obstructive sleep apnea; Liver disease associated with metabolic dysfunction; Some types of cancer; Infertility and hormonal changes related to reproductive function. What are the treatment options for obesity? Obesity treatment is generally based on three main pillars : Lifestyle changes, which include: Individualized nutritional monitoring; Promotion of physical activity appropriate to the clinical condition; Improved sleep; Strategies to deal with emotional factors associated with eating. Pharmacological treatment In recent years, innovative medications have emerged that help to act on the biological mechanisms involved in obesity. Metabolic or bariatric surgery It may be indicated in selected cases, when other approaches have not been sufficient or when there are significant complications associated with obesity. Although lifestyle changes remain fundamental, we now know that, for many patients, these measures alone may not be sufficient to counteract the biological mechanisms that favor weight regain. New medicines for obesity In recent years, new injectable medicines have emerged that represent a significant advance in the treatment of obesity. They do not replace lifestyle changes but are a very important complementary tool. These medications act primarily on hormones produced in the gut that communicate with the brain , such as GLP-1 (glucagon-like peptide-1) and, in some cases, also GIP (glucose-dependent insulinotropic peptide), playing an essential role in regulating appetite and energy metabolism. By acting on these hormonal pathways, these drugs help to: Increase the feeling of satiety; Reduce hunger and appetite between meals; Delay gastric emptying; Improve blood sugar control. These treatments have demonstrated in clinical trials average weight losses that can range from about 10% to more than 20% of initial body weight , depending on the medication and the characteristics of each person. It is important to emphasize that the benefits of these treatments go beyond weight loss . Some of these medications have also demonstrated improvements in several diseases associated with obesity, including type 2 diabetes, metabolic liver disease, obstructive sleep apnea syndrome, and cardiovascular risk. Who can benefit from pharmacological treatment for obesity? In general, obesity medications can be considered in adults with a body mass index (BMI) : Equal to or greater than 30 kg/m² , or Equal to or greater than 27 kg/m² , when there are associated diseases such as diabetes, high blood pressure, dyslipidemia, or sleep apnea. Not everyone responds the same way to these medications, and not everyone needs pharmacological treatment. The decision should always be individualized and made jointly by the doctor and patient after a detailed clinical evaluation. Medication safety and medical follow-up Like any medical treatment, the medicines to treat obesity can have adverse effects. The most frequent side effects are gastrointestinal , such as nausea, feeling of fullness, diarrhea, or constipation. In most cases, they are mild and transient, especially when the dose is increased gradually. Obesity is a chronic and relapsing disease, so treatment often tends to be prolonged , requiring regular medical follow-up. Medical follow-up is important to: Adjust the dose individually; Monitor possible adverse effects; Ensure that weight loss occurs in a healthy way, preserving muscle mass. Data from large international studies that together involved millions of patients suggest that these treatments have a favorable long-term safety profile when used under medical supervision. Understanding obesity and seeking medical care It is well established that obesity is not just a matter of lifestyle or willpower; it is a chronic disease with a biological basis that requires understanding, medical follow-up, and access to appropriate treatments . Recognizing this reality is essential to reducing the stigma associated with the disease and improving access to effective healthcare. Anyone who has difficulty controlling their weight, is overweight, or suspects they are obese should seek medical advice. There are now several therapeutic options that can help improve health, reduce the risk of complications, and increase quality of life. In Portugal, it is estimated that about two-thirds of the adult population are overweight or obese , which reinforces the importance of recognizing this condition as a relevant public health problem. Author: Bárbara Filipa Araújo (Endocrinology) The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
