Obesity treatment is shifting toward long-term disease management—where the goal is not only to reduce weight but also to maintain it safely and sustainably. New agents targeting gut–brain and metabolic pathways have expanded available treatment options, while also underscoring the need to address long-term engagement.

Adherence remains a key challenge. Real-world evidence shows that many patients discontinue therapy within the first year, often due to side effects, administration burden, or mismatched expectations. As new formats emerge—including oral formulations—treatment strategies are evolving to better align with patient preferences and routines.

Studies suggest that mode and frequency of administration can influence persistence. Some patients prefer the simplicity of once-weekly injections; others find daily oral dosing easier to incorporate. These differences highlight the need for early, personalized conversations about lifestyle fit, tolerability, and long-term commitment.

Pharmacotherapy is just one pillar of sustainable obesity care. Lasting outcomes still rely on nutrition, behavioral support, and structured follow-up. The opportunity now lies in integrating these therapies into adaptable models that reinforce patient engagement well beyond the initial response.

How do you navigate adherence challenges when patients transition between therapy formats? What potential do emerging oral options hold for improving persistence in long-term obesity care?

Obesity is a multifaceted, escalating global health crisis, affecting over a billion people in 2022 and projected to impact more than half the adult population by 2050. As a chronic, relapsing, multifactorial disease, it increases the risk of serious non-communicable diseases (e.g., type 2 diabetes, cardiovascular diseases, certain cancers) and contributes to over 5 million deaths annually. The global economic burden is projected to reach $4.32 trillion by 2035, alongside psychosocial challenges such as stigma, low self-esteem, and social isolation.

For adults with a BMI ≥30 kg/m², or ≥27 kg/m² with at least one obesity-related comorbidity, pharmacologic therapy should be considered when lifestyle interventions alone fail to achieve ≥5% weight loss after 3–6 months. When paired with behavioral and lifestyle measures, long-acting, once-weekly GLP-1 receptor agonists have been associated with substantial, sustained weight loss (e.g., a mean 12.1% reduction in body weight) and improvements in BMI, waist circumference, and blood pressure.

Viewing obesity as a chronic disease means shifting from short-term fixes to long-term care strategies. Management should address genetic, metabolic, environmental, and social drivers while evaluating the impact of functional limitations and emotional factors—such as psychological distress, stigma, and disordered eating—that may compromise adherence. Personalized care, aligned to each patient’s clinical, functional, and psychosocial profile, is essential for durable outcomes.

How can functional and emotional burden assessments be systematically integrated into obesity care to improve adherence and outcomes? What strategies can HCPs use to embed these therapies into long-term care plans that integrate pharmacologic, behavioral, and lifestyle support?

Obesity is increasingly recognized not merely as a lifestyle issue, but as a chronic, relapsing disease requiring sustained clinical management. Despite rising prevalence and cardiometabolic risks, pharmacologic treatment remains underutilized. While lifestyle interventions are foundational, maintaining weight loss over time through lifestyle changes alone is often challenging. High-intensity behavioral interventions may yield 5–8% total body weight loss, but this often plateaus or regresses by 12 months.

US clinical guidelines recommend anti-obesity medications when BMI is ≥30 kg/m², or ≥27 kg/m² with comorbidities. However, fewer than 2% of eligible patients receive prescriptions. Barriers such as stigma, limited access to specialists, and coverage restrictions may contribute to low treatment rates. GLP-1 receptor agonists, among newer therapies, address the biological drivers of obesity and have demonstrated significant weight loss (>10–20%) and cardiovascular risk reduction in clinical trials.

With an expanding range of therapeutic options, the focus is shifting to identifying the right patients and aligning treatment with their individual clinical needs and goals. Long-term success often depends not just on initiating therapy, but on sustaining it over time.

What clinical factors guide your decision to initiate pharmacologic therapy for obesity, and how do you approach patient selection, support long-term adherence, and identify those most likely to achieve sustained outcomes?

At CHEST 2025 in Chicago, pulmonology experts shared new insights in asthma, COPD, interstitial lung disease, pulmonary hypertension, and sleep medicine. Dr. Sandhya Khurana highlighted emerging asthma data—such as imaging-based reductions in mucus plugging and outcomes in severe asthma with nasal polyps—while also discussing the future of nanobody therapeutics. Dr. Cosmo Fowler reviewed GLP-1 RA–linked survival benefits in OSA.

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