Weight loss and obesity: the winning combination for lasting health

More than 2.5 billion adults around the world are estimated to be overweight or obese, according to the World Health Organization. This remarkable figure underlines an escalating global health crisis.

Obesity involves far more than body weight: it is a major risk factor for numerous serious illnesses, including type 2 diabetes, kidney disease, heart attacks and strokes. With awareness increasing, many people are confronting a crucial question: how can I lose weight while remaining healthy over the long term?

A complex range of factors contributes to obesity. It cannot be explained simply by eating excessively or doing too little exercise.

Emotional and psychological strain is an important factor for many individuals. Pressure at work, money worries, family problems and social anxiety may all prompt emotional eating.

For others, obesity may arise alongside depression, which can disrupt both dietary habits and the motivation to be physically active.

Modern living can also make weight gain easier than ever. Many people spend prolonged periods seated, whether at a desk, in a car or on the sofa, while heavily promoted, highly processed and calorie-dense foods are widely accessible.

Together, these behavioural, psychological, social and environmental influences can make weight gain progressively harder to prevent - and even more difficult to reverse.

Since obesity has multiple causes, it needs a multifaceted response. The most successful treatments use a multimodal approach, in which healthcare professionals such as psychologists, nutritionists and physicians collaborate to assist people throughout their weight-loss journey.

This team-based model considers not only food and physical activity, but also the underlying emotional and mental-health difficulties.

The approach is particularly helpful for people with prediabetes, where blood sugar is raised but has not reached the diabetic range. Research has found that lifestyle changes supported by a multidisciplinary team can substantially lower the risk of progressing to full-blown diabetes.

Although losing 5–7 percent of body weight is a worthwhile target for lowering health risks, recent research by our team in Tübingen, Germany, indicates that pairing weight loss with blood sugar control is more effective still. Evidence from another study suggests that addressing both is associated with fewer diabetes complications, including kidney damage and problems involving small blood vessels.

Visceral fat

What makes this pairing so effective? People who succeed in losing weight while reducing their blood sugar levels generally also decrease visceral fat - the fat stored in the abdomen around internal organs.

Visceral fat is especially harmful because it promotes inflammation throughout the body. This inflammation can, in turn, make insulin - the hormone responsible for regulating blood sugar - less effective.

Fortunately, some lifestyle adjustments are particularly effective at reducing visceral fat. Regular physical activity, especially aerobic exercise, is one example. Diets containing plenty of polyunsaturated fatty acids, found in nuts, seeds, fish and plant oils, have also proved beneficial. Of the various dietary approaches, the Mediterranean diet - which prioritises whole grains, healthy fats, vegetables and lean proteins - is particularly effective.

A Mediterranean-style diet combined with regular exercise supports not just weight loss, but long-term cardiovascular and metabolic health too. Yet sustaining these routines over time remains difficult for many people.

Studies show that a substantial proportion of people who lose weight regain it within several years. When weight returns, the related risks of diabetes, high blood pressure and high cholesterol return as well.

This repeated pattern of losing and regaining weight may be frustrating and emotionally draining, causing many people to look for alternatives that offer more sustainable outcomes.

Medication and surgery

Over recent years, GLP-1 receptor agonists - medicines first created to treat diabetes - have demonstrated potential for encouraging weight loss.

These medicines imitate the hormone GLP-1 (glucagon-like peptide-1), which the gut releases after food is eaten. It regulates appetite by helping people feel full, while also stimulating insulin release and reducing blood sugar.

However, GLP-1-based medicines are being used increasingly for cosmetic weight loss, which raises questions about ethics and safety. Although these drugs can work effectively, their long-term effects in people without obesity remain insufficiently understood.

Possible side effects include nausea, vomiting and more serious problems, meaning their use should always be overseen by a medical professional.

A key drawback of GLP-1 medicines is that their benefits usually disappear once treatment stops, often leading to swift weight regain. Maintaining the health benefits may therefore require long-term, or even permanent, treatment.

For people with severe obesity, especially those facing serious complications such as type 2 diabetes or heart disease, bariatric surgery can transform lives. Procedures including gastric bypass and sleeve gastrectomy reduce stomach size and may, in some cases, change gut hormone signalling.

This can produce substantial, lasting weight loss and reduce the risk of obesity-related illness, including a significant reduction in the risk of heart disease and premature death. Bariatric surgery is not suitable for everybody, but where appropriate, it remains among the most effective interventions available.

Researchers are also developing medicines that combine the actions of several gut hormones to increase weight loss. Certain drugs may deliver results comparable with bariatric surgery, though most are still being assessed in clinical trials.

Winning combination

For people starting a weight-loss journey, the best first step remains combining physical activity with a healthy eating pattern, such as the Mediterranean diet. If these changes are maintained, they can produce long-term improvements in weight, blood sugar and general health.

For anyone with raised blood sugar, it is especially important to target visceral fat through lifestyle changes alongside blood sugar management. For people struggling with obesity and associated medical conditions, medical therapies and surgical treatments provide powerful means of supporting lasting change.

Ultimately, sustained weight loss and better health depend on recognising that no single solution suits everyone. The aim is to identify the right combination of support, strategy and science for each individual.

Reiner Jumpertz-von Schwartzenberg, Professorship for Clinical Metabolism and Obesity Research, University Hospital and Medical Faculty, University of Tübingen

This article is republished from The Conversation under a Creative Commons licence. Read the original article.