The arrival of GLP-1 receptor agonists could mark a turning point in obesity treatment. But their effectiveness will depend on how we choose to use them. Not as a shortcut to weight loss, but as a tool for treating a disease. Not for a few weeks, but as part of long-term care. Not as a replacement for lifestyle changes, but as a way to help patients make and sustain them.
In a nutshell:
- Obesity is a multifactorial disease, not a matter of willpower: weight loss alone is not enough; the goal is significant, sustained weight reduction and a lasting reduction in associated complications.
- GLP-1 medications are a tool, not a shortcut: to be effective, they must be part of an integrated care plan that includes nutrition, physical activity and psychological support.
- The real challenge is balancing effectiveness, costs and equity: clear criteria for access to treatment are needed, based on clinical need and expected benefit.
Why Obesity Isn’t a Matter of Willpower
Obesity is not simply a matter of weight or excess body fat. It is a complex, multifactorial disease involving the function of adipose tissue and the mechanisms that regulate energy balance.
When these mechanisms are disrupted, adipose tissue produces signals that can affect multiple organs and systems, including the heart, kidneys, liver, pancreas, musculoskeletal system, endocrine system, respiratory system and immune system.
This helps explain the association between obesity and numerous chronic diseases, including diabetes, cardiovascular disease and cancer, as well as liver, kidney and respiratory complications.
Stigmatising people living with obesity as unable to control their eating behaviour is therefore scientifically inaccurate and socially harmful.
Weight loss alone is not enough
Losing a few kilograms does not necessarily mean treating obesity. Clinically meaningful benefits require significant weight loss and, above all, maintaining it over time.
Nutrition, physical activity, behavioural changes and psychological support remain fundamental components of treatment. When these interventions are insufficient on their own, GLP-1 medications can provide an important additional therapeutic option.
GLP-1 medications: a tool, not a shortcut
Often misleadingly described simply as “slimming drugs”, GLP-1 receptor agonists act on the mechanisms that regulate hunger and satiety. Their beneficial effects can improve several risk factors associated with obesity.
But medication alone cannot solve the problem. Treatment requires an integrated approach: nutrition education, physical activity – an intervention that can be medically prescribed – and psychological support must remain essential components of care. The US National Institute of Diabetes and Digestive and Kidney Diseases also emphasises that weight management medications complement healthy eating and physical activity.
The goal is lasting change.
Obesity treatment, not cosmetic weight loss
These medications are not cosmetic tools. Their use should be reserved for patients with a clinical indication, within an appropriate treatment plan. Inappropriate and indiscriminate use risks both trivialising a complex disease and diverting resources from patients who genuinely need them.
The risk of weight regain
The real challenge is maintaining results over time. If treatment is discontinued, weight can be regained. Sustained lifestyle changes remain essential, but they do not guarantee that weight regain will be prevented. Research following the withdrawal of semaglutide highlights the importance of ongoing treatment in managing obesity as a chronic disease.
Regaining weight does not necessarily mean returning to the starting point: weight loss involves reductions in both fat mass and lean mass, and subsequent weight regain may alter the balance between them.
The number on the scale does not tell the whole story.
What does treating obesity cost – and what does leaving it untreated cost?
GLP-1 medications are expensive, but their economic impact cannot be assessed solely through the price of treatment. Treating obesity also means reducing the risk of associated diseases, which impose substantial costs on healthcare systems. We must therefore also ask what it costs to leave obesity untreated.
However, the balance of costs and benefits varies between patients. It is potentially more favourable for high-risk patients already affected by obesity-related complications, and may be less favourable for those without associated conditions. Clear eligibility and reimbursement criteria are therefore needed, based on disease severity and expected benefit.
This is also a matter of equity. If obesity is recognised as a disease, treatment cannot be reserved for those who can afford it. Otherwise, we risk creating a new health inequality: people with greater financial resources can access new therapies more easily, while more vulnerable groups – who often also experience a higher prevalence of obesity – risk being excluded.
At least partial coverage by Italy’s National Health Service (SSN) could therefore become an important tool for equity and prevention.
Transforming obesity care starts with medical training
Responding to this shift requires a new understanding of obesity, starting with the training of general practitioners.
Nutrition and obesity often receive less attention in medical training than the scale of the problem demands. There is therefore an urgent need to train a new generation of doctors who can manage the disease by integrating nutrition, physical activity, psychological support and medication.
This would bring care closer to patients, ensuring that obesity treatment is available beyond a small number of highly specialised centres.
The challenge for healthcare systems
Healthcare systems must strike the right balance between effectiveness, financial sustainability and equity. The question is not simply how much these new medications cost. It is how extensively they should be used, who should receive them and how to integrate them into a care pathway that delivers lasting benefits.