- New research found that behavioral changes, surgery, or medications (like Ozempic) are the most effective treatment option for obesity.
- Among medication options, Mounjaro and Zepbound had “the greatest effect.”
- Experts noted that many of the most effective treatment options come with questions regarding accessibility of care that need to be discussed on a larger scale.
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. 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.
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Behavioral Changes, Medications, and Surgery Are the Best Obesity Treatments
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.
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 explained that different treatments have different levels of effectiveness based on how they impact a person’s feeling of fullness or hunger.
Bariatric surgery is generally recommended for people with a body mass index (BMI) of at least 35 or people with a BMI of 30 to 34.9 who have concurrent metabolic disease.
There are multiple types of bariatric surgery; the procedures typically limit how much food a person can consume. Some also alter the way you absorb nutrients and digest food.
Bariatric surgery may be considered when lifestyle interventions—like diet and exercise—haven’t worked.
Semaglutide and liraglutide, as well as tirzepatide, are recommended for people with a BMI of 30 or higher or people with a BMI of at least 27 who have an obesity-related comorbidity. This could be hypertension, type 2 diabetes, cardiovascular disease, or sleep apnea.
These medications suppress appetite and delay gastric emptying, which means they cause food to sit in the stomach for longer periods.
Behavioral interventions are recommended for people with obesity or overweight.
People who implement behavioral interventions may start dieting or exercising, and these interventions also include stress management techniques and advice for people who get insufficient sleep.
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The Future of Obesity Treatment in the US
Though the report explains that multiple treatments currently on the market can be effective, Jay explained there are currently many challenges in the field of obesity treatment.
She explained that there aren’t enough obesity specialists in the U.S., which is worrying given that the number of people with obesity is expected to increase.
Though the new medications have been helpful to many, they’ve also created new dilemmas in the healthcare industry—like accessibility.
“There’s a lot of access issues,” Jay said. “The supply’s not keeping up with the demand.”
The question of who can access the medications also needs to be addressed.
“If we have better treatments, but they widen health disparities, that would be an unintended consequence” of these new treatment options, she explained.
Ultimately, more studies need to be done to answer questions about who should get the new medications and how they can be covered by insurers.
And, though the new review provides a thorough look at obesity treatments right now, the topic will need to be continuously studied to keep up with the market.
“The review, in a year, will be slightly outdated,” Jay said, “because of the new medications coming out.”
