The reality of obesity care: Medicines can help, but lifestyle still matters

Obesity requires an integrated approach combining lifestyle changes, balanced nutrition and physical activity. While GLP-1 medicines can support weight loss when prescribed by experts, they cannot replace healthy habits. Adequate nutrition and long-term behavioural changes remain essential for sustainable weight management

Obesity is no longer a problem confined to high-income countries. It has emerged as one of the global public health challenges, affecting adults, adolescents and even children. According to the World Health Organization (WHO), global obesity has more than doubled since 1990. Obesity is closely linked with rising rates of diabetes, hypertension, fatty liver disease, cardiovascular diseases, infertility and certain cancers.

India is witnessing a profound nutrition transition. Once largely focused on tackling undernutrition, the country is now confronting a “double burden”, where obesity coexists with undernutrition. National Family Health Survey (NFHS)-6 (2023-2024) indicates that nearly one in three women (30.7 per cent) and more than one in four men (27.3 per cent) are overweight or obese, reporting a substantial increase from NFHS-5. The trend extends beyond metropolitan cities and has now deepened its roots in rural areas. Changing dietary patterns, rising consumption of energy-dense foods, sedentary lifestyles, stress, inadequate sleep and reduced physical activity are collectively fuelling this epidemic.

Obesity is globally recognised as a chronic, relapsing and multifactorial disease influenced by genetics, hormones, metabolism, environment, behaviour and food systems. This understanding has transformed the way obesity is managed today.

The foremost line of obesity management remains diet and lifestyle intervention, including healthy eating, regular physical activity, adequate sleep and behavioural support. However, sustained weight loss can be challenging because hormonal and metabolic adaptations can increase hunger and favour weight regain. For appropriately selected individuals, particularly those with chronic and unmanaged obesity-related conditions such as diabetes, hypertension or sleep apnoea, pharmacotherapy may therefore be added by expert physicians, and this does not replace lifestyle management. Bariatric surgery is reserved for morbid obesity when all other measures fail. The goal is not simply weight loss but improved metabolic health and reduced long-term disease risk.

Pharmacotherapy using GLP-1 receptor agonists such as semaglutide mimics a naturally occurring gut hormone involved in appetite and glucose regulation. These medicines act on appetite-regulating pathways in the brain to increase satiety, reduce hunger and food intake, while also slowing gastric emptying and improving glucose control. Clinical trials have reported significant weight reduction with these therapies, making them effective anti-obesity medications currently available.

But reducing appetite is not the same as improving nutritional status. However, the growing popularity of these medicines has also led to an oversimplified public perception that obesity can now be “fixed” through medication alone. This is scientifically incorrect and harmful.

The WHO’s 2025 guidance on GLP-1 medicines emphasises that these therapies should be used alongside nutrition and lifestyle interventions, not in isolation. It also stresses responsible use under the supervision of qualified healthcare professionals and procurement through authorised sources, particularly amid concerns about unsupervised use and falsified products. In India, the Drug Controller General of India (DCGI) has strengthened regulatory surveillance against the unauthorised sale and promotion of GLP-1 medicines, including action against misleading advertising and inappropriate dispensing.

These medicines may significantly reduce appetite, leading to the unintentional inadequate consumption of important nutrients such as protein, fibre and essential micronutrients. Hence, rapid weight loss without proper dietary planning can lead to loss of muscle mass, weakness, fatigue and nutritional deficiencies. In some individuals, gastrointestinal side-effects such as nausea and vomiting may further compromise dietary intake.

Nutrition management during GLP-1 therapy is therefore not optional — it is essential. Patients require guidance on consuming balanced meals with adequate protein, fruits, vegetables, whole grains and hydration despite reduced appetite. Physical activity, especially resistance training, is equally important to preserve muscle mass during weight loss. The ICMR-National Institute of Nutrition Dietary Guidelines for Indians 2024 continue to emphasise balanced diets, moderation in highly processed foods and regular physical activity as the foundation of metabolic health.

Another important concern is long-term sustainability. Research shows that weight regain is common after discontinuation of GLP-1 medicines if healthy dietary habits and lifestyle modifications are not maintained. For India, this information carries particular importance. The country is already facing rising rates of overweight and obesity alongside persistent anaemia and micronutrient deficiencies. In such a setting, weight loss without nutritional adequacy can create a new set of health problems. Hence, obesity management requires long-term behavioural change even when medical and surgical interventions are prescribed. Obesity is a chronic disease. Scientific obesity care lies in an integrated approach, starting fundamentally with lifestyle modification. Medicines provide support when indicated but do not replace nutrition counselling, healthy diets, physical activity and long-term lifestyle modification. Its treatment must therefore focus not just on losing weight but on building a healthy individual.

Obesity is globally recognised as a chronic, relapsing and multifactorial disease influenced by genetics, hormones, metabolism, environment, behaviour and food systems. This understanding has transformed the way obesity is managed today

M Srinivas, Member (Health), NITI Aayog, and Neha Bakshi, Consultant, NITI Aayog; Views presented are personal.