From diet to drugs: what really works for long-term weight loss

More than 2.5 billion adults worldwide are currently overweight or obese, according to estimates from the World Health Organization. This staggering number highlights a growing global health crisis. Obesity isn’t just about weight – it’s a powerful risk factor for a range of serious diseases, including type 2 diabetes, kidney disease, heart attacks, and strokes. As awareness grows, more people are asking a critical question: how can I lose weight and stay healthy in the long run?

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Obesity is a complex condition with many contributing factors. It’s not simply a result of eating too much or exercising too little. For many people, emotional and psychological stress plays a major role. Work-related pressure, financial concerns, family issues, or social anxiety can all lead to emotional eating. Others may develop obesity as a result of depression, which often disrupts both eating patterns and motivation for physical activity.

In addition, modern lifestyles can make it easier than ever to gain weight. Many of us spend long hours sitting – at desks, in cars, or on the couch – and highly processed, calorie-dense foods are readily available and heavily marketed. This combination of behavioural, psychological, social and environmental factors creates a situation where weight gain becomes increasingly difficult to avoid and even harder to reverse.

Read more: Beyond blame: The role of malfunctioning fat tissue in the disease of obesity

Because obesity has many causes, it also requires a multifaceted solution. The most effective treatments follow a multimodal approach, where healthcare professionals – psychologists, nutritionists, and physicians – work together to support people on their weight loss journey. This team-based approach not only addresses diet and exercise but also tackles underlying emotional and mental health challenges.

This strategy is especially effective for people with prediabetes, a condition where blood sugar levels are elevated but not yet in the diabetic range. Research has shown that lifestyle changes guided by a multidisciplinary team can significantly reduce the risk of developing full-blown diabetes

While losing 5–7% of body weight is a good target for reducing health risks, recent research from our team in Tübingen, Germany, shows that combining weight loss with blood sugar control is even more effective. Data from a different study indicates that focusing on both aspects goes along with fewer complications from diabetes, such as kidney damage and issues affecting small blood vessels.

Visceral fat

Why is this combination so powerful? It turns out that people who manage to both lose weight and lower their blood sugar levels tend to reduce visceral fat – the type of fat stored around internal organs in the abdomen.

Read more: Belly fat linked to higher risk of premature death, regardless of your weight

Visceral fat is particularly dangerous because it triggers inflammation in the body, which in turn can reduce the effectiveness of insulin, the hormone that regulates blood sugar.

Fortunately, certain lifestyle changes specifically help reduce visceral fat. For instance, regular physical activity – especially aerobic exercise – and diets rich in polyunsaturated fatty acids (found in nuts, seeds, fish and plant oils) have been shown to be especially effective. Among various eating plans, the Mediterranean diet, which emphasises whole grains, healthy fats, vegetables and lean proteins, is particularly effective.

Combining regular exercise with a Mediterranean-style diet is not only good for weight loss but also for long-term cardiovascular and metabolic health. However, maintaining these habits over time remains a challenge for many.

Research shows that a significant portion of those who lose weight will regain it within a few years. As weight returns, so too do associated health risks like diabetes, high blood pressure and high cholesterol. This cycle of weight loss and regain can be frustrating and emotionally taxing, leading many to seek other options for more sustainable results.

Medication and surgery

In recent years, GLP-1 receptor agonists – a class of medications originally developed to treat diabetes – have shown promise in promoting weight loss. These drugs mimic the hormone GLP-1 (glucagon-like peptide-1), which is released by the gut after eating. It helps regulate appetite by promoting feelings of fullness and also encourages the release of insulin, lowering blood sugar.

However, GLP-1-based medications are increasingly used for cosmetic weight loss, raising ethical and safety concerns. While these drugs can be effective, their long-term impact on people without obesity is still poorly understood. Side effects can include nausea, vomiting and more serious issues, so their use should always be guided by a medical professional.

One major limitation of GLP-1 medications is that the benefits typically wear off after stopping the medication, resulting in rapid weight regain. So, long-term or even permanent use may be required to maintain health benefits.

For people with severe obesity, particularly those with serious health complications like type 2 diabetes or heart disease, bariatric surgery can be life-changing. Surgical procedures such as gastric bypass or sleeve gastrectomy reduce the size of the stomach and, in some cases, alter gut hormone signalling. The result is significant, sustained weight loss and a reduced risk of obesity-related diseases, including a significant reduction in the risk of heart disease and premature death. Bariatric surgery isn’t for everyone, but when appropriate, it remains one of the most effective interventions available.

Researchers are now developing new medications that combine the effects of multiple gut hormones to enhance weight loss. Some of these drugs may achieve results comparable to bariatric surgery, but most are still being tested in clinical trials.

Winning combination

For people beginning their weight loss journey, a combination of physical activity and a healthy diet – such as the Mediterranean diet – is still the best place to start. These changes, if sustained, can lead to long-term improvements in weight, blood sugar and overall health.

For those with elevated blood sugar, targeting visceral fat through combined lifestyle changes and blood sugar management is especially important. And for people who struggle with obesity and related health conditions, medical therapies and surgical options offer powerful tools to support lasting change.

Ultimately, the key to lasting weight loss and improved health lies in understanding that there is no one-size-fits-all solution. It’s about finding the right combination of support, strategy and science that works for each person.