Medical Debate Emerges Over Who Truly Needs Obesity Treatment

Medical science has achieved a major breakthrough in combating obesity, yet it now faces a more complex question than treatment itself: what exactly constitutes obesity, and which patients genuinely need medication?

This issue was highlighted in the program "Journal Tour" referencing an article in The Economist, which noted that the widespread availability of drugs mimicking the GLP-1 hormone has not ended the fight against obesity but has instead initiated a new medical discussion about its definition and who should receive these treatments.

The Economist explains that these medications represent the most significant advancement in obesity treatment in decades. They function by reducing appetite and slowing gastric emptying, thereby enhancing the feeling of fullness. Many patients experience weight loss ranging from 15 to 20 percent, along with improvements in obesity-related conditions such as type 2 diabetes, hypertension, cardiovascular diseases, fatty liver, and sleep apnea.

However, according to the magazine, this success has revealed a new challenge regarding which patient groups qualify for treatment, as previous reliance largely centered on the body mass index (BMI).

Many researchers now consider BMI insufficient because two individuals with the same BMI can have markedly different health statuses; one may be healthy without metabolic disorders, while the other suffers from diabetes, hypertension, and heart disease. This indicates that weight alone does not reflect the extent of health risks.

Consequently, support is growing within medical circles to redefine obesity by distinguishing "pathological obesity," which leads to clear health disorders and warrants pharmacological or surgical intervention, from weight gain without direct health harm, where lifestyle modifications may be more beneficial than medication.

The magazine points out that this shift in thinking did not arise arbitrarily. GLP-1 drugs are costly and may require prolonged use, with potential side effects, while demand for them is rapidly increasing. This situation makes identifying the true beneficiaries a matter of both health and economic concern.

Expanding the use of these treatments to all individuals with excess weight raises questions about the capacity of healthcare systems and insurance companies to bear the costs, priorities in health spending, and equitable distribution mechanisms, especially if everyone with excess weight is classified as a patient needing medication.

At the core of this debate lies another significant question: is obesity an independent disease, or merely a risk factor that increases the likelihood of other illnesses?

The Economist notes a medical trend that views obesity as a chronic disease deserving treatment, while another perspective regards it as a risk factor that only becomes a disease if it causes actual health disorders. This disagreement directly affects patient diagnosis, drug prescriptions, medical guidelines, and health insurance policies.

Despite criticisms of the BMI, the magazine does not call for its abandonment but suggests using it only as a starting point, alongside other indicators such as waist circumference, body fat percentage and distribution, comorbidities, blood sugar and lipid levels, physical fitness, and the ability to perform daily activities.

The Economist concludes that medicine is gradually moving toward a concept of "personalized treatment," which involves a comprehensive assessment of each patient's health status rather than relying solely on a number on the scale or BMI.

The magazine views the revolution brought by GLP-1 drugs as extending beyond changing obesity treatment methods; it has prompted the medical community to reconsider the very definition of the disease. The issue has evolved from how to lose weight to a deeper question: who truly needs treatment, and who can manage with lifestyle changes alone?