Challenges and Novelties in the Treatment of Obesity in Adults. A review
DOI:
https://doi.org/10.12775/JEHS.2025.77.57095Keywords
obesity, nutrition, lifestyle, bariatric surgery, pharmacotherapy in obesityAbstract
Introduction
Obesity is a complex, chronic disease that continues to be a significant global health challenge due to its prevalence and association with numerous comorbidities. Etiology of this disease includes different factors from genetic, environmental, and lifestyle fields, while effective management of obesity is still being studied.
Aim of the study
The aim of this comprehensive review is to examine arising innovations in the treatment of adult obesity. Deeper insight into the available database would help to provide better understanding of obesity and of its treatment.
Materials and Methods
To reach satisfying results the research was conducted on the articles referring to obesity treatment from the Pubmed databases. Articles from recent years were preferably utilized to keep the review up to date.
Results
Nowadays, pharmacotherapy can offer GLP-1 receptor agonists like liraglutide or semaglutide, and new drugs like tirzepatide that show great effectiveness. Additionally, bariatric surgery continues to offer great solution for severe obesity, combining restrictive and malabsorptive mechanisms for significant weight loss and metabolic benefits. The main procedures include gastric bypass with sleeve gastrectomy or duodenal switch. Personalized treatment, referring to different obesity phenotypes, has shown improvement in the therapeutic outcomes. Some new therapies are studied including triple agonists (retatrutide), non-peptide GLP-1 receptor agonists, and drugs reaching other receptors. All of them are promising for the effective obesity treatment in the future.
Summary
This review underlines the need for multidisciplinary and personal approach in the treatment of obesity and the need to share the knowledge about it to address the growing obesity epidemic effectively. Recognizing obesity as a chronic and complex disease is essential to improve patient’s understanding of their condition as well as to reach effective treatment outcomes.
References
World Health Organization. Obesity: Preventing and Managing the Global Epidemic: Report of a WHO Consultation.WHO Technical Report Series 894. Geneva, Switzerland: World Health Organization; 2000. ISBN: 9241208945.
World Health Organization. Obesity and overweight. Accessed December 8, 2024. https://www.who.int/en/news-room/fact-sheets/detail/obesity-and-overweight
Afshin A, Forouzanfar MH, Reitsma MB, et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017;377:13-27. doi:10.1056/NEJMoa1614362
Stefan N, Birkenfeld AL, Schulze MB. Global pandemics interconnected—Obesity, impaired metabolic health and COVID-19. Nat Rev Endocrinol. 2021;17:135-149. doi:10.1038/s41574-020-00462-1
Matyjaszek-Matuszek B, Szafraniec A, Porada D. Pharmacotherapy of obesity — state of the art. Endokrynol Pol.2018;69(4):448-457.
Blüher M. Obesity: Global epidemiology and pathogenesis. Nat Rev Endocrinol. 2019;15:288-298. doi:10.1038/s41574-019-0176-8
Roomy MA, Hussain K, Behbehani HM, et al. Therapeutic advances in obesity management: an overview of the therapeutic interventions. Front Endocrinol (Lausanne). 2024;15:1364503. doi:10.3389/fendo.2024.1364503
Blüher M. Metabolically healthy obesity. Endocr Rev. 2020;41. doi:10.1210/endrev/bnaa004
Oliveros E, Somers VK, Sochor O, Goel K, Lopez-Jimenez F. The concept of normal weight obesity. Prog Cardiovasc Dis. 2014;56:426-433. doi:10.1016/j.pcad.2013.10.003
Pujia R, Tarsitano MG, Arturi F, et al. Advances in phenotyping obesity and in its dietary and pharmacological treatment: a narrative review. Front Nutr. 2022;9:804719. doi:10.3389/fnut.2022.804719
Golacki J, Matyjaszek-Matuszek B. Obesity - Standards, trends and advances. Adv Med Sci. 2024;69(1):208-215. doi:10.1016/j.advms.2024.04.001
Acosta A, Camilleri M, Abu Dayyeh B, et al. Selection of antiobesity medications based on phenotypes enhances weight loss: a pragmatic trial in an obesity clinic. Obesity. 2021;29:662-671. doi:10.1002/oby.23120
Kanoski SE, Fortin SM, Arnold M, Grill HJ, Hayes MR. Peripheral and central GLP-1 receptor populations mediate the anorectic effects of peripherally administered GLP-1 receptor agonists, liraglutide and exendin-4. Endocrinology.2011;152:3103-3112.
Sundbom M, Järvholm K, Sjögren L, Nowicka P, Lagerros YT. Obesity treatment in adolescents and adults in the era of personalized medicine. J Intern Med. 2024;296(2):139-155. doi:10.1111/joim.13816
Marso SP, Daniels GH, Brown-Frandsen K, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2016;375:311-322.
Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and cardiovascular outcomes in obesity without diabetes. N Engl J Med. 2023;389:2221-2232.
Gorgojo-Martínez JJ, Mezquita-Raya P, Carretero-Gomez J, et al. Clinical recommendations to manage gastrointestinal adverse events in patients treated with GLP-1 receptor agonists: a multidisciplinary expert consensus. J Clin Med.2022;12. doi:10.3390/jcm12010145
Sodhi M, Rezaeianzadeh R, Kezouh A, Etminan M. Risk of gastrointestinal adverse events associated with glucagon-like peptide-1 receptor agonists for weight loss. JAMA. 2023;330:1795-1797. doi:10.1001/jama.2023.19574
Pi-Sunyer X, Astrup A, Fujioka K, et al. A randomized, controlled trial of 3.0 mg of liraglutide in weight management. N Engl J Med. 2015;373:11-22. doi:10.1056/NEJMoa1411892
Wadden TA, Bailey TS, Billings LK, et al. Effect of subcutaneous semaglutide vs placebo as an adjunct to intensive behavioral therapy on body weight in adults with overweight or obesity: the STEP 3 randomized clinical trial. JAMA.2021;325:1403-1413. doi:10.1001/jama.2021.1831
Rubino D, Abrahamsson N, Davies M, et al. Effect of continued weekly subcutaneous semaglutide vs placebo on weight loss maintenance in adults with overweight or obesity: the STEP 4 randomized clinical trial. JAMA.2021;325:1414-1425. doi:10.1001/jama.2021.23619
Rubino DM, Greenway FL, Khalid U, et al. Effect of weekly subcutaneous semaglutide vs daily liraglutide on body weight in adults with overweight or obesity without diabetes: the STEP 8 randomized clinical trial. JAMA. 2022;327:138-150. doi:10.1001/jama.2021.23619
Nauck MA, Quast DR, Wefers J, Pfeiffer AFH. The evolving story of incretins (GIP and GLP-1) in metabolic and cardiovascular disease: a pathophysiological update. Diabetes Obes Metab. 2021;23(Suppl 3):5-29.
Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med.2022;387:205-216. doi:10.1056/NEJMoa2206038
Garvey WT, Frias JP, Jastreboff AM, et al. Tirzepatide once weekly for the treatment of obesity in people with type 2 diabetes (SURMOUNT-2): a double-blind, randomized, multicentre, placebo-controlled, phase 3 trial. Lancet.2023;402(10402):613-626. doi:10.1016/S0140-6736(23)01200-X
le Roux CW, Zhang S, Aronne LJ, et al. Tirzepatide for the treatment of obesity: rationale and design of the SURMOUNT clinical development program. Obesity (Silver Spring). 2023;31:96-110. doi:10.1002/oby.23612
Tek C. Naltrexone HCl/bupropion HCl for chronic weight management in obese adults: patient selection and perspectives. Patient Prefer Adherence. 2016;10:751-759. doi:10.2147/PPA
Patel K, Allen S, Haque MN, Angelescu I, Baumeister D, Tracy DK. Bupropion: a systematic review and meta-analysis of effectiveness as an antidepressant. Ther Adv Psychopharmacol. 2016;6:99-144. doi:10.1177/2045125316629071
Booth K, Clements JN. Role of bupropion plus naltrexone for the management of obesity. J Pharm Technol.2016;32:125-132. doi:10.1177/8755122515624220
Kujawska-Luczak M, Szulinska M, Skrypnik D, Musialik K, Swora-Cwynar E. The influence of orlistat, metformin and diet on serum levels of insulin-like growth factor-1 in obese women with and without insulin resistance. J Physiol Pharmacol. 2018;69:69. doi:10.26402/jpp.2018.5.08
Sjostrom L, Rissanen A, Andersen T, et al. Randomised placebo-controlled trial of orlistat for weight loss and prevention of weight regain in obese patients. Lancet. 1998;352:167-172.
Gillies CL, Abrams KR, Lambert PC, et al. Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance: systematic review and meta-analysis. BMJ. 2007;334:299. doi:10.1136/bmj.39063.689375.55
Kelly AS, Bensignor MO, Hsia DS, et al. Phentermine/topiramate for the treatment of adolescent obesity. NEJM Evid.2022;1:6. doi:10.1056/EVIDoa2200014
Gadde KM, Allison DB, Ryan DH, et al. Effects of low-dose, controlled-release, phentermine plus topiramate combination on weight and associated comorbidities in overweight and obese adults (CONQUER): a randomized, placebo-controlled, phase 3 trial. Lancet. 2011;377:1341-1352. doi:10.1016/S0140-6736(11)60205-5
Chakhtoura M, Haber R, Ghezzawi M, et al. Pharmacotherapy of obesity: an update on the available medications and drugs under investigation. EClinicalMedicine. 2023;58:101882. doi:10.1016/j.eclinm.2023.101882
Wiechert M, Holzapfel C. Nutrition concepts for the treatment of obesity in adults. Nutrients. 2022;14:169. doi:10.3390/nu14010169
Sundbom M. Laparoscopic revolution in bariatric surgery. World J Gastroenterol. 2014;20:15135-15143.
Sierzantowicz R, Ladny JR, Lewko J. Quality of life after bariatric surgery-a systematic review. Int J Environ Res Public Health. 2022;19(15):9078.
Toussi R, Fujioka K, Coleman KJ. Pre- and postsurgery behavioral compliance, patient health, and postbariatric surgical weight loss. Obesity. 2009;17:996-1002. doi:10.1038/oby.2009.21
Shai I, Schwarzfuchs D, Henkin Y, et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med. 2008;359:229-241. doi:10.1056/NEJMoa0708681
Sacks FM, Bray GA, Carey VJ, et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med. 2009;360:859-873. doi:10.1056/NEJMoa0804748
Zeevi D, Korem T, Zmora N, et al. Personalized nutrition by prediction of glycemic responses. Cell. 2015;163:1079-1094. doi:10.1016/j.cell.2015.11.001
Jastreboff AM, Kaplan LM, Frías JP, et al. Triple-hormone-receptor agonist retatrutide for obesity - a phase 2 trial. N Engl J Med. 2023;389:514-526. doi:10.1056/NEJMoa2301972
Aroda VR, Aberle J, Bardtrum L, et al. Efficacy and safety of once-daily oral semaglutide 25 mg and 50 mg compared with 14 mg in adults with type 2 diabetes (PIONEER PLUS): a multicentre, randomised, phase 3b trial. Lancet.2023;402:693-704. doi:10.1016/S0140-6736(23)01127-3
Wharton S, Blevins T, Connery L, et al. Daily oral GLP-1 receptor agonist orforglipron for adults with obesity. N Engl J Med. 2023;389:877-888. doi:10.1056/NEJMoa2302392
Zimmermann T, Thomas L, Baader-Pagler T, et al. BI 456906: discovery and preclinical pharmacology of a novel GCGR/GLP-1R dual agonist with robust anti-obesity efficacy. Mol Metab. 2022;66:101633. doi:10.1016/j.molmet.2022.101633
Dubern B, Mosbah H, Pigeyre M, Clement K, Poitou C. Rare genetic causes of obesity: diagnosis and management in clinical care. Ann Endocrinol (Paris). 2022;83:63-72.
Farooqi IS, O’Rahilly S. 20 years of leptin: human disorders of leptin action. J Endocrinol. 2014;223:T63-T70. doi:10.1530/JOE-14-0242
Clement K, van den Akker E, Argente J, et al. Efficacy and safety of setmelanotide, an MC4R agonist, in individuals with severe obesity due to LEPR or POMC deficiency: single-arm, open-label, multicentre, phase 3 trials. Lancet Diabetes Endocrinol. 2020;8:960-970. doi:10.1016/S2213-8587(20)30364-8
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Copyright (c) 2025 Karolina Kuczapska, Marek Kurowski, Anna Gliwa, Monika Ryglewicz, Dariusz Fabian, Elżbieta Leszczyńska-Knaga, Natalia Jakubczyk, Weronika Rutkowska-Kawalec, Paweł Moczydłowski, Karolina Michalczuk
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