Obesity and being overweight put you at risk for other health conditions, including:

• Cardiovascular disease
• Type 2 diabetes
• Asthma
• Osteoarthritis
• Sleep apnea
• Metabolic-associated related liver disease (MASH)
• Some types of cancer.

It’s important to maintain a healthy weight to minimize your risk of these diseases. Maintaining a healthy weight can also improve your quality of life.

Diagnosing Obesity

Diagnosing obesity is more than just looking at a scale. The spectrum of weight ranges from underweight to extremely obese. Medical professionals may use two ratios to determine where your weight falls on this spectrum.

One of these ratios is body mass index, or BMI, which is weight compared to height. The goal for most people is to have a BMI that's over 18 and under 25. 

• Overweight: BMI of 25 to 29.9
• Obesity: BMI of 30 to 34.9
• Extreme obesity: BMI of 35 or higher

Another ratio is body roundness index, or BRI. This looks at the ratio between the circumference of your waist compared to the circumference of your hips and buttocks.

Having a waist circumference of more than 40 inches in men and 35 inches in women increases your risk of cardiovascular disease.

Weight Loss Options

To lose weight, most people need to eat fewer calories than they burn every day. To maintain a certain weight, most people can eat as many calories as they burn every day. But for some people who are overweight or who have obesity, it’s not that straightforward.

Bariatric (weight loss) surgery helps people who are obese lose weight if they have not had success with diet and exercise. There are many different types of bariatric surgery, but they all have the same goal.

Bariatric surgery shrinks the size of your stomach so that you feel fuller after smaller meals. Feeling full makes you want to eat less, but bariatric surgery also affects multiple hormones associated with hunger and satiety, essentially decreasing the amount of the “hunger hormone” you produce and increasing the amount of hormones that tell your brain that you are full.

“We see the hormonal impact immediately after surgery,” says Northwestern Medicine Bariatric Surgeon Matthew R. Pittman, MD.

Recently, another non-invasive weight loss tool has been increasing in popularity: GLP-1 medications. Weight loss medications help tell your brain that you’re full. They do this by mimicking a hormone your stomach releases after you eat, called GLP-1.

GLP-1 medications were originally intended to treat diabetes, as they also help manage blood sugar levels. They have been effective in helping people lose weight. They also have proven to be good for your heart health.

Weight Loss Surgery vs. Weight Loss Medications

If you want to lose a large amount of weight and haven’t been successful through lifestyle interventions, you may be wondering, “Should I get weight loss surgery, or should I use weight loss medications?”

Dr. Pittman explains that it all depends on your personal health history and goals — but chances are you may benefit from both.

“When addressing obesity, you need to have a big toolbox,” says Dr. Pittman. “Everyone has a different set of circumstances and genetics. Combination therapy, meaning weight loss surgery and weight loss medications, is highly effective, in addition to psychological support, exercise and nutritional support.”

• People with a BMI in the 30 to 34.9 range may benefit just from weight loss medications.
• People with a BMI of 35 or higher will likely benefit from surgery or a combination of weight loss surgery and weight loss medication.

However, your treatment plan ultimately boils down to you as an individual.

How Weight Loss Medications and Weight Loss Surgery Work Together

“Bariatric surgeons were prescribing GLP-1 medications to patients undergoing weight loss surgery long before these medications gained popularity,” says Dr. Pittman. “Weight loss medications work well in concert with surgery, especially for people with a BMI of above 40.”

Another way these two interventions may work together is by helping patients whose weight loss has plateaued after bariatric surgery or people who have experienced some weight regain after bariatric surgery.

Dr. Pittman explains that after bariatric surgery there is an expected weight loss curve. If you fall off this curve after surgery, your care team may add a GLP-1 into your treatment plan to help with additional weight loss.

Dr. Pittman says that once you stop GLP-1 medications, you go back to your baseline genetic settings, which is why most people will need to be on GLP-1 medications for the rest of their lives to not regain weight.

GLP-1 medications help quiet the “food noise,” or constant psychological desire to eat, that many people experience. So, for people who have struggled with obesity or being overweight since childhood, their care team will likely recommend lifelong use of GLP-1 medications.

If you haven’t struggled with obesity for years and perhaps had an orthopaedic injury and or major life event that has contributed to your weight gain, you could potentially taper off GLP-1 medications with the proper support from a dietitian, psychologist and exercise physiologist or personal trainer.

You Don’t Have to Navigate Obesity Alone

“Obesity is a chronic disease, and we have to treat it as such,” concludes Dr. Pittman. “If you have high blood pressure, we don’t tell you to figure it out on your own, and obesity should be no different. It’s important to have a multidisciplinary care team in your corner to help you reach the best weight loss outcomes.”