Weight management for obesity: the role of family physicians

Kwok-keung Ng 吳國強

HK Pract 2026;48:1-2

Obesity is a common, chronic and progressive disease. It is associated with a significant increase in mortality and contributes to a number of chronic conditions like diabetes, cardiovascular disease, dyslipidaemia and certain cancers.¹ As first contact healthcare providers, family physicians are the crucial professionals to provide them with early intervention, continuous support and holistic care. The emergence of new and effective obesity management strategies like the glucagon-like peptide-1 receptor agonists (GLP-1RAs) may result in over-reliance on drug treatment and reduced adherence to lifestyle interventions.

Current Management of Obesity

The initial management for all individuals with obesity who would benefit from weight loss is a comprehensive lifestyle intervention, which includes a combination of diet, exercise, and behavioural modification. Drug treatment could be considered if the target of weight reduction (reduce at least 5 percent of total body weight within three to six months) is not met after implementation of comprehensive lifestyle intervention, with their body mass index (BMI) over 30kg/m², or BMI over 27kg/m² with at least one weightrelated comorbidity. In severe cases, surgical interventions might be required.

The World Health Organization released new guidelines regarding the use of GLP-1RAs for the treatment of obesity in 2025.² The guidelines emphasise that long term treatment with GLP-1RAs would be required, and the drug treatment should be combined with lifestyle intervention to maximise and maintain weight loss. They also discuss the need for frameworks to expand equitable access to these drugs.

The American Diabetes Association's Obesity Association issued Standards of Care in Overweight and Obesity in early 2026.³ They emphasise shared decision-making when selecting an obesity medication, incorporating factors such as cost, access, tolerability, adverse effects, and individual preferences. Lifestyle intervention in combination with long-term drug treatment is recommended to achieve and maintain long-term weight loss. In terms of drug of choice, GLP-1RAs or dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1RAs is preferred, given their superior weight-loss efficacy and cardiometabolic benefits.

GLP-1RAs reduces appetite, slow gastric emptying, and enhance insulin sensitivity. In clinical trials, weight loss of 15% or more can be achieved. They also reduce risks of major cardiovascular events and improve conditions like metabolic dysfunction-associated liver disease.

Limitations of GLP-1RAs include high rates of gastrointestinal side effects like nausea and vomiting, reduction in lean body mass, the need of long-term treatment to prevent weight regain, high costs and potential risks of pancreatitis and gallbladder diseases. Contraindications include personal or family history of medullary thyroid cancer or multiple endocrine neoplasia syndrome type 2, hypersensitivity to the drug, history of pancreatitis. The drug should be used with caution for patients with severe renal impairment (e.g. eGFR< 30 ml/min).

Over-reliance on Drug Treatment for Obesity

While the new anti-obesity drug treatment represents a breakthrough, the obese individuals run a risk of overreliance on drug therapy.

A strong and sustained motivation is necessary for obese individuals to adopt reduced calorie diet, remain physically active and practice behavioural strategies to reinforce changes in diet and physical activity. Studies showed that up to 10% of weight loss could be achieved over 6 months to 1 year.^4,5

Studies also showed that, a weekly injection of GLP1-RAs could achieve up to 20% of weight loss in about 70 weeks.^6,7

Apart from weight reduction, GLP1-RAs also offer cardiovascular, renal and metabolic protection. It is understandable that, obese individuals are tempted to adopt this effective short-cut to achieve their weight reduction goals. The time and effort consuming lifestyle interventions tend to be ignored, even though it is emphasised by various health authorities.

Long-term drug treatment is often necessary; discontinuation leads to regaining two-thirds of lost weight within a year, and a return to original weight within 1.5 to 2 years.⁸ Without a strong commitment of sustainable lifestyle changes, obese individuals may rely solely on drugs for their weight management and surrender the control over their own health conditions.

Importance of Family Physicians in Promoting Non-Drug Measures

Family physicians, as the first contact, can screen their patients for obesity (e.g., BMI, waist circumference). Those obese patients can be assessed about their motivation of sustainable lifestyle changes. Dietary assessment can be made, with counselling as appropriate. This includes advice on the consumption of fast foods, portion control, and sugary drinks. Prescription of physical activities can be tailor-made according to their nature of work and current activity level.

With or without drug treatment, lifestyle intervention is important for preventing weight regain after successful weight loss.^9,10

Even without weight loss, exercise and physical activity can improve fitness and health, including increased muscle mass, improved bone health, prevent type 2 diabetes mellitus, lower blood pressure, decrease visceral fat, reduce risk of cardiovascular and all-cause mortality. It may decrease the risk of falls and fall-related injuries in older adults, and reduce stress, anxiety, and depression.^11,12,13

While the new anti-obesity drug treatment offers powerful effect on weight reduction and reduce the risk of complications of various chronic diseases, family physicians play pivotal role to advocate a balanced paradigm: drugs as adjuncts to robust lifestyle promotion. The target is not only a reduction of disease consequences; but an enhancement of overall health.

References

1. Yao Z, Tchang BG, Albert M, et al. Associations between Class I, II, or III Obesity and Health Outcomes. NEJM Evid 2025; 4:EVIDoa2400229.
2. Celletti F, Farrar J, De Regil L. World Health Organization Guideline on the Use and Indications of Glucagon-Like Peptide-1 Therapies for the Treatment of Obesity in Adults. JAMA 2026; 335:434.
3. American Diabetes Association Professional Practice Committee for Obesity. Pharmacologic treatment of obesity in adults: Standards of care in overweight and obesity. BMJ Open Diabetes Res Care 2026; 13.
4. Yanovski SZ, Yanovski JA. Approach to Obesity Treatment in Primary Care: A Review. JAMA Intern Med 2024; 184:818.
5. Goodpaster BH, Delany JP, Otto AD, et al. Effects of diet and physical activity interventions on weight loss and cardiometabolic risk factors in severely obese adults: a randomized trial. JAMA 2010; 304:1795.
6. Wilding JPH, Batterham RL, Calanna S, et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med 2021; 384:989.
7. Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide Once Weekly for the Treatment of Obesity. N Engl J Med 2022; 387:205.
8. West S, Scragg J, Aveyard P, et al. Weight regain after cessation of medication for weight management: systematic review and meta-analysis. BMJ 2026; 392:e085304.
9. Thomas JG, Bond DS, Phelan S, et al. Weight-loss maintenance for 10 years in the National Weight Control Registry. Am J Prev Med 2014; 46:17.
10. Wadden TA, Chao AM, Moore M, et al. The Role of Lifestyle Modification with Second-Generation Anti-obesity Medications: Comparisons, Questions, and Clinical Opportunities. Curr Obes Rep 2023; 12:453.
11. Kodama S, Saito K, Tanaka S, et al. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA 2009; 301:2024.
12. Herring MP, O'Connor PJ, Dishman RK. The effect of exercise training on anxiety symptoms among patients: a systematic review. Arch Intern Med 2010; 170:321.
13. Martin CK, Church TS, Thompson AM, et al. Exercise dose and quality of life: a randomized controlled trial. Arch Intern Med 2009; 169:269.