F
or decades, obesity has carried a heavy burden, not only on the body, but also in the form of stigma. Too often, it has been reduced to questions of appearance, willpower or personal discipline, viewed through a lens of blame rather than biology.
But that narrative is steadily changing.
In conjunction with World Obesity Day, medical experts are urging the public to rethink long-held assumptions, stressing that obesity is not a personal failure but a complex, chronic disease that demands structured, long-term and compassionate care.
Dr Kiran Nair, Consultant Endocrinologist and Internal Medicine Physician at ParkCity Medical Centre here, said one of the most persistent misconceptions is the belief that obesity stems purely from laziness or a lack of self-control.
“This is medically inaccurate. Obesity is a chronic disease officially recognised by the World Health Organisation (WHO) in 1997, much like diabetes or heart disease,” she told Bernama when met recently.
“It is influenced by genetics, hormones and brain signals that regulate hunger, as well as sleep patterns, stress, medications and the environment we live in.”
She noted that modern treatment approaches increasingly acknowledge this complexity, moving beyond simplistic advice to ‘eat less and move more’ towards multidisciplinary strategies that address biological, psychological and lifestyle factors in tandem.
WHY OBESITY IS MORE THAN WILLPOWER
As Dr Kiran explained, obesity is far more than a matter of body weight; it is a condition that can affect nearly every organ system, from the lungs and liver to the joints. It significantly increases the risk of type 2 diabetes, heart disease, hypertension, certain cancers and even infertility.
For years, conventional weight-loss advice revolved around a simple formula: “eat less and exercise more.” While balanced nutrition and regular physical activity remain essential pillars of good health, she noted that this approach alone does not work for everyone.
ParkCity Medical Centre Consultant Endocrinologist and Internal Medicine Physician, Dr Kiran Nair.
“As with other chronic conditions, some individuals require structured medical care, medication or even surgery. Above all, people living with obesity deserve care and compassion, not condemnation or shame,” she said.
Dr Kiran shared that many patients recount years of trying different diets, exercise programmes and weight-loss plans, only to find themselves struggling repeatedly.
“I hear this very often in clinic, and in most cases, it is absolutely true,” she added.
The reason, she explained, lies in biology. The human body is programmed to defend its highest sustained weight. When weight loss occurs, hormonal pathways respond by increasing hunger and slowing metabolism, making it difficult to maintain results.
“Our bodies are designed to protect us from starvation, not to help us lose weight. When someone loses weight, the body interprets it as a threat and responds by increasing hunger hormones while reducing energy expenditure,” she said.
Beyond these biological mechanisms, factors such as hormonal imbalances, certain medications, chronic stress, menopause and underlying medical conditions can further complicate weight management. In such circumstances, repeated setbacks are not signs of personal weakness, but rather signals that structured medical support, not blame, is needed.
A NEW ERA IN OBESITY TREATMENT
One of the most significant shifts in recent years, Dr Kiran explained, is the deeper medical understanding of obesity as a complex biological disease. This evolving perspective has fundamentally transformed clinical practice, moving away from the era of blame and toward evidence-based, structured care.
“For individuals with significant biological resistance to weight loss, modern obesity care now includes medically supervised weight management programmes, prescription therapies and, in selected cases, bariatric or minimally invasive endoscopic procedures,” she said.
ParkCity Medical Centre.
“Today, the focus is no longer solely on weight reduction, but on improving overall health, reducing obesity-related complications and sustaining weight loss over the long term.”
Among the most notable advancements is the emergence of next-generation medications known as Glucagon-Like Peptide-1 (GLP-1) therapies. Unlike older weight-loss drugs that primarily acted as appetite suppressants by targeting the brain, these newer treatments are based on hormones that naturally regulate hunger, satiety, blood sugar and metabolism.
“These medications work with the body’s natural systems rather than overriding them. They help individuals feel full sooner and improve how the body processes blood sugar, instead of simply suppressing appetite,” she explained.
Importantly, these therapies have undergone extensive long-term clinical trials and are approved for chronic use under medical supervision. While generally well tolerated, they may have side effects like any medication and must be prescribed and monitored by qualified healthcare professionals.
Dr Kiran emphasised that medications such as Ozempic, Mounjaro and Wegovy are not quick fixes or “magic injections.”
“They are tools; part of a comprehensive, long-term treatment plan that integrates lifestyle modification, behavioural support and ongoing medical care,” she said, noting that abrupt discontinuation may result in weight regain.
Addressing concerns about dependency, she said such fears often stem from misconceptions about chronic disease management.
“These medications are not addictive in the conventional sense. However, stopping them can lead to weight regain because the body’s biological mechanisms remain unchanged and continue to defend its previous weight,” she explained.
Ultimately, she stressed, the goal is to combine medication with sustainable lifestyle habits, regular monitoring and continuous support.
“For many patients, this integrated approach leads to meaningful and lasting improvements in weight, metabolic health and overall well-being,” she added.
BEYOND FAD DIETS: BUILDING HABITS THAT LAST
While modern medications and medical procedures can support weight loss, nutrition remains the cornerstone of sustainable obesity management.
Ng Kar Foo, a dietitian at ParkCity Medical Centre, said many individuals continue to struggle because they turn to trendy or overly restrictive diets widely promoted online or by lifestyle influencers.
Ng Kar Foo (left).
“One of the most common mistakes is excessive dietary restriction,” he said. “This includes skipping meals, eliminating entire food groups, relying on extreme plans or following popular trends such as juice cleanses, rigid fasting routines or influencer-driven ‘fad diets.’ While these approaches may lead to short-term weight loss, they are rarely sustainable.”
He explained that fad diets — popular eating trends that promise rapid results without strong scientific backing — often create unrealistic expectations. A recent example is TikTok’s viral “Oatzempic” shake, made from oats, lime and water, which may temporarily reduce calorie intake but offers little evidence of long-term health benefits.
According to Ng, such methods frequently lead to fatigue, emotional eating and rebound overeating. Over time, individuals can become trapped in a discouraging cycle of strict dieting, temporary success, relapse and weight regain.
“When this pattern repeats, people often blame themselves. In reality, the issue is not a lack of willpower, but an approach that fails to recognise the complex biology and psychology of obesity,” he said.
Ng stressed that effective obesity management extends far beyond calorie counting. It requires attention to food quality, balanced meal timing, adequate sleep, stress management and a healthier emotional relationship with food.
Sustainable change, he added, is built on realistic habits, not extremes.
PERSONALISED NUTRITION
Building sustainable eating habits requires more than a standard meal plan. Ng explained that dietitians assess the individual as a whole, including daily routines, cultural practices, stress levels and, importantly, their relationship with food.
“For some, food symbolises celebration and connection. For others, it becomes a way to cope with stress or simply a source of daily fuel. Understanding what food represents to each person is essential in creating realistic and lasting habits,” he said.
Now, the focus is no longer solely on weight loss, but on improving overall health, reducing obesity-related complications, and maintaining that weight loss.
Flexibility, he added, is equally important. Rather than prescribing a single rigid diet, dietitians develop adaptable strategies tailored to each individual’s circumstances. This may involve offering multiple nutrition care plans that can be adjusted during travel, work transitions or major life events.
“Consistency, not perfection, is the main goal. Sustainable change comes from practising small, achievable habits repeatedly over time,” he explained. “For example, instead of eliminating all snacks at once, someone might begin by replacing sugary treats with fruit during the day. Forming a habit typically requires about three months or more of consistent effort.”
Ultimately, the objective is improved health and overall well-being, not merely weight reduction.
Ng emphasised that this reinforces the importance of multidisciplinary care, where endocrinologists, gastroenterologists, bariatric surgeons and dietitians collaborate to address the biological, behavioural and social dimensions of obesity.
MODERN, INCISIONLESS SOLUTIONS
For some patients, lifestyle modification, nutritional support and medication may still be insufficient to achieve meaningful health improvements. In such cases, minimally invasive endoscopic procedures can play a complementary role in obesity management.
Dr James Emmanuel, Consultant Gastroenterologist and Hepatologist at the same hospital, explained that these incisionless procedures, including Endoscopic Sleeve Gastroplasty (ESG) and intragastric balloons (IGB), are performed through the mouth without any abdominal incisions.
Dr James Emmanuel.
ESG works by reducing the size of the stomach using internal sutures, helping patients feel full sooner and consume less food. Recovery typically takes only a few days. Meanwhile, the intragastric balloon is a temporary device placed in the stomach to promote early satiety and support short-term weight loss, usually for up to six months.
“Unlike traditional bariatric surgeries such as laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass, these therapies preserve the natural anatomy of the gastrointestinal tract, involve shorter recovery periods and carry lower procedural risks,” he said.
While surgical interventions may result in greater weight loss for individuals with severe obesity, Dr Emmanuel noted that endoscopic therapies offer a safe and effective option for carefully selected patients.
These procedures are generally recommended for individuals with a Body Mass Index (BMI) of 30 or higher, or above 27 with metabolic risk factors, particularly when lifestyle interventions alone have not produced adequate results. For selected patients with higher BMI who decline surgery for personal or medical reasons, ESG may be considered as an alternative.
However, he stressed that careful patient selection and participation in a structured multidisciplinary programme are essential to ensure meaningful and sustainable outcomes.
“In terms of results, realistic expectations are around 15 to 20 per cent total body weight loss within the first year, with most patients experiencing noticeable changes within the first three to six months,” he said.
Beyond weight reduction, these procedures can improve obesity-related health markers, including blood sugar control, fatty liver disease and cardiovascular risk factors, underscoring their role in comprehensive metabolic care.
BRIDGING THE GAP
Patient safety remains a key consideration. Dr Emmanuel explained that large international studies indicate serious adverse events occur in fewer than two to three per cent of cases. Most patients are able to return to normal activities within two to three days, and a short hospital stay is typically sufficient to monitor and manage temporary symptoms such as mild abdominal discomfort.
He emphasised that endoscopic procedures are not a one-time solution. As obesity is a chronic metabolic condition, long-term success still relies heavily on sustained lifestyle engagement.
According to him, Endoscopic Sleeve Gastroplasty (ESG) is potentially reversible and has demonstrated sustained weight loss for up to five years in long-term studies when supported by structured follow-up. This means durable results can only be achieved when patients adhere to dietary guidance, maintain healthy activity patterns and undergo regular clinical monitoring as part of a comprehensive weight management programme.
Looking ahead, he envisions obesity treatment becoming increasingly personalised, with a spectrum of options tailored to disease severity, metabolic profile and patient preference.
“In this fast-evolving landscape, minimally invasive endoscopic procedures are expected to bridge the gap between medical therapy and surgery, forming an essential part of comprehensive obesity care in the near future,” he said.
