Obesity non-surgical treatment options
Obesity: Non-Surgical Treatment Options
Treatment Options and Goals
Treatment options for obesity should be individualized, with the primary goal of improving health, managing obesity-related diseases, and enhancing quality of life. Health care professionals experienced in obesity management should work in partnership with people living with obesity to determine the most appropriate treatment strategy.
Treatment goals extend beyond short-term weight change and include:
- Long-term disease control
- Improvement or prevention of obesity-related conditions
- Maintenance of treatment benefits over time
- Improvement in quality of life
Clinical studies show that a 5-15% reduction in body weight can provide meaningful health benefits for many individuals, with greater reductions often required in those with more severe obesity to achieve similar health improvements.
Stepwise Treatment Approach
A step-up approach is generally recommended, unless more rapid health improvement is required due to medical urgency:
- Behavioral and lifestyle interventions
- Nutrition therapy
- Physical activity programs
- Psychological support
- Pharmacotherapy
Typically considered for individuals with BMI ≥ 30 kg/m², or BMI ≥ 27 kg/m² with obesity-related diseases
- Metabolic Bariatric Surgery
- Endoscopic therapies (in selected situations, including as a bridging option or when surgery is not appropriate)
Because obesity is a chronic disease with adaptive biological mechanisms, long-term follow-up and ongoing care are essential to achieve sustained health benefits.
Non-Surgical Treatment
Non-surgical management aims to improve health through sustained treatment, which may include lifestyle modification, medications, and behavioral support. While these approaches can lead to meaningful health improvements, continued treatment is often necessary to maintain benefits over time. Interruption of therapy may be associated with a return of obesity-related complications, underscoring the need for long-term disease management.
Endoscopic Treatment Options
Endoscopic bariatric therapies have been developed as less invasive treatment options for selected individuals living with obesity, particularly when lifestyle and pharmacologic interventions have provided insufficient clinical response.
While several endoscopic techniques are available, long-term outcome data remain limited, and these procedures may carry risks. Careful evaluation and counseling by an experienced multidisciplinary team are essential.
Endoscopic therapies may be considered in specific clinical situations, including:
- As a bridging therapy to reduce risk before other necessary procedures (e.g., orthopedic surgery, organ transplantation, complex abdominal wall hernia repair)
- When surgical access is technically challenging due to prior operations
- When metabolic and bariatric surgery is not appropriate at the current time
- In selected individuals with lower BMI categories who have not achieved adequate health improvement with other treatments
Types of Endoscopic Therapies
Gastric interventions:
- Intragastric Balloon: a temporary device placed in the stomach to reduce food capacity
- Endoscopic Sleeve Gastroplasty: endoscopic suturing that reduces stomach volume
- Primary Obesity Surgery Endoluminal (POSE): endoscopic plications that limit gastric accommodation
Small bowel interventions:
- Duodenal-jejunal bypass liner (EndoBarrier®): a temporary liner placed in the duodenum to reduce contact between food and the intestinal lining, mimicking some metabolic effects of surgical bypass