Finally Lose Weight Permanently: Medical and Non-Medical Approaches

In medicine, body weight is typically classified using the Body Mass Index (BMI). While a BMI between 18.5 and 25 is considered a normal weight, a BMI of 25 or higher is classified as being overweight, and a BMI of 30 or higher as obesity. At this point, at the very latest, weight loss is no longer merely a lifestyle choice but a medical necessity.

Excess adipose tissue is metabolically active and drastically increases the risk of numerous comorbidities. These include cardiovascular diseases such as high blood pressure, metabolic disorders such as type 2 diabetes mellitus, joint wear and tear (osteoarthritis) due to mechanical stress, and sleep apnea. Successful weight loss measurably reduces the strain on the body: blood pressure improves, blood sugar levels stabilize, and the joints are spared.

Every treatment begins with what is known as conservative treatment. The key here is achieving a negative energy balance: more calories must be burned than are consumed.

• Dietary changes instead of fad diets: Short-term crash diets almost always lead to the dreaded yo-yo effect. Instead, experts recommend a lasting change in eating habits. This isn’t about deprivation, but about awareness. A high-fiber diet rich in vegetables, whole grains, and high-quality proteins provides long-lasting satiety and keeps insulin levels stable.

• Exercise and sports: Physical activity is the second pillar. Endurance sports (such as swimming, walking, or cycling) are ideal for boosting calorie burn. Strength training, on the other hand, builds muscle mass—and since muscles burn more energy than fat tissue, this also increases the body’s resting metabolic rate.

• Behavioral Therapy: Eating is often linked to emotions—whether it’s stress, boredom, or frustration. Behavioral therapy can help break these patterns and restore a healthy relationship with food.

For people who are severely overweight (Class II or III obesity), conservative measures are often insufficient to achieve significant, long-term weight loss. The body resists weight loss through hormonal mechanisms, which makes losing weight physiologically difficult. This is where modern medicine steps in.

Medication-Based Support In recent years, new classes of medications (such as GLP-1 analogs) have revolutionized treatment. These medications, which were originally developed for diabetes treatment, increase feelings of fullness and slow gastric emptying. However, they should only ever be used under medical supervision and in conjunction with dietary changes.

Surgical Procedures as a Last Resort If the BMI is over 40 (or over 35 with comorbidities) and all conservative attempts have failed, bariatric surgery is often the most effective option. The most common procedures include:

• Gastric bypass: In this procedure, the stomach is reduced in size and a portion of the small intestine is bypassed. This results in the patient being able to eat less, and the body absorbing fewer nutrients (and thus fewer calories).

• Sleeve Gastrectomy: A large portion of the stomach is removed, leaving only a tube-shaped remnant of the stomach. Stomach capacity is greatly reduced, and fewer hunger hormones (ghrelin) are produced.

• Gastric balloon: A non-surgical, temporary method in which a balloon is inserted into the stomach to induce a feeling of fullness sooner.

Whether conservative or surgical, weight loss is a lifelong commitment. Lifelong follow-up care is essential, especially after surgical procedures. Since the body absorbs nutrients less efficiently, vitamins and minerals often need to be supplemented. Regular blood tests at the doctor’s office are also mandatory. In addition, significant weight loss can leave behind excess skin (e.g., on the abdomen or upper arms). In such cases, plastic surgery procedures to tighten the skin can help complete one’s physical well-being and sense of body image.

Losing weight is more complex than simply “eating half as much.” It involves a combination of metabolism, mental health, and behavior. Anyone suffering from severe obesity should not hesitate to seek professional help. At specialized centers, nutritionists, surgeons, psychologists, and physical therapists work hand in hand to find the right path to a lighter life for each patient.