Why is it so hard to lose weight and keep it off? The GLP-1 agonists and new drugs under development with multiple actions can help. But for the vast majority of patients who can afford them and stay on them without suffering annoying side effects or complications, they are not a permanent solution. They are a lifetime of drug-taking with nasty backtracking upon cessation. This video explains why this fat is so hard to take off permanently and a new, promising and permanent approach to the problem,
bariatric surgery
The War Against Obesity
Despite the emergence of new pharmacologic alternatives to traditional bariatric surgery, the global obesity epidemic continues to escalate. Semaglutides, while effective for some, are costly, require weekly injections, and often cause side effects that lead many patients to discontinue treatment and subsequently regain much or all of the weight they lost. Both bypass and restrictive bariatric procedures carry significant risks, side effects, and long-term lifestyle adjustments, and most patients ultimately reach a weight-loss plateau. Endoscopic visceral lipectomy, though not yet clinically validated or widely adopted, offers the potential for a more permanent solution one that might help patients achieve a lower, more sustainable weight plateau without the same tradeoffs. Clinicians can work together to tailor combinations of pharmacologic and surgical strategies to best support the health of individual patients. Earlier intervention may help future generations.
Continued development of new medications and research into alternative surgical approaches should be encouraged. However, the widespread availability of highly addictive, calorie-dense, nutrient-poor junk and ultra-processed foods-paired with increasingly sedentary lifestyles and the pervasive use of addictive social media-continues to drive the epidemic beyond our current capacity to control it. Meaningful progress will require coordinated efforts among governments, schools, and food manufacturers to improve labeling, reduce the caloric density of snack foods, promote physical activity, limit screen time, decrease youth exposure to junk-food advertising, and foster healthier eating and exercise habits. A fuller discussion of the critical question of when-and how early-we should intervene to reverse the tightening spiral of obesity found in a recent article: The Next Frontier in Obesity and Type 2 Diabetes Treatment: Permanent Minimally Invasive Visceral Fat Removal and the Emerging Role of Early Intervention. R. L. Cucin OAJS 17:555952 (2025)
Weight Loss and Weight Loss Surgery Dramatically Reduces Cancer Risk
Obesity increases the incidence and mortality from some types of cancer, but it remained uncertain whether intentional weight loss can decrease this risk.
In a retrospective cohort study of 318 patients, bariatric surgery was significantly associated with a lower risk of obesity-associated cancer and cancer-related mortality. [Aminian A, Wilson R, Al-Kurd A et al. Association of Bariatric Surgery with Cancer Risk and Mortality in Adults with Obesity. JAMA. Published online June 3, 2022. doi:10.1001/jama.2022.9009]
Among adults with obesity, bariatric surgery compared with no surgery was associated with a significantly lower incidence of obesity-associated cancer and cancer-related mortality. This gives one more important benefit of bariatric surgery, in addition to the improvement of metabolic syndrome, type 2 diabetes, and reduction of cardiovascular morbidity.