Obesity isn't just a health issue anymore—it's a global crisis. By 2035, 1.5 billion adults worldwide are projected to have obesity. Chronic conditions like heart disease and diabetes are skyrocketing, creating a burden we can't afford to ignore. The road ahead presents two distinct futures—one that perpetuates the shortcomings of the past and another that embraces innovation and precision.
The first future is where we've been stuck for years—a frustrating cycle of trial and error. While GLP-1s and weight-loss drugs have delivered results for many, they have their limitations. For too many patients, these medications bring side effects, fleeting success, or worse—no success at all.
The second future, though, offers a more targeted solution—precision obesity. This approach does what trial-and-error cannot by uncovering the root causes of obesity. It treats patients as individuals, not statistics, and enables physicians to deliver treatments that are as unique as the people who need them.
The statistics continue to be alarming, with no indication that the global rise in obesity is slowing. The real question isn't whether we'll act, but which future we'll choose to shape the future of obesity care.
The Trial-and-Error Path
For decades, obesity treatment has leaned on temporary fixes—diets, medications, and weight-loss fads. Today, nearly 12 percent of U.S. adults have used a GLP-1 drug. As access to these medications expands, more patients are trying them, but many do so without knowing if they'll work for them.
And the options are only multiplying. With an influx of new weight-loss drugs poised to enter the market, the trial-and-error process will likely intensify. Patients will face an overwhelming list of choices—and bear the burden of figuring out what works for their bodies. While more treatments may seem like progress, it risks turning obesity care into an endless experiment.
These drugs can be effective for the right patient, but most won't stay on them long enough to see lasting results. Side effects ranging from nausea and gastrointestinal distress to more severe complications often push patients to stop treatment. Research shows that persistent medication coverage—staying on the treatment without significant gaps—is crucial for achieving meaningful weight loss. For many, the discomfort of side effects or the challenge of maintaining the regimen pushes them back to square one.
Even those who achieve weight loss often struggle to maintain it once they stop the medication. Without ongoing treatment, patients often regain the lost weight due to the body's natural metabolic adaptations. The result is a revolving door of temporary fixes that don't address the root causes of obesity, leaving many stuck in a cycle of short-term solutions without lasting change.
The Precision Medicine Path
Precision obesity zeroes in on the why behind excess weight. It goes further than addressing the numbers on the scale to uncover the biological, genetic, and metabolic factors that contribute to each person's unique struggle with obesity. For some, genetic predispositions may disrupt appetite regulation; for others, a sluggish metabolism might be the culprit.
With tools like genetic testing, physicians can pinpoint the specific phenotype—the biological pattern—driving each patient's obesity. This approach allows for more targeted and personalized treatment plans, including whether GLP-1 medications should be incorporated. Research has shown that when treatment is customized based on a patient's phenotype, they lose nearly twice as much weight compared to those following standard lifestyle changes.
This same precision-driven approach has redefined cancer care. In the past, oncologists were fixated on tumor size and whether cancer had spread. But today, the focus is on what drives tumor growth—whether it's genetic mutations, abnormal cell behavior, or underlying molecular mechanisms. The same potential exists for obesity. With the right precision tools, we can target the root causes and offer treatments that aren't just effective—they're sustainable and long-lasting.
Tailoring Treatment for Long-Term Solutions
Without addressing obesity's root cause, this trial-and-error path only delays patients from finding a true solution. It's an unsustainable future of endless experimentation, mounting frustration, and missed opportunities to offer the personalized and effective care patients deserve.
With a personalized approach that targets a patient's unique genetic and biological factors, they're more likely to experience long-term improvements in their health. The obesity epidemic is a ticking time bomb, and the current system of trial and error isn't cutting it. Quick fixes and fleeting solutions won't solve a problem of this magnitude.
It's time to move beyond temporary treatments and start addressing obesity for what it truly is—a complex and deeply individual condition. The future of obesity treatment isn't about more medications—it's about precision, science, and targeting the root cause.
Andres J. Acosta, M.D., Ph.D., is an associate professor and consultant in the division of gastroenterology and hepatology, Department of Internal Medicine at Mayo Clinic in Rochester, Minn. Dr. Acosta is also the co-founder of Phenomix Sciences, a precision obesity biotechnology company on a mission to conquer obesity globally. Disclosure: He has received speaking fees from Novo Nordisk, Eli Lilly, Vivus, and Currax.
The views expressed in this article are the writer's own.
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