Obesity
Obesity is a chronic, relapsing disease driven by a complex interaction of genetics, hormones, environment, and behavior. It is defined by a BMI of 30 or higher, but the clinical focus is on metabolic health, fat distribution, and complication risk rather than BMI alone. Medical management has advanced significantly with medications that target appetite-regulating pathways in the brain.
Symptoms
Weight that is difficult to lose despite reduced intake, fatigue, joint pain especially in knees and hips, sleep apnea and snoring, shortness of breath with exertion, low mood, and insulin resistance symptoms. Visceral fat accumulation raises cardiovascular and metabolic risk independently of total body weight.
Causes and risk
Hormonal factors including leptin resistance, ghrelin dysregulation, and insulin resistance create a physiological environment that resists weight loss. Genetic predisposition accounts for 40 -- 70% of BMI variance. Sleep deprivation, high-stress environment, processed food availability, and certain medications (antidepressants, antipsychotics, steroids) contribute significantly.
How it is evaluated
We assess BMI and waist circumference, blood pressure, fasting glucose, insulin, A1C, lipid panel, liver enzymes, TSH, and screen for sleep apnea. We discuss previous weight-loss attempts, diet history, and mental health factors before building a plan.
Treatment
Structured nutrition and behavioral change are foundational. GLP-1 receptor agonists (semaglutide, tirzepatide) produce 15 -- 22% body weight loss in clinical trials with favorable metabolic effects. We also evaluate candidates for other obesity medications and coordinate bariatric surgery referrals when appropriate.