Obesity, weight management & metabolic care

Obesity
& Overweight

Obesity and overweight are common health conditions affecting adults, children and adolescents. They occur when excess body fat accumulates and may begin to affect physical health, metabolism and overall wellbeing. Obesity is now recognised as a chronic and often recurring medical condition rather than simply a problem of eating too much or exercising too little. Body weight is influenced by several interconnected factors, including genetics, appetite-regulating hormones, metabolism, food habits, physical activity, sleep, medicines and environmental influences. Some people gain weight gradually over many years, while others experience rapid or unexplained weight gain. Excess body fat, particularly around the abdomen, can increase the risk of diabetes, high blood pressure, heart disease, fatty liver, sleep apnea and other health problems. Appropriate evaluation and treatment can improve health, even when weight loss is modest.

Obesity in Indian patients requires special attention because health risks may develop at a lower body weight than expected. Many Indians and other South Asians tend to accumulate more fat around the abdomen and internal organs, even when their overall body weight does not appear very high. This is called central or abdominal obesity and is closely associated with insulin resistance, type 2 diabetes, abnormal cholesterol and fatty liver disease. Body mass index (BMI) is a commonly used screening tool, but BMI alone cannot accurately measure body fat or determine an individual’s health risk. In Asian Indian adults, increased metabolic risk can begin at a BMI of around 23 kg/m2, although the cut-offs used to classify overweight and obesity vary between guidelines. Waist circumference, body fat distribution and associated medical conditions are therefore important parts of obesity assessment.

Not every person with obesity has a hormonal disorder, but certain endocrine conditions can contribute to weight gain. An underactive thyroid gland (hypothyroidism), Cushing syndrome, selected pituitary or hypothalamic disorders, and certain other hormonal abnormalities may contribute to increased body weight. Polycystic ovary syndrome (PCOS) is commonly associated with insulin resistance and weight-related metabolic concerns. Some medicines, including long-term glucocorticoids, certain psychiatric medicines and selected diabetes treatments, may also promote weight gain. However, most people living with obesity do not have an identifiable hormone deficiency as the primary cause. A detailed medical history, physical examination and appropriately selected investigations help distinguish common weight-related problems from less frequent endocrine conditions that require specific treatment.

Obesity is not only about appearance or body weight; its effects on internal organs and long-term health are especially important. Excess body fat can contribute to prediabetes, type 2 diabetes, hypertension, abnormal cholesterol, metabolic dysfunction-associated steatotic liver disease (MASLD or fatty liver), obstructive sleep apnea and cardiovascular disease. It may also worsen osteoarthritis, mobility problems and quality of life. In women, obesity can contribute to menstrual irregularities, PCOS-related problems, reduced fertility and pregnancy complications. In men, excess weight may be associated with reduced testosterone levels, erectile dysfunction and sleep-related disorders. Childhood obesity can increase the risk of metabolic problems at a young age. Importantly, some individuals have significant abdominal fat and metabolic complications despite having a BMI that would not traditionally be classified as obese.

Successful weight management begins with understanding why weight gain has occurred and identifying associated health problems. Evaluation may include body weight, height, BMI, waist circumference, blood pressure, weight history, eating patterns, physical activity, sleep, medicines and family history. Depending on clinical findings, investigations may include blood glucose, HbA1c, cholesterol, liver function and thyroid function, with further hormonal testing when indicated. The goal is not simply to reach a particular number on the weighing scale, but to improve metabolic health, reduce obesity-related complications and achieve sustainable weight reduction. Even a weight loss of around 5% to 10% can produce meaningful improvements in blood sugar, blood pressure and other metabolic risk factors in many patients. Greater weight reduction may provide additional benefits in selected conditions.

Modern obesity treatment goes beyond traditional dieting and exercise advice. A personalised plan includes appropriate nutrition, portion management, physical activity, resistance exercise, adequate sleep, behavioural support and long-term follow-up. For selected patients, prescription weight-management medicines can provide additional benefits. Newer treatments such as semaglutide, a GLP-1 receptor agonist, and tirzepatide, a dual GIP/GLP-1 receptor agonist, can help reduce appetite and support clinically significant weight loss when prescribed for appropriate indications. These medicines are not suitable for everyone and require assessment of medical eligibility, potential adverse effects, contraindications and long-term treatment needs. In patients with more severe obesity or significant weight-related complications, metabolic and bariatric surgery may be considered after appropriate specialist evaluation. The choice between lifestyle treatment, medicines and surgery depends on the individual’s health, treatment goals and preferences.

Obesity management is a long-term process, and maintaining weight loss is as important as achieving it. The body can respond to weight reduction with changes in appetite, hunger hormones and energy expenditure, making weight regain common after restrictive diets or stopping treatment. This is why repeated crash dieting, unregulated slimming supplements and unsupervised weight-loss injections are not recommended. A structured and supportive treatment plan can help patients improve their health while preserving muscle mass and maintaining appropriate nutrition. Treatment also needs to be adapted for children, older adults, pregnant women and people with diabetes or other medical conditions.

Dr. Rajesh Moganti (MD, DM Endocrinology) provides comprehensive evaluation and personalised medical management of obesity, overweight, insulin resistance, metabolic syndrome and weight-related hormonal disorders at our Rajahmundry and Tanuku centres. Care includes assessment of underlying causes, identification of diabetes and cardiovascular risk factors, lifestyle-based treatment, evidence-based prescription weight-management medicines when appropriate, and long-term monitoring. The focus is on improving metabolic health, achieving sustainable weight management and reducing the risk of future complications rather than pursuing rapid or unrealistic weight-loss targets.