Overweight and obesity: today, treatment involves integrated and personalised approaches
In recent months, it’s been all over the place. Social media, television, newspapers. The new “weight-loss drugs” have become one of the most talked-about topics. Behind the media hype, however, lies a real revolution: today, obesity can be treated with methods that were unthinkable just a few years ago. But be careful: for them to be effective and safe, it is essential to use them correctly.
“Obesity is a complex and recurrent chronic disease, which requires a multidisciplinary and personalised approach. The arrival of these molecules has significantly expanded therapeutic possibilities, offering additional tools to develop increasingly personalised and effective treatment plans,” explains Professor Stefano Olmi, head of the General, Oncological and Robotic Surgery Unit, the Obesity Surgery Centre and the Amico (Integrated Metabolic Clinic and Obesity Treatment) at the San Marco Polyclinic of the San Donato Group and Associate Professor of General Surgery at the Vita-Salute San Raffaele University in Milan.
The Amico project was established precisely with this aim: to provide a point of reference for the integrated management of overweight, obesity and metabolic disorders, combining nutritional support, drug therapy and bariatric surgery, where indicated.
How the new anti-obesity drugs work
The most widely used molecules today are semaglutide and tirzepatide. ‘Initially developed for the treatment of type 2 diabetes, both belong to the class of incretin-based drugs, i.e. medicines that mimic the action of gut hormones involved in controlling blood sugar and appetite. In practice, they work by slowing gastric emptying and increasing the feeling of fullness. Furthermore, they reduce appetite at a central level. Tirzepatide, thanks to a dual action, also appears to influence fat metabolism more significantly.”
Who are they suitable for
In both cases, the indications are overweight individuals with a BMI over 27 and comorbidities (type 2 diabetes, hypertension, dyslipidaemia, OSAS, etc.) and people with class I obesity (BMI between 30 and 34.9). In certain situations where surgery is not recommended, they may also represent an alternative to surgery.
Medicines yes, but under strict medical supervision
The most common side effects associated with taking these medicines are nausea, heartburn, diarrhoea, constipation and, more rarely, vomiting. Acute pancreatitis, however, is very rare. ‘For this reason treatments must be prescribed and monitored by experienced specialists, capable of assessing not only which drug to use, but also the most suitable course of action for each individual patient’.
The synergy between medication and bariatric surgery: an increasingly effective approach
Today, one of the most innovative aspects of obesity treatment is precisely the integration of drug therapy and bariatric surgery. “These are no longer alternative approaches, but often complementary ones. The use of medication prior to surgery allows for an initial reduction in body weight, improved metabolic control and a reduction in visceral fat. This makes it possible to undergo surgery under more favourable conditions, reducing the risk of complications and improving recovery”, continues the specialist. “After surgery, however, the new drugs can help maintain results over time, supporting the patient in managing hunger. In some cases, they also help enhance weight loss and improve associated metabolic conditions, such as diabetes, high blood pressure and fatty liver disease.”
The role of bariatric surgery
In cases of severe obesity (BMI over 40 or 35 in the presence of significant comorbidities), bariatric surgery remains the most effective treatment. And it is precisely in this area that the Policlinico San Marco is a well-established centre of excellence for the multidisciplinary management of patients with complex obesity, through integrated care pathways involving surgeons, nutritionists and psychologists (for over 10 years it has been a centre of excellence recognised by SICOB – the Italian Society for Obesity and Metabolic Disease Surgery).
“In recent years, obesity surgery has also evolved significantly with innovative procedures, thanks in part to the use of laparoscopic and robotic surgery,” emphasises Olmi. “Among the most commonly used procedures are sleeve gastrectomy and gastric bypass, as well as more recent techniques such as transit bipartition, which enable not only significant weight loss but also a marked improvement in conditions such as type 2 diabetes, high blood pressure and metabolic syndrome.”
“The real innovation today is not choosing between medication or surgery, but designing the most suitable treatment pathway for each patient, integrating the various available options. The aim is not simply to lose weight, but to achieve a stable improvement in metabolic health and quality of life,” concludes Professor Olmi.
