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Obesity is not just about weight gain. Experts explain why improving metabolic health is key to reducing risks like diabetes, heart disease, and fatty liver.
Metabolic health refers to the body’s ability to efficiently convert food into energy while regulating blood glucose, cholesterol levels, inflammation, and hormonal balance. In obesity, these systems become overworked and gradually less efficient.
Obesity is a growing healthcare challenge worldwide and has now reached pandemic proportions. Often viewed only as a problem of weight gain, it is far more complex than it appears. This narrow perception leads people to overlook the real danger hidden beneath excess weight: metabolic dysfunction.
Obesity is a multifactorial, chronic medical condition that disrupts energy processing, hormone regulation, and vital body functions. When weight loss becomes the sole focus, deeper metabolic issues remain unaddressed, leading to ongoing health risks and repeated cycles of weight regain.
Dr Mohit P Shetti, Senior Consultant, Gastroenterology, Hepatology, Therapeutic & Bariatric Endoscopy, Manipal Hospitals, Old Airport Road, Bengaluru, shares all you need to know:
Why is obesity more than a weight issue?
Obesity affects the body at a systemic level. Excess fat, particularly visceral fat, disrupts metabolic pathways that regulate insulin, cholesterol, inflammation, and energy production. This disruption creates the foundation for multiple interconnected problems, such as high blood pressure, fatty liver disease, and hormonal imbalances.
Importantly, these metabolic changes often begin long before visible weight gain becomes alarming, making timely medical intervention crucial.
Understanding metabolic health in obesity
Metabolic health refers to the body’s ability to efficiently convert food into energy while regulating blood glucose, cholesterol levels, inflammation, and hormonal balance. In obesity, these systems become overworked and gradually less efficient.
The hidden dangers of poor metabolic health
Long-term metabolic dysfunction significantly contributes to serious illnesses:
• Type 2 Diabetes:
Insulin resistance prevents cells from absorbing glucose, leading to elevated blood sugar levels and long-term complications.
• Cardiovascular Disease:
High blood pressure, chronic inflammation, and abnormal cholesterol levels increase the risk of heart attack and stroke.
• Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) (formerly Non-Alcoholic Fatty Liver Disease or NAFLD):
Fat accumulation in the liver can lead to inflammation, fibrosis, and potentially cirrhosis.
• Polycystic Ovary Syndrome (PCOS):
Metabolic dysfunction contributes to hormonal imbalance, irregular menstrual cycles, and infertility.
• Respiratory Problems and Sleep Apnea:
Excess fat around the neck and abdomen reduces oxygen flow and disrupts sleep.
When the focus remains only on weight, deeper issues such as insulin resistance, inflammation, loss of lean muscle mass, poor gut health, and nutrient deficiencies remain untreated. As a result, weight-loss attempts often fail or lead to unhealthy and unsustainable crash dieting.
Treatments to manage obesity
Treating obesity requires a comprehensive and personalised approach that targets both weight and underlying metabolic pathways.
1. Lifestyle Modifications
Lifestyle changes remain the foundation of obesity treatment and play a crucial role in improving long-term metabolic health. These include diet, exercise, and behavioural changes.
How it helps:
• Enhances insulin sensitivity and overall metabolic balance
• Supports sustainable, gradual weight loss
• Reduces inflammation and stabilises blood glucose levels
• Improves gut health and digestion
• Is essential both before and after interventions such as Endoscopic Sleeve Gastroplasty (ESG), intragastric balloon placement, or bariatric surgery
Best for:
• Individuals at all stages of obesity
• People beginning their weight-management journey
• Patients preparing for ESG, intragastric balloon placement, or bariatric surgery
• Anyone aiming for long-term metabolic wellness and weight stability
2. Medications for Obesity
Medications can be an effective option for individuals who do not achieve adequate weight loss with lifestyle modification alone. They are used as an adjunct to diet and physical activity. Various medications are available, including newer agents that target GLP-1 and GLP-1/GIP receptors.
How it helps:
• Regulates appetite and reduces food cravings, aiding portion control
• Delays gastric emptying, leading to earlier satiety
• Improves insulin sensitivity and blood sugar control
• Can be used alongside lifestyle measures and other weight-loss modalities such as endoscopic therapies and bariatric surgery
• Helps achieve long-term weight maintenance
Best for:
• Individuals with a BMI ≥ 27 kg/m² or ≥ 25 kg/m² with at least one associated comorbidity (such as diabetes or fatty liver)
• Individuals unable to achieve weight loss with lifestyle measures alone
• Individuals who prefer a non-surgical approach or are not surgical candidates
• Individuals preparing for endoscopic or surgical therapies, where medications can help initiate weight loss
Patients should be counselled that anti-obesity medications must be used in conjunction with lifestyle changes and may need to be continued long-term, as weight regain is common upon discontinuation.
3. Endoscopic Sleeve Gastroplasty (ESG)
ESG is a minimally invasive endoscopic procedure that reduces the stomach’s size by approximately 60–70%, creating a sleeve-like shape without surgical incisions.
How it helps:
• Slows stomach emptying and improves satiety
• Promotes steady weight loss
• Improves metabolic markers such as insulin resistance, cholesterol, and fatty liver
• Has a low risk of serious adverse events, with a short hospital stay and quick recovery
Best for:
Individuals with a BMI of 30–40 kg/m² seeking an effective, non-surgical option to improve both weight and metabolic health. It may also be considered for patients with a BMI of ≥ 27 kg/m² with comorbidities.
4. Intragastric Balloon
The intragastric balloon is a temporary, non-surgical device placed in the stomach to reduce available stomach volume and promote early fullness.
How it works:
A soft balloon is inserted endoscopically and filled with fluid or gas, helping individuals control portion sizes and regulate appetite.
Benefits:
• Supports 6–12 months of controlled weight loss
• Improves blood sugar levels, insulin response, and cholesterol
• Is completely reversible and minimally invasive
Best for:
Individuals with a BMI of 30–35 kg/m², and in some cases 27–30 kg/m² with comorbidities, who require appetite control or are not ready for surgical options.
5. Bariatric Surgery
Bariatric surgery is an effective treatment option that results in significant and sustained weight loss, particularly for individuals with severe obesity and related medical conditions.
How it helps:
• Achieves sustained weight loss through restrictive and hormonal mechanisms
• Improves insulin sensitivity due to both weight loss and hormonal changes
• Enhances satiety and reduces hunger
• Improves underlying medical conditions and overall quality of life
Best for:
• Individuals with a BMI ≥ 40 kg/m² or ≥ 35 kg/m² with comorbidities
• Individuals not achieving meaningful weight loss with other treatment modalities
• Individuals committed to long-term lifestyle changes
• Those seeking significant and durable weight loss
Obesity is not merely excess weight; it is a complex metabolic disease with far-reaching consequences. By shifting the focus from weight alone to improving metabolic health, individuals can reduce disease risk, restore hormonal balance, and achieve sustainable long-term wellness.
Weight loss may be the visible outcome, but true healing lies in restoring metabolic function. Treatment choices should be personalised based on medical comorbidities, patient preferences, cost considerations, and contraindications.
Disclaimer: Issued in the public interest and for educational purposes only. This article is not intended to provide medical or clinical advice. Please consult your doctor for personalised guidance.
March 18, 2026, 14:08 IST