For many people, weight loss is more than just willpower; it’s biological. If you’re exercising regularly and eating well but aren’t seeing results, it may be time to look at your metabolism from a medical perspective. Experts say there are clear signs that lifestyle changes alone may not be enough, and that’s where medical weight loss treatments come in.
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Dr. Eduardo Grunwald is an internist and obesity medicine specialist in San Diego. Dr. Amanda Kahn is a board-certified internal medicine physician in New York State.
1. We are ready to treat obesity as a chronic disease
“The question is whether you are prepared to treat your obesity as a chronic disease rather than simply losing weight,” says Dr. Grunwald. “We think of obesity as a chronic metabolic disease, just like diabetes or hypertension. For most people who use GLP-1 drugs, you have to be prepared to take them not just for short periods of time, but for long periods of time.”
2. Weight affects health
The first step, Dr. Grunwald says, is to identify whether excess weight is causing the problem. “There are three elements to this,” he explains. “One is metabolic complications, such as insulin resistance, diabetes, fatty liver, and hypertension. The second is biomechanical issues, such as joint pain and sleep apnea. The third is functional or psychosocial issues, where weight is interfering with quality of life, mood, and work.”
3. I’ve been doing everything right, but it’s not working.
“Diet and exercise are essential in today’s environment, but for many people, they are no longer enough,” says Dr. Khan. “Our food is designed for overconsumption, stress disrupts hormones, lack of sleep causes insulin resistance, and environmental toxins affect metabolism. When someone is doing everything right and still struggles, it’s often an indication that biology, not willpower, is the barrier.”
4. There are signs of metabolic imbalance.
If you have elevated fasting insulin, PCOS, or visceral fat accumulation, those are early warning signs, says Dr. Khan. “If you see early signs of metabolic imbalance, such as visceral fat or hormonal imbalances, it’s time to look beyond lifestyle and consider a targeted medical approach.”
5. Understand that health is not about BMI.
“There are guidelines, but BMI isn’t everything. A BMI of 30 and lots of muscle mass may not mean you’re a good candidate, whereas someone with a low BMI but a weight-related health problem may be a good candidate,” Dr. Grunwald explains. He says the focus should always be on health outcomes, not just target numbers.
6. Enjoys being watched and coached.
Dr. Khan recommends a comprehensive exam before you begin. “Start with fasting blood sugar, insulin, A1C, advanced lipid testing, liver and kidney function, thyroid and hormone panels, and nutrient profile,” she says. “Retest every three to four months to make sure your body is responding safely.” She also emphasizes finding a qualified health care provider who will personalize your care, monitor your progress, and thoughtfully manage your side effects.
7. Focuses on long-term health, not temporary solutions
“The real results aren’t just about weight loss,” says Dr. Khan. “It’s about optimizing long-term health: improving insulin sensitivity, reducing inflammation, increasing energy, and preventing disease.”
Dr. Grunwald adds, “These drugs can be life-changing, but only if you are ready to accept them as part of a lifelong strategy to improve your health.”
