Obesity as a Chronic Disease
Obesity is officially classified as a chronic disease that drives hypertension, type 2 diabetes, nonalcoholic
fatty liver disease (NAFLD) and cardiovascular events. Nearly 890 million adults are obese worldwide,
and in Iran over 60 percent of the population carries excess weight, with one in three schoolchildren
already overweight.
Lifestyle Modification: The Foundation of Treatment
Obesity is officially classified as a chronic disease that drives hypertension, type 2 diabetes, nonalcoholic fatty liver disease (NAFLD) and cardiovascular events. Nearly 890 million adults are obese worldwide, and in Iran over 60 percent of the population carries excess weight, with one in three schoolchildren already overweight.
Diet quality, regular exercise and stress management must remain the first line of defense. All pharmacologic or surgical interventions—including injectable incretin mimetics—are only justified when a patient has genuinely tried and failed to achieve sustained weight loss through structured lifestyle changes alone.
Incretin-Mimetic Drugs as Metabolic Tools
Medications such as GLP-1 agonists (e.g., semaglutide/Ozempic®) and dual GLP-1/GIP agonists (e.g., tirzepatide/Spartina®) should be viewed as metabolic instruments rather than “miracle” weight-loss shots. By replicating gut-hormone signals, they enhance insulin secretion, slow gastric emptying and activate central satiety pathways, which together curb appetite and improve insulin resistance.
Broad Metabolic Benefits Beyond Weight Loss
Even modest weight reduction achieved with these agents improves liver steatosis and glycemic control—often allowing clinicians to reduce or stop other antidiabetic medications. Sustained weight loss also lowers the long-term risks of cirrhosis, cardiovascular disease and potentially weight-related cancers.
Patient Selection and Multidisciplinary Care
Appropriate candidates are adults with BMI ≥ 30 kg/m² or BMI ≥ 27 kg/m² plus at least one comorbidity (T2DM, hypertension or dyslipidemia). Optimal results demand a team-based model—combining hepatology, endocrinology, nutrition, psychology and lifestyle coaching—to set realistic goals, manage side effects and reinforce behavior change.
Safe Prescribing, Titration, and Monitoring
Therapy must begin at low doses, with gradual up-titration over weeks to balance efficacy and tolerability. Patients should be counseled on managing gastrointestinal side effects (nausea, diarrhea, constipation) by eating small, low-fat meals, staying well-hydrated and boosting protein intake to preserve lean mass.
Ensuring Drug Quality and Access
Illegal or smuggled products lack guaranteed cold-chain storage and authenticity, posing serious risks. Domestic GMP-certified manufacturing of tirzepatide (Spartina®) ensures wider affordability and quality. National guidelines are needed to guarantee that all patients receive genuine, high-quality medications.
Insurance Coverage and Health Economics
Just as bariatric surgery is covered when obesity’s future costs outweigh treatment expenses, high-risk groups—especially those with established T2DM or advanced NAFLD—should gain insurance support for incretin therapy. Blanket coverage for all users may exceed insurers’ budgets, so prioritization is essential.
Leveraging Social Media Responsibly
Rather than demonizing “health influencers,” partnerships with trusted public figures can spread accurate messages about lifestyle hygiene and safe drug use. Such collaborations help counteract misinformation and promote evidence-based health practices.
Long-Term Use and Sustaining Weight Loss
Obesity therapies—including incretin mimetics—should be regarded like antihypertensives or antidiabetics, often requiring years of continuous treatment to maintain benefits. Upon discontinuation, patients must intensify diet and exercise efforts to prevent weight regain, underscoring that lifelong lifestyle commitment remains indispensable.
Conclusion
Incretin-based therapies offer powerful adjuncts in managing metabolic syndrome by bridging the gap between lifestyle measures and invasive surgery. Their promise hinges on careful patient selection, multidisciplinary support, stringent quality assurance, responsible prescribing and unwavering emphasis on diet and physical activity as the true pillars of long-term health.
