Eighty-eight percent of people living with obesity report experiencing stigma, reproval, or abuse related to their condition—a reality that continues to shape how care is delivered and received.
That context frames a new international perspective from Miras et al., published in Obesity Science & Practice, which argues that in addition to ongoing scientific questions, major barriers to effective obesity care include gaps in how health systems diagnose, stage, and manage the disease.
Drawing on input from clinicians, researchers, and industry participants, the authors describe nine areas of challenge in current obesity care. These include continued reliance on body mass index as a primary diagnostic tool, limited use of staging systems that better capture disease severity, the absence of widely adopted treatment targets comparable to those used in other chronic diseases, and fragmented, short-term care pathways that do not reflect obesity’s chronic nature.
The paper notes that while treatment options—including pharmacotherapy, surgery, and intensive lifestyle interventions—have expanded, access remains limited. Only a small proportion of eligible patients receive these therapies, suggesting a gap between available treatments and their use in practice.
The authors also describe growing public awareness of the biological drivers of obesity, including gut hormones and central nervous system pathways, which may contribute to changes in how obesity is understood. At the same time, they note that stigma remains pervasive, including within health care settings, and continues to influence both policy and practice.
Beyond clinical care, the perspective points to broader system-level implications. Economic analyses from the Organisation for Economic Co-operation and Development suggest obesity is associated with measurable impacts on national productivity, indicating potential population-level economic effects.
The paper also raises questions about how emerging tools—such as machine learning–based phenotyping—might support more individualized care, while noting that these approaches are not yet integrated into routine clinical workflows.
Recent population data are discussed cautiously. Gallup survey findings show a decline in US adult obesity prevalence from 40% in 2022 to 37% in 2025. While the timing coincides with increased use of anti-obesity medications, the authors note that causation cannot be determined.
A recurring theme throughout the perspective is the need to move beyond uniform treatment goals. Although modest weight loss (for example, 5%) can improve some health outcomes, the authors suggest that treatment targets may need to be individualized based on complications, risk profiles, and disease stage. Established tools such as the Edmonton Obesity Staging System—shown to predict outcomes independently of body mass index—remain underused in clinical practice.
The authors state that obesity should be managed as a chronic disease, with treatment focused on long-term outcomes and obesity-related complications rather than weight alone.
They conclude that progress in obesity care will depend in part on whether health systems adopt approaches that treat obesity as a chronic, heterogeneous disease requiring long-term, individualized management.
Disclosures are reported in the original publication.
Source: Obesity Science & Practice
