Contemporary medical, device, and surgical therapies for obesity in adults.

The goal of obesity management is to improve health. Sustained weight loss of more than 10% overall bodyweight improves many of the complications associated with obesity (eg, prevention and control of type 2 diabetes, hypertension, fatty liver disease, and obstructive sleep apnoea), as well as quality of life. Maintenance of weight loss is the major challenge of obesity management. Like all chronic diseases, managing obesity requires a long-term, multimodal approach, taking into account each individual's treatment goals, and the benefit and risk of different therapies. In conjunction with lifestyle interventions, anti-obesity medications and bariatric surgery improve the maintenance of weight loss and associated health gains. Most available anti-obesity medications act on central appetite pathways to reduce hunger and food reward. In the past 5 years, therapeutic advances have seen the development of targeted treatments for monogenic obesities and a new generation of anti-obesity medications. These highly effective anti-obesity medications are associated with weight losses of more than 10% of overall bodyweight in more than two-thirds of clinical trial participants. Long-term data on safety, efficacy, and cardiovascular outcomes are awaited. Long-term studies have shown that bariatric surgical procedures typically lead to a durable weight loss of 25% and rapid, sustained improvements in complications of obesity, although they have not yet been compared with new-generation highly effective anti-obesity medications. Further work is required to determine optimal patient-specific treatment strategies, including combinations of lifestyle interventions, anti-obesity medications, endoscopic and bariatric surgical procedures, and to ensure equitable access to effective treatments.

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Declaration of interests CMP reports speaker fees from Novo Nordisk. RVC reports research grants paid to their institution from Johnson & Johnson Brazil and Medtronic Brazil. RVC reports payment or honoraria for lectures from Johnson & Johnson Brazil, Medtronic, Janssen Pharmaceuticals, Novo Nordisk, and Abbott. RVC is on the scientific advisory board for GI Dynamics. PS reports research grants paid to their institution from National Health and Medical Research Council. PS reports speaker fees and medical writing assistance from Novo Nordisk. PS reports unpaid positions at the Australian and New Zealand Obesity Society (council member), The Obesity Collective (leadership group), and a Data Safety Monitoring Board for an investigator-initiated (dietary intervention) study sponsored by the University of Adelaide. KC reports research grants paid to their institution from Confo Therapeutics, Integrative Phenomics, and the Novo Nordisk Jacobæus Prize. KC reports consulting fees paid to their institution from Danone Research. KC reports payment to public association from Biocodex, and payment of honoraria for lectures from Sanofi. KC is on the scientific advisory board for Ysopia and Astanor. GF reports research grants paid to their Institution from the Carlos III Health Institute. GF reports payment of honoraria for lectures from Novo Nordisk as member of the OPEN Spain Initiative. GF reports payment or honoraria for attendance to the 2022 Lilly Diabetes Global Medical Affairs Portfolio Advisory Board. GF is a co-chair of the scientific advisory board of the European Society for the Study of Obesity—it is an unpaid position.