A Comprehensive Approach to Obesity Treatment: Combining Lifestyle, Medication, and Surgery

At the ACP Internal Medicine Meeting 2025, Laura Davisson, MD, offered a practical roadmap for treating obesity using an individualized, evidence-based approach. In this conversation, Dr Davisson reviews the current landscape of pharmacologic treatments, including GLP-1 receptor agonists, and addresses how to manage their most common side effects. She also emphasizes the enduring value of bariatric surgery and the non-negotiable foundation of lifestyle intervention. Whether treating patients with BMI thresholds for medical or surgical therapy, Dr Davisson makes clear that sustainable outcomes come from a comprehensive, team-based strategy.

Dr Davisson is a professor of medicine at the West Virginia University School of Medicine.

The following transcript has been edited for clarity, style, and length.

Patient Care: To start, can you provide an overview of the most effective pharmacologic approaches currently available for weight loss in patients with obesity?

Laura Davisson, MD: We have a variety of treatment options, ranging from oral medications to newer injectable therapies. The injectable GLP-1 receptor agonists are getting the most attention right now because they’re the most effective, but we do have several options across the spectrum. That’s what I focused on in my talk today—helping clinicians understand the full range of pharmacologic tools available.

Patient Care: What complications are commonly associated with obesity medications, and what strategies do you recommend for managing those side effects?

Laura Davisson, MD: One of the most common issues we see with GLP-1 medications is related to their effect on gastric emptying. They slow it down, which often leads to a sense of fullness, mild nausea, occasional vomiting, and frequently, constipation. These gastrointestinal side effects are the most common ones we manage in our clinic.

Another issue we sometimes hear about is “sulfur burps,” which, while unpleasant, can be managed easily with over-the-counter remedies, dietary adjustments, and simple strategies. The key is to be proactive—educating patients upfront and equipping them with tools to manage symptoms.

Fortunately, most of these side effects improve over time as the body adjusts to the medication. They might return briefly with each dose increase, but they typically resolve again with continued use. More serious complications are possible but rare.

Patient Care: In your presentation at ACP 2025, you discussed several obesity treatment strategies beyond pharmacotherapy, including lifestyle programs and bariatric surgery. Based on your experience, which combination of treatments has shown the most promise?

Laura Davisson, MD: Medications are receiving a lot of attention right now—and rightly so—but it’s important not to overlook bariatric surgery. It’s been around for a long time and still has the strongest data when it comes to both the amount of weight lost and the durability of that weight loss. That said, not every patient wants surgery, and not everyone qualifies for it. But it’s an important tool, especially for patients with a BMI of 40 or higher. I always make sure to mention it to those patients during the initial visit.

At first, many patients are resistant to the idea of surgery. But after trying medical therapy and understanding that tools like medications or surgery can reduce the sense of constantly battling their own biology, many begin to shift their perspective. They come to see obesity as a disease, and with that mindset shift, they often become more open to surgical options down the road.

Medical therapy is a good option for patients with a BMI of 30 and above, or 27 and above if they have weight-related comorbidities. But regardless of whether we’re using medications, surgery, or both, everything rests on a foundation of lifestyle change. Dietary improvements, physical activity, and behavioral strategies are essential components. For some patients, lifestyle alone may be sufficient. For most, combining these foundational changes with pharmacologic or surgical interventions yields the best results.