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Around 13 million Australian adults live with overweight or obesity and almost one-third of adults are obese.
Overweight and obesity are the leading risk factors causing disease burden in Australia. The subsequent cost to the nation is forecast to reach $87.7 billion by 2032.
New weight loss drugs, have created new treatment pathways for doctors and nurse practitioners and have paved the way for more successful outcomes for patients, bridging the gap between diet/exercise and surgery.
The first step in treatment begins with a conversation
“Obesity is the proverbial elephant in the room that most people, both doctors and patients, are reluctant to bring up,” Dr Anita Sharma said.
However, the new popularity of glucagon-like peptide-1 (GLP-1) agonists + gastric inhibitory polypeptide (GIP)/GLP-1 drugs is visible across all types of media and this has given people the confidence to seek treatment.
“Fortunately, the recent hype in the media from celebrities about weight loss drugs and how much success they’ve had and TV programs constantly airing, this has encouraged some to start these conversations themselves,” she said.
Language and non-judgemental communication are essential to put the patient at ease.
“Providing a safe and supportive environment in your consulting room and being non-judgemental fosters trust and encourages patients to actually initiate conversations about their weight,” Dr Sharma said.
Obesity stigma and the importance of language for health care providers
“Most patients who live with being overweight or obese welcome guidance from health care professionals and really want to talk about it, but they’re afraid to bring it up because they have this perceived bias and stigma against them,” Dr Sharma said.
“I think it is very important to use first-person language and use phrases like ‘person living with obesity’, not say obese person or fat person,” Dr Sharma said.
People living with obesity are subject to discrimination due to the stigma surrounding obesity.
“I think one of the most important things I can do is take away that stigma,” said nurse practitioner Jane Overland.
“It really is a medical problem. It’s not a lifestyle problem… we don’t blame people for getting prostate cancer. And yet we do blame people for being overweight or perhaps for getting type 2 diabetes,” she said.
Causes
A person’s genetics will determine whether or not they have a tendency towards obesity. It can be a big relief for patients to know that it’s not all their fault.
“It’s very important to absolve patients of that guilt because traditionally people have said, ‘Oh, you’re just lazy, you just need to eat less, move more’”, Dr Sharma said.
“It’s not just a simple case of calories in, calories out. There’s a strong genetic component to obesity and being overweight, and it can be anything from 40 to 70% accounting for that person’s obesity,” she said.
Dr Sharma always asks patients about their family’s weight.
“I say: ‘What’s your mum like? What are your sisters like? What’s your family like?’ And the minute they say they’ve all been overweight, I go: ‘There you are’ and you almost see a sigh of relief when you say that to patients and they realise: ‘Oh wow, I thought it was all my fault,’” she said.
Evolution, medical conditions and medication can also contribute to obesity.
“Obesity is a complex, biologically driven condition influenced by a variety of factors beyond just diet and exercise,” Dr Gary Kilov said.
“Humankind has evolved and adapted to surviving famine and food insecurity. Our post-scarcity milieu has created a potent obesogenic environment,”Dr Kilov said.
Treatment and benefits
GLP-1 + GIP/GLP-1 drugs have now become important new treatments after many years of different weight loss medications being on the market.
“The graveyard of weight loss medications is full to overflowing. Most agents were either ineffective or unsafe,” Dr Kilov said.
“The gold standard for weight loss medications in 2025 is incretin-based therapies, which have been shown to be highly effective, safe and durable in achieving and maintaining weight loss”, he said.
“We are on the threshold of a new era, equipped with medications that have been developed in response to, and guided by, a much deeper understanding of the pathophysiology of obesity,” he said.
In September last year, the TGA approved tirzepatide, also known by its brand name Mounjaro, for the treatment of overweight and obesity. Being the only registered single agent that activates GIP and GLP-1 receptors, this treatment offers a new option for healthcare practitioners and patients.
“Incretin therapies piggyback on the body’s own energy regulation and satiety pathways. These agents have been shown to have many health benefits beyond weight loss,” Dr Kilov said.
Patients who find their treatment successful report a range of benefits, physical health improvements, greater wellbeing and a feeling like they are winning and empowered.
“So often patients who have commenced medications like tirzepatide will report great satisfaction,” Dr Sharma said.
“Suddenly patients see this ray of hope and they feel they’re in such a good place,” she said.
“They say things like, you know for the first time I felt that I’m actually winning, not only have I lost weight, but I feel so much more in control, empowered and confident,” she said.
“They notice that their knee arthritis pain has gone, patients with diabetes notice their glycaemic control has improved, they have less gastroesophageal reflux” she said.
“For the first time, they can sleep lying down flat. Their blood pressure has dropped, so they sometimes need less medications,” she said.
“So, it’s really a plethora of benefits that patients see and report,” Dr Sharma said.
It’s important to recognise that obesity is a chronic disease. Obesity is a chronic, remitting and relapsing condition. Like other chronic diseases, it is manageable but not curable,” Dr Kilov said.
“As many patients have experienced once weight loss has been achieved, discontinuing the successful intervention may result in inexorable weight regain resulting in weight cycling,” he said.
“As with all chronic, non-communicable diseases, therapeutic interventions need to be optimised for the patient, modified as necessary, and continued in perpetuity to achieve weight loss and avoid weight regain,” Dr Kilov said.
Bariatric surgery vs medication
Historically, bariatric surgery has been the most effective option for severe obesity.
“Surgery still remains the most effective option for severe obesity,” Dr Sharma said.
“Medications like tirzepatide offer significant weight loss – up to 23% – and may reduce the need for bariatric surgery in some cases,” Dr Sharma said.
“Whilst these agents are highly effective, there remains a gap between the weight loss efficacy of surgery and incretin therapies,” Dr Kilov said.
“It should be noted however that there is significant heterogeneity in response to both surgery and incretin therapy,” he said.
“Irrespective of the initially chosen therapy, when intensification of weight loss treatments is called for, bariatric surgery and incretin therapies can be used in combination,” Dr Kilov said.
Safety
The new weight loss medications have undergone rigorous testing. However, long term monitoring for potential side effects will be important.
“Current incretin therapies undergo extensive evaluation in multiple clinical trials designed to establish their efficacy, tolerability and safety,” Dr Kilov said.
“These are by far the most closely scrutinised of all our weight loss medications to date,” he said.
“Drugs like tirzepatide have been in many trials and we’ve had so many patients be on them and now we’ve had worldwide experience that they are relatively safe drugs if chosen correctly for the right patient,” Dr Sharma said.
Patients can manage common side effects themselves with advice from their treating health care practitioner.
“You just need to follow a system of making sure there’s no contraindication, combined with proper advice to the patient on what and what not to do,” Dr Sharma said.
“These can be overcome by having small meals, avoiding fatty foods, avoiding alcohol, have enough fluid and advise how to manage other effects like constipation,” she said.
Measuring obesity
While body mass index (BMI) has been a traditional tool for measuring overweight and obesity, it has its shortfalls.
“The BMI of an individual informs us about how big that person is but not how sick they are. To assess the severity of clinical obesity, various tools have been developed, such as the Edmonton Obesity Staging System,” Dr Kilov said.
“Recently, The Lancet diabetes and endocrinology commission on clinical obesity published the most recent incarnation on guidelines to diagnose and optimally manage clinical obesity,” he said.
“Tools such as these are needed to supplement the data from scales and tape measures,” Dr Kilov said.
Multidisciplinary team
With GPs and health care practitioners like endocrinologists being time poor, nurse practitioners can spend more time with patients and are an important part of the multidisciplinary team for treating obesity.
Nurse practitioner Jane Overland sees patients who have been referred to her by their GP or through other recommendations.
“I think we can get to spend a lot more time with patients. We’re not quite as pressured as our medical counterparts,” Ms Overland said,
“It’s about providing support and education, which can be done by GP or an endocrinologist. But you’d like to think that we’re freeing up some of their time so that they can worry about more complex medical issues,” she said.
Obesity is a complex, chronic disease that can be successfully treated with surgery and/ or new GLP1 agonists medications like tirzepatide. These new weightloss drugs have helped people to lose weight, with associated health benefits, including a feeling of greater wellbeing and better sleep. Treatment starts with a supportive conversation with a Health Care Practitioner, who can explain the causes of obesity are related to genetics and a complex mix of factors. Conversations like these can help cut through the stigma surrounding obesity, and help patients make informed decisions about their weight loss journey. Support, education and medication create successful outcomes for patients.
Dr Jane Overland is one of Australia’s leading nurse practitioners in the field of diabetes and is based in Sydney.
Associate Professor Gary Kilov is a General Practitioner based in Launceston. He has a keen interest in chronic disease management including diabetes and obesity.
Dr Anita Sharma is the Medical Director and founder of Platinum Medical Centre – a multi doctor, holistic family practice in Brisbane. Dr Sharma has high level of expertise in the management of Type 2 Diabetes and Obesity.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.