Article produced in collaboration with Eli Lilly Italia S.p.A
Numbers matter. According to the latest report from the Italian Barometer Obesity Forum (1) of the IBDO (Italian Barometer Diabetes Observatory) Foundation, obesity and overweight have reached global and regional dimensions that warrant new health policies, the development of strategies for innovative care and new drugs.
Research provides opportunities and effective answers. While the management of patients with obesity and overweight must be considered “chronic”, with ongoing, multidisciplinary care sustained by a team of specialists and health professionals (endocrinologist, diabetologist, nutritionist, dietitian, dietician, surgeon, psychologist, hospital nurse), the aim is to guide patients through the treatment journey, enhance engagement, promote adherence, and, therefore, elicit a therapeutic response. This is especially critical for the most vulnerable segments of the condition: maintaining results after weight loss, since patients tend to abandon treatment and risk relapse once the weight is reduced.
Dimensions of the phenomenon
Prevalence is estimated at 10-15% for obesity and about 35% for overweight, implying that in Italy nearly one in every two people struggles with excess weight, with gender differences: obesity is more common in men than in women, with figures alongside overweight that exceed 50%, compared with about 35-40% in women.
However, the 2026 edition of the Italian Barometer Obesity Forum notes an uptick in incidence, i.e., new cases, among young women. A multitude of factors contribute to overweight and obesity: genetics, cultural influences, lifestyle, eating habits, sedentary behavior, physical activity, and income.
High prevalence of obesity in children and adolescents, among the highest in Europe: about one in four people aged 5 to 18, or 25% of the population, has overweight or obesity issues, with peaks between ages 3 and 10 and a higher prevalence in the south of the country than in the north. The social determinants also play a significant role in overweight and obesity: adolescence bullying, for instance, can create barriers to professional and social advancement in adulthood and contribute to prejudice in healthcare settings, where a person with obesity is sometimes labeled as lazier, less reliable, or less determined to solve their problem.
Obesity’s Identikit
«This is a systemic, chronic disease that can affect all organs and tissues— explains Gianluca Perseghin, Professor of Endocrinology at the University of Milan-Bicocca, and director of the Department of Internal Medicine and Rehabilitation at Monza’s Policlinico—associated with a high rate of complications, the best known being cardiovascular disease due to atherosclerosis, such as heart attack and stroke, but also thromboembolic diseases, metabolic disorders including diabetes, certain cancer types, respiratory illnesses such as sleep apnea (OSA), osteoarticular conditions from excessive load on the knees and hips, implications for the reproductive system with more pronounced issues in women due to frequent association with polycystic ovary syndrome. Finally, a very strong link exists between psychiatric disorders and obesity (2). All of these conditions impact quality of life, social and economic aspects: obesity carries high direct costs (medications, visits, tests, hospitalizations) and indirect costs (reduced productivity, diminished performance).»
In Italy, the figure nears 1% of GDP, about 10 billion euros per year (1).
Therapeutic approaches
«Treatment opportunities— continues Perseghin — can be traced to three intervention areas: lifestyle modifications, pharmacotherapy, and bariatric surgery, each supported by solid, evidence-based data (2). These approaches have different indications and effectiveness, with applicability dependent on the severity of obesity, which, as a chronic disease, tends to relapse more when interventions target lifestyle changes alone because they require a radical shift in normal habits and behaviors that are hard to sustain over time (3). Even pharmacotherapy, which aims to increase satiety and blunt the hedonic pleasure of food, is associated with high relapse rates after stopping treatment. A common pattern is seen when patients reach the target weight and then quickly revert to previous eating behaviors. Therefore, there is a need for safe therapies that can be used long-term, with robust protocols (not yet fully validated) for maintaining weight once the therapeutic goal is achieved, developing clinician-focused strategies on how to manage “follow-up” therapy. For example, methods to gradually taper the dose to curb appetite, as well as proper communication and educational approaches to (inform) patients about outcomes and expectations of therapy».
For example, lifestyle changes typically yield a realistic weight loss of 5-8%, achieved by a combination of nutritional intervention to reduce calories and increased physical activity. From clinical trials, to date there is no clear long-term advantage of one dietary pattern over another, whether it be a mimicked fasting approach, low-carbohydrate or low-fat regimes, or a ketogenic diet (4). It should be noted that some nutritional interventions cannot be maintained chronically, risking weight regain. The second approach concerns pharmacologic support, with efficacy that varies depending on the specific drug and the individual patient response.
Anti-obesity drugs
«We now have GLP-1 receptor agonists, peptide drugs represented mainly by Liraglutide, Dulaglutide, Semaglutide, and more recently, Tirzepatide. Tirzepatide is innovative because it simultaneously targets the GLP-1 and GIP (Gastric Inhibitory Peptide or Glucose-dependent Insulinotropic Polypeptide) receptors, with additive effects on weight loss and on glycemic control for people with diabetes, thanks to a synergistic action on both receptors. These drugs act predominantly on the CNS (central nervous system), suppressing hunger and modulating taste and pleasure associated with eating. They also have peripheral effects, slowing gastric emptying and thereby increasing satiety. While both drugs are highly effective, head-to-head studies have shown that Tirzepatide provides some edge in diabetes control and weight reduction» (5,6).
Currently, these are injectable medications, given subcutaneously once a week and requiring titration—starting at a low dose and gradually increasing month by month to mitigate nausea, the most common side effect affecting nearly half of patients, typically self-limiting, though 5-10% must discontinue therapy. Weight loss expectations range from 15-20% over approximately 6-12 months in people with obesity without diabetes, with smaller reductions in those with diabetes.
«The critical issue lies in patients with obesity without diabetes— emphasizes the expert—where it would seem reasonable that, once a therapeutic goal is reached, therapy could be stopped without a high risk of rapid regain. Therefore, it is essential to define common strategies for action and management. The first recommendation is not to discontinue therapy abruptly but to taper the dose gradually, allowing the body to find a new equilibrium, while also engaging the patient more in physical activity or other combined interventions to foster weight maintenance or further reduction».
The therapeutic landscape also includes Oral Semaglutide, with another oral solution, Orforglipron, a synthetic, non-peptide molecule, on the horizon. Finally, Orlistat has been available in Europe for some time as an oral medication (7), known for inhibiting fat absorption and achieving an average weight loss of 5-8%, though it is less favored by patients due to steatorrhea, and the fixed-dose combination naltrexone/bupropion (8), which targets compulsive eating. These latter approaches could be competitive due to lower costs of GLP-1 and GIP therapies, but they are less effective.
Bariatric surgery is proposed for patients with severe obesity with BMI (Body Mass Index) >40 kg/m2 or in the 35-40 range but with complications such as diabetes. The response tends to be higher and longer-lasting than other interventions (9), with the potential for an average weight loss of around 30%, albeit with surgical risk (infections, complications, etc.).
«Often a combination with preoperative pharmacologic therapy is necessary — clarifies the endocrinologist — to reduce body mass and facilitate the surgical procedure or to maintain results postoperatively. Combined approaches are very likely to reshape the future of obesity treatment.
Benefits beyond weight loss
While social media attention has popularized these drugs, originally used to treat diabetes, their positive effects on weight loss are complemented by clear evidence that Liraglutide (10), Dulaglutide (11), Semaglutide (12), and Tirzepatide (13) consistently reduce the risk of cardiovascular disease and slow the progression of kidney disease.
Famous trials include Leader (10), Rewind (11), Sustain-6 (12), SURPASS-CVOT (13) in people with diabetes, and positive data have also emerged with the oral Semaglutide formulation in the SOUL study (14). Studies have also shown a reduced need for osteoarticular surgery (e.g., knee or hip replacement), improvements in obstructive sleep apnea syndrome (16), and reduced risk of liver damage (cirrhosis and fibrosis) (17). Even in people without diabetes, the cardiovascular preventive effect of Semaglutide was confirmed in the SELECT trial (18), and the Tirzepatide SURMOUNT-MMO trial is about to conclude (19). It is important to remember— comments Perseghin — that these trials enrolled patients with a very high cardiovascular risk and often with prior cardiovascular events.
The role of the primary care physician in care delivery
Gianluca Perseghin concludes by stressing the need for multidisciplinary care grounded in trust and empathy between the patient and the managing team, in a collaboration that is meant to last over time. The chronic nature of obesity must accompany the chronic nature of the disease. Building such an alliance is challenging for patients but essential.
«Having a structured, consolidated network to manage people with diabetes and/or obesity, with the family physician coordinating and guiding the patient through the journey, is a decisive factor for therapeutic success» concludes the expert.
References
1. Italian Barometer Obesity Forum 2026, Sala degli Atti Parlamentari, Biblioteca del Senato, July 2026
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Abbonati a Karla Miller
