Obesity Care
Obesity & Weight Loss
Medically supervised weight management — including GLP-1 therapy — with a whole-health approach.
Obesity is a chronic, treatable medical condition — not a matter of willpower. As endocrinologists, we treat the biology behind it: the hormones and metabolism that regulate appetite, weight, and fat storage. Excess weight also drives insulin resistance, type 2 diabetes, fatty liver, high blood pressure, and cardiovascular disease, so effective treatment protects far more than the number on the scale.
Our approach is individualized and evidence-based: a thorough metabolic evaluation, nutrition and activity guidance, and — when appropriate — medical weight-management options including GLP-1 and dual-agonist therapies (such as semaglutide and tirzepatide) that produce substantial, durable weight loss. Because obesity and metabolic health are intertwined, care is coordinated with our Diabetes & Metabolic Health program.
Obesity and lipedema are different conditions and often coexist. Weight management improves overall health and metabolic disease, but lipedema fat does not respond to diet and weight loss the way ordinary fat does — which is why accurate diagnosis matters.
Understanding Obesity
What is obesity?
Obesity is a chronic, relapsing medical disease in which excess body fat harms health. It is defined most simply by a body mass index (BMI) of 30 or higher, but it is fundamentally a disorder of the hormones and metabolism that regulate appetite, energy, and fat storage — not a failure of willpower.
How is obesity measured?
BMI (weight relative to height) is the starting point: 25–29.9 is overweight, 30 or above is obesity, and 40 or above is severe obesity. Because BMI does not distinguish muscle from fat or show where fat sits, we also use waist circumference (risk rises above about 35 inches in women and 40 inches in men) and, when helpful, body-composition measurement to assess visceral fat and muscle mass.
What causes obesity?
Obesity has strong biological roots. Genetics influence your resting metabolism and how your brain regulates hunger and fullness through hormones such as leptin, ghrelin, and GLP-1. On top of that, an environment of calorie-dense food, physical inactivity, poor sleep, and chronic stress promotes weight gain. Certain medications (some antidepressants, antipsychotics, steroids, and older diabetes drugs) and medical conditions (hypothyroidism, Cushing’s syndrome, PCOS) can also drive it.
Is obesity really a disease?
Yes. The body defends its fat stores through powerful hormonal and neural signals, which is why weight lost through willpower alone is so often regained. Understanding obesity as a chronic disease is what makes effective, lasting medical treatment possible.
Why Obesity Matters: Health Impact
What health problems does obesity cause?
Excess weight raises the risk of type 2 diabetes and insulin resistance, fatty liver disease (MASLD), high blood pressure, abnormal cholesterol, heart disease and stroke, obstructive sleep apnea, osteoarthritis, acid reflux, gallstones, PCOS and fertility problems, and several cancers. Severe obesity can shorten life expectancy — but effective treatment reverses much of this risk.
How is obesity connected to diabetes and metabolic disease?
Excess fat, especially around the abdomen and liver, is a major driver of insulin resistance — the root of prediabetes, type 2 diabetes, fatty liver, and abnormal cholesterol. Treating obesity often improves or reverses these conditions, which is why we manage weight and metabolic health together with our diabetes and metabolic care.
How much weight loss makes a difference?
A great deal. Losing just 5–10% of body weight meaningfully improves blood pressure, blood sugar, cholesterol, fatty liver, and sleep apnea. Losing 15% or more can push type 2 diabetes into remission and reverse fatty liver in many people.
How We Evaluate Obesity
What does an obesity evaluation involve?
We start with a detailed history — your weight over time, previous attempts, eating and activity patterns, sleep, stress, medications, and family history — followed by a focused exam. Laboratory testing typically includes A1c and glucose, a lipid panel, a comprehensive metabolic panel, liver tests, and thyroid function, with additional hormone testing when indicated. We also screen for complications such as fatty liver and sleep apnea.
Will you look for a hormonal cause?
Yes — and this is a key advantage of seeing an endocrinologist. We identify and treat hormonal contributors such as thyroid disease, Cushing’s syndrome, and PCOS, and we review any medications that may be promoting weight gain before building your plan.
Treatment: A Multimodal, Individualized Plan
How is obesity treated?
There is no single fix. The best results come from combining approaches — lifestyle and nutrition, medication, and, when appropriate, surgery — tailored to your biology, health, and goals. Our aim is durable improvement in your health, not just a number on the scale.
Lifestyle & Nutrition
What lifestyle changes help?
Sustainable nutrition (not crash dieting), regular physical activity that includes strength training, better sleep, and behavioral support form the foundation of every plan. We set realistic, individualized targets rather than short-term fixes.
Do I have to do this on my own?
No. We provide structured guidance and regular follow-up, and this foundation makes every other treatment — including medication and surgery — work better and last longer.
Medication (GLP-1 and Other Options)
Who is a candidate for weight-loss medication?
Medication is generally appropriate at a BMI of 30 or higher, or 27 or higher with a weight-related condition such as type 2 diabetes, prediabetes, high blood pressure, abnormal cholesterol, sleep apnea, or fatty liver. It is always used alongside lifestyle changes.
What medications are available?
The most effective are the GLP-1 and combined GIP/GLP-1 receptor agonists — semaglutide (Wegovy) and tirzepatide (Zepbound), along with liraglutide (Saxenda). These mimic natural gut hormones so you feel full sooner and stay satisfied longer. Additional options include phentermine, phentermine-topiramate, naltrexone-bupropion, and orlistat. We match the medication to your health profile.
How much weight can I expect to lose?
On average, with lifestyle support, liraglutide produces roughly 5–8% weight loss, semaglutide around 15%, and tirzepatide around 20%. Individual results vary.
How are they taken?
Most are self-administered injections given weekly (or daily) with a simple pen, with the dose increased gradually over weeks to limit side effects. Some oral options are also available.
What are the side effects?
Side effects are mainly digestive — nausea, early fullness, or constipation — and usually ease as the dose is raised slowly. We monitor you throughout treatment to keep therapy comfortable and safe.
How long will I take medication?
Because obesity is a chronic disease, medication is typically long-term. If it is stopped, appetite and weight often return, so we plan for maintenance from the start.
Muscle Loss and Sarcopenia
What is sarcopenia?
Sarcopenia is the progressive loss of muscle mass and strength. Muscle is central to metabolism, mobility, and healthy aging, so protecting it is an important part of weight management.
Why is muscle a concern with weight-loss treatment?
Rapid weight loss from any cause — GLP-1 medications, very-low-calorie diets, or bariatric surgery — removes fat and muscle together. Without attention, up to a quarter or more of the weight lost can be lean tissue. Preserving muscle keeps your metabolism higher and protects strength and function.
How do we protect muscle during weight loss?
Three things matter most: adequate protein intake, regular resistance (strength) training, and a steady rather than extreme rate of weight loss. We build these into every plan and monitor as needed — particularly in older adults and during medication or post-surgical weight loss.
Bariatric Surgery (When Appropriate)
When is weight-loss surgery considered?
Surgery is an option for severe obesity — generally a BMI of 40 or higher, or 35 or higher with a serious weight-related condition — when other treatments have not achieved enough benefit. It is an individualized decision made together.
What procedures are used?
The most common are sleeve gastrectomy and Roux-en-Y gastric bypass, which reduce stomach size and favorably change gut hormones. The older gastric band is now rarely used.
Do you perform surgery?
We are a medical endocrinology practice and do not perform bariatric surgery. What we do is evaluate whether surgery is right for you, optimize your health before and after the procedure, coordinate referral to an experienced bariatric surgeon, and provide the long-term metabolic and nutritional follow-up that surgery requires.
