Weight management is a lifelong journey

Losing weight and keeping it off requires proper nutrition, lifestyle interventions, exercise, and in some cases, medication or surgical management.

Weight loss is often framed as a short-term goal. However, we know this is a chronic, relapsing condition that needs long-term management and support. As a bariatric nurse practitioner, and bariatric patient, I approach weight management with both clinical expertise and with personal understanding. The most effective strategies are rooted in evidence, individualized care, and compassion.

Understanding obesity as a chronic disease

Obesity is a complex, multifactorial disease influenced by genetics, hormonal regulation, environment, food resources, and behavior. Research consistently shows that the human body actively resists weight loss.

Changes that occur as weight reduces include decreased resting metabolic rate (a slower metabolism), increased hunger hormones, and fewer signals indicating fullness and satisfaction. These biological responses to weight loss are the reason why the disease of obesity and overweight is chronic in nature and requires long-term treatment and support. 

Nutrition strategies

There is no single “best” diet for everyone. Key dietary strategies include portion control, reduction or elimination of processed foods and added sugar, increased fruit and vegetable intake, along with caloric restriction. Recommendations for caloric restriction to assist in weight loss is around 1,200-1,500 kcal/day for women, and 1,500-1,800 for men. Food choices should include adequate fiber intake to help you feel full longer and improve metabolic health in conjunction with high protein intake to preserve lean muscle mass.

Some of the best evidence-based dietary recommendations include the Mediterranean and DASH diets — but should be individualized to each patient based on metabolic risk and likelihood of long-term adherence. Sustainable weight loss and nutrition should focus on consistency. 

Are weight loss medications right for you?

Anti-obesity medications may be recommended for certain patients who have a Body Mass Index of 30 or higher or who have a BMI of 27 or higher with weight-related comorbidities when lifestyle modifications alone are inadequate.

Medication therapy can sometimes improve feelings of fullness after eating, thus reducing caloric intake, and some can help support improved metabolic regulation. There are many types of medications that reduce obesity when combined with lifestyle and dietary modifications, which include the well-known GLP-1 “shots.”

Among these, tirzepatide and semaglutide demonstrate the greatest efficacy. Tirzepatide produces a mean weight loss of 11.69% (with high-certainty evidence showing superiority), while semaglutide achieves 8.48-11.40% weight loss while on the medication.

It is important to note, studies have shown that discontinuing medications at goal weight typically leads to weight regain, so continued use of these medications is generally recommended for weight maintenance when lifestyle interventions alone are inadequate.

The benefits of bariatric surgery

Bariatric surgery is a powerful tool, not a last resort in weight loss. Surgery remains the most effective long-term treatment for severe obesity. It has been shown to lead to sustained long-term weight loss, improvement or remission of conditions like Diabetes Mellitus Type 2, hypertension and sleep apnea.

The two most common procedures include sleeve gastrectomy and gastric bypass. However, keep in mind that surgery is not “the easy way out.” It is simply a tool that requires life-long changes in nutrition, activity, and follow-up care. 

Making a commitment to weight loss

Sustainable weight loss and maintenance require more than motivation, it requires understanding, commitment, and evidence-based support. As both a provider, and a patient, I have seen firsthand that success is not defined by perfection, but consistency, adaptability, and utilization of the right tools. Weight loss is not a short-term goal; it is lifelong care. 

Ashley Childs, DNP, FNP-BC, is a family nurse practitioner specializing in bariatric services at MountainView Medical Group - Wellness and Weight Loss Center