[Changes in obesity management: The clinician's perspective]

Obesity now affects nearly one in five French people, and its prevalence has more than doubled since 1997. It is defined as a chronic, progressive disease responsible for numerous mechanical complications (osteoarthritis, low back pain, incontinence, gastroesophageal reflux disease), metabolic complications (diabetes, fatty liver disease, cardiovascular disease), and psychosocial complications (anxiety, depression, stigmatization), as well as an increased risk of numerous cancers. A new definition, developed in 2025, distinguishes preclinical obesity from clinical obesity by incorporating the Body Mass Index, organs damages and functional limitations, and encourages detailed phenotyping to personalize care. In France, the High Authority for Health (HAS) recommendations (2022, 2024) outline a stepwise care pathway [general practitioner, specialist, Specialized Obesity Center (CSO)] where the goal is not limited to weight but also addresses comorbidities, quality of life, and mobility. The foundation of treatment remains lifestyle modifications (nutrition, physical activity, psychological support) within a therapeutic education framework. Incretin agonists (GLP-1, GLP-1/GIP) are effective second-line pharmacological treatments, resulting on average in over 10% weight loss and a significant improvement in metabolic comorbidities. However, their use is limited by common gastrointestinal side effects, a risk of weight regain upon discontinuation, micronutrient deficiencies, muscle and bone loss, high cost, and often poor adherence in real-world settings. They must therefore be integrated into a comprehensive and sustainable treatment plan focused on nutritional guidance, physical activity, psychological support, and the prevention of deficiencies, in order to optimize long-term benefits beyond weight loss alone.