Obesity Management Comparison Chart

February 2025

The Treatment of Overweight and Obesity (for adults)

Overweight and obesity are complex medical conditions that require multi-disciplinary treatment. In this comparison chart we discuss four treatment options: lifestyle interventions, incretin-based medications, endoscopic gastric remodelling, and metabolic surgery. It is important that these options are not viewed as singular treatment pathways, but rather as tools that may be needed alone or in combination to achieve optimal weight loss. This should be tailored to the individual patient’s body weight and distribution, weight-related disease risk, patient preference and what is available within the local healthcare system.

Lifestyle Interventions (Behavioural modification, diet, and exercise)

Lifestyle modification is the first line of treatment for overweight and obesity and forms the foundation of additional weight loss therapies. Optimal lifestyle modification, including a 500-750 kcal daily deficit, can result in a weight loss of 4-8% of total body weight over one year.^1,2 This should be combined with a minimum of 150 minutes of moderate exercise a week for weight maintenance and 300 minutes of exercise a week for weight loss. Long-term weight loss maintenance can be limited; however, if weight loss is maintained, there are significant improvements in health outcomes, including reductions in blood pressure and blood sugar levels.

Incretin-Based Medications (Liraglutide, Semaglutide, Tirzepatide)

Incretin-based medications, such as glucagon like peptide-1 (GLP-1) receptor agonists (liraglutide, semaglutide) and the dual GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) receptor agonist tirzepatide, are effective pharmacological treatments for obesity. These medications are recommended for average risk patients with a body mass index (BMI) of 30 kg/m² or greater, or 27 kg/m² or greater with weight-related comorbidities, but lower BMIs can be considered for high-risk patients. Incretin-based medications can lead to substantial weight loss, with tirzepatide showing the greatest effect, achieving an average weight loss of 21%.^3–6 Long-term weight loss maintenance with these medications is promising, although ongoing use is necessary to prevent weight regain. Incretin-based medications can reduce rates of diabetes, and reduce the number of blood pressure and cholesterol medications patients require (34% and 21% respectively).⁷ There is also a significant reduction in the risk of cardiovascular disease on these medications. Given the need for continued therapy, and high medication costs, it is relatively expensive when compared to lifestyle modification alone or procedure-based treatments.

Endoscopic Gastric Remodelling (Endoscopic Sleeve Gastroplasty)

Endoscopic sleeve gastroplasty (ESG) is a minimally invasive procedure that reduces the size of the stomach using an endoscope. This procedure is suitable for average risk patients with a BMI of 30 kg/m² or greater, or 27 kg/m² or greater with weight-related comorbidities but lower thresholds can be considered for high-risk individuals. ESG can result in a weight loss of 13% to 16% one year after the procedure and the weight loss is maintained five years after the procedure.^8–10 Up to 92% of patients will see improvement in their diabetes and about half of patients will see improvement in their blood pressure and cholesterol levels.^8,11 Long-term data on weight maintenance and durability of comorbidity improvements are still emerging, but initial results are promising.

Metabolic Surgery (Sleeve Gastrectomy, Roux-en-Y Gastric Bypass)

Metabolic surgery, including sleeve gastrectomy and Roux-en-Y gastric bypass, are surgical procedures that work by altering the stomach and, in the case of a Roux-en-Y gastric bypass, by also altering the path of ingested food through the intestines. The surgeries are recommended for individuals with a BMI of 35 kg/m² or greater, or 30 kg/m² or greater with weight-related comorbidities, but lower BMIs can be considered for high-risk patients. Metabolic surgery can result in a weight loss of 25% to 30% at 12 months, with durable long-term maintenance of weight loss.¹² Rates of improvements in diabetes, blood pressure, and cholesterol are higher than other treatment methods and the improvement in the risk of cardiovascular disease is also better than other treatment methods for overweight and obesity. However, these procedures carry surgical risks and require lifelong follow-up to manage potential complications and nutritional deficiencies.

The choice of treatment for obesity must be personalised based on patient characteristics, patient preferences and availability of treatments. Lifestyle interventions are the foundation of obesity management, while pharmacotherapy, endoscopic procedures, and metabolic surgery offer additional options for achieving and maintaining significant weight loss. A comprehensive approach is essential for effective obesity management.

Below you can download the Comparison Chart - depending on your intended use, we have it available in both A3 and A2 size, and versions best suited for print and digital.