Managing Obesity Like Any Other Chronic Condition, With Alina Elperin, M.D.

Alina Elperin, M.D.

Credit: Forward Focus Concierge Medicine

For millions of Americans, managing weight can feel like a constant uphill battle — one often met with frustration, stigma and confusion. But experts say it’s time to change the conversation. Obesity is not a matter of willpower or discipline; it’s a chronic, complex medical condition that requires thoughtful, long-term management, just like asthma or diabetes. The Educated Patient spoke with Alina Elperin, M.D., a board-certified obesity medicine specialist at Forward Focus Concierge Medicine, to break down what patients should know about the science of obesity, new treatment options like GLP-1 medications and why no one should feel ashamed to seek help.

Many people think obesity is just about willpower or lifestyle. Can you explain why obesity is considered a chronic medical condition?
Alina Elperin, M.D.: Obesity is actually an extremely complex, multifactorial disorder and a chronic disease. It has been recognized as such for quite some time. It often starts with genetics — more than half of people struggling with obesity have at least one family member who does as well. It can even begin in the womb, through what we call epigenetics. The maternal environment — nutrition and exercise habits during pregnancy — can influence a child’s future weight.

Beyond genetics, many factors contribute: diet quality, physical activity, hormone imbalances and even certain medications. Because so many factors play a role, obesity is rarely caused by one thing alone. We also know it’s a chronic, relapsing condition — some people respond well to treatment, but many regain weight over time. This shows why obesity requires lifelong management, just like other chronic diseases.

What are the main treatment options available today for people living with obesity?
AE: Like any chronic disease, obesity treatment includes lifestyle changes, medications, and in some cases, surgical options. There’s no one-size-fits-all approach. Counseling and treatment plans should be individualized — what works for one person may not work for another.

We might start with lifestyle changes and monitor progress. If a patient has already optimized their lifestyle but still struggles, medication can be added. For some with multiple complications, bariatric surgery may be appropriate. The key is that obesity management often involves a combination of approaches tailored to each patient’s needs.

There’s been a lot of attention on new medications like GLP-1s. Who can benefit from them, and are they short- or long-term treatments?
AE: We’ve had U.S. Food and Drug Administration (FDA)-approved anti-obesity medications for decades, though many people didn’t know about them until GLP-1 medications became more common nearly 12 years ago. GLP-1 agonists have truly revolutionized obesity care. They’re the most effective medications currently available, with some — like tirzepatide (Zepbound) — showing up to 20% weight loss in certain patients.

These drugs are generally indicated for adults with a body mass index (BMI) of 30 or higher, or 27 and higher with a weight-related condition such as hypertension, high cholesterol, sleep apnea or type 2 diabetes. However, they aren’t suitable for everyone — patients with a history of pancreatitis or a rare thyroid cancer called medullary thyroid carcinoma should avoid them. For most others, though, they are safe and highly effective for long-term treatment.

What should patients ask their doctor when considering medical obesity treatment?
AE: Weight can be an uncomfortable topic, but it shouldn’t be. Obesity is a chronic disease — no different from asthma or diabetes — and it deserves open discussion and treatment. Patients should feel empowered to tell their doctor, “I’d like help losing weight. What are my options?”

Physicians should approach this without bias, and patients shouldn’t hesitate to bring it up. Understanding that obesity underlies many common health problems, including type 2 diabetes and high blood pressure, makes it an essential part of preventive care.

What advice do you have for patients who feel stigma or shame about seeking medical help for obesity?
AE: This is such an important issue. Many people struggling with obesity have faced stigma — from health care providers, family, or society — and it creates guilt and shame. But obesity is not a disease of willpower. It’s a chronic, multifactorial condition, and no one should feel responsible or ashamed.

Everyone struggles with something — some challenges are just more visible than others. Obesity deserves the same compassion and medical attention as any other chronic illness. If your doctor isn’t addressing your concerns, look for a board-certified obesity medicine specialist. You can find one on the Obesity Medicine Association website. Specialized care can make a huge difference.

This transcript was edited for clarity.