FROM LIFESTYLE INTERVENTIONS TO BARIATRIC SURGERY: AN OVERVIEW OF OBESITY TREATMENT MODALITIES

Krzysztof Jamroch; Aleksandra Marek; Katarzyna Garncarz; Karolina Dziki; Wiktoria Dybizbańska; Zofia Nowakowska; Agnieszka Burzej; Mateusz Kacalak; Maciej Komenda; Julia Szklarska-Komenda

doi:10.31435/ijitss.4(48).2025.4420

Authors

Krzysztof Jamroch 5th Military Clinical Hospital with Polyclinic SPZOZ, Wrocławska 1-3, 30-901 Kraków, Poland https://orcid.org/0009-0003-2562-1276
Aleksandra Marek Central Teaching Hospital of the Medical University of Lodz, Pomorska 251, 92-213 Łódź, Poland https://orcid.org/0009-0002-3391-5082
Katarzyna Garncarz 5th Military Clinical Hospital with Polyclinic SPZOZ, Wrocławska 1-3, 30-901 Kraków, Poland https://orcid.org/0009-0001-7554-2715
Karolina Dziki 5th Military Clinical Hospital with Polyclinic SPZOZ, Wrocławska 1-3, 30-901 Kraków, Poland https://orcid.org/0009-0005-1720-3810
Wiktoria Dybizbańska Independent Public Healthcare Institution of the Ministry of the Inferior and Administration in Kraków https://orcid.org/0009-0000-9899-7272
Zofia Nowakowska Upper Silesian Medical Center of the Medical University of Silesia in Katowice, Ziołowa 45/47, 40-635 Katowice, Poland https://orcid.org/0009-0000-8030-7341
Agnieszka Burzej 5th Military Clinical Hospital with Polyclinic SPZOZ, Wrocławska 1-3, 30-901 Kraków, Poland https://orcid.org/0009-0003-0066-3197
Mateusz Kacalak The Nicolaus Copernicus Provincial Multispecialty Center for Oncology and Traumatology in Łódź, ul. Pabianicka 62, 93-513 Łódź, Poland https://orcid.org/0009-0006-3386-0906
Maciej Komenda 105th Military Hospital SP ZOZ in Żary, ul. Domańskiego 2, 68-200 Żary, Poland https://orcid.org/0009-0009-7327-417X
Julia Szklarska-Komenda 105th Military Hospital SP ZOZ in Żary, ul. Domańskiego 2, 68-200 Żary, Poland https://orcid.org/0009-0000-9914-4917

DOI:

https://doi.org/10.31435/ijitss.4(48).2025.4420

Keywords:

Obesity, Weight Loss, Bariatric Surgery, Tirzepatide, Diabetes

Abstract

Obesity is a chronic, multifactorial disease associated with serious metabolic, cardiovascular, psychological, and socioeconomic consequences. This review aims to synthesize current evidence on the contemporary treatment strategies for obesity: lifestyle interventions, pharmacotherapy, endoscopic therapies, and bariatric surgery.

Our findings indicate, that obesity develops through the interaction of genetic, metabolic, behavioral, and environmental factors, making simple lifestyle-based approaches insufficient for many patients. While multi-component lifestyle interventions remain the foundation of therapy, their long-term effectiveness is limited. The effectiveness strongly depends on patient’s involvement, usually fluctuating between 2.4% and 10.8% of reduced total body weight per year. Modern drugs are the second stage of treatment. According to our results, the most effective is tirzepatide - dual incretin agonist - that demonstrates weight loss outcomes averaging up to 25.3% in 88 weeks follow-up. The next step of managing obesity is endoscopic treatment, that provide profound efficacy with favorable safety profiles. For example, endoscopically inserted intragastric balloons can lead to an average weight loss of around 25% within 12 months. Endoscopic methods seem to be a promising alternative for patients who are unwilling or unsuitable for surgical interventions. The most effective and durable treatment from many years remains bariatric surgery, offering substantial weight reduction and improvement in comorbidities. The most commonly performed is laparoscopic sleeve gastrectomy, averaging 35.14% total body weight loss after one year. However, we should remember that bariatric surgery also carries the highest risk of serious complications and it is the most invasive of all available obesity treatment methods.

References

Abbott, S., Smith, E., Tighe, B., & Lycett, D. (2021). Group versus one-to-one multi-component lifestyle interventions for weight management: a systematic review and meta-analysis of randomised controlled trials. Journal of Human Nutrition and Dietetics, 34(3), 485–493. https://doi.org/10.1111/jhn.12853

Angrisani, L., Santonicola, A., Iovino, P., Palma, R., Kow, L., Prager, G., Ramos, A., & Shikora, S. (2024). IFSO Worldwide Survey 2020–2021: Current Trends for Bariatric and Metabolic Procedures. Obesity Surgery, 34(4), 1075–1085. https://doi.org/10.1007/s11695-024-07118-3

Aronne, L. J., Sattar, N., Horn, D. B., Bays, H. E., Wharton, S., Lin, W.-Y., Ahmad, N. N., Zhang, S., Liao, R., Bunck, M. C., Jouravskaya, I., Murphy, M. A., Investigators, S.-4, Fretes, J. O., Coronel, M. J., Gutnisky, L. L., Frechtel, G. D., Gelersztein, E., Aizenberg, D., … Nardandrea, J. P. (2024). Continued Treatment With Tirzepatide for Maintenance of Weight Reduction in Adults With Obesity: The SURMOUNT-4 Randomized Clinical Trial. JAMA, 331(1), 38–48. https://doi.org/10.1001/JAMA.2023.24945

Caklili, O. T., Cesur, M., Mikhailidis, D. P., & Rizzo, M. (2023). Novel Anti-obesity Therapies and their Different Effects and Safety Profiles: A Critical Overview. In Diabetes, Metabolic Syndrome and Obesity (Vol. 16, pp. 1767–1774). Dove Medical Press Ltd. https://doi.org/10.2147/DMSO.S392684

Chen, Y., Ma, L., Han, Z., & Xiong, P. (2024). The global burden of disease attributable to high body mass index in 204 countries and territories: Findings from 1990 to 2019 and predictions to 2035. Diabetes, Obesity and Metabolism, 26(9), 3998–4010. https://doi.org/10.1111/DOM.15748;SUBPAGE:STRING:ACCESS

Dominguez, L. J., Veronese, N., Di Bella, G., Cusumano, C., Parisi, A., Tagliaferri, F., Ciriminna, S., & Barbagallo, M. (2023). Mediterranean diet in the management and prevention of obesity. Experimental Gerontology, 174, 112121. https://doi.org/10.1016/J.EXGER.2023.112121

Fayad, L., Adam, A., Schweitzer, M., Cheskin, L. J., Ajayi, T., Dunlap, M., Badurdeen, D. S., Hill, C., Paranji, N., Lalezari, S., Kalloo, A. N., Khashab, M. A., & Kumbhari, V. (2019). Endoscopic sleeve gastroplasty versus laparoscopic sleeve gastrectomy: a case-matched study. Gastrointestinal Endoscopy, 89(4), 782–788. https://doi.org/10.1016/j.gie.2018.08.030

Foster-Schubert, K. E., Alfano, C. M., Duggan, C. R., Xiao, L., Campbell, K. L., Kong, A., Bain, C. E., Wang, C. Y., Blackburn, G. L., & Mctiernan, A. (2012). Effect of diet and exercise, alone or combined, on weight and body composition in overweight-to-obese postmenopausal women. Obesity, 20(8), 1628–1638. https://doi.org/10.1038/oby.2011.76

Friedenreich, C. M., Ryder-Burbidge, C., & McNeil, J. (2021). Physical activity, obesity and sedentary behavior in cancer etiology: epidemiologic evidence and biologic mechanisms. In Molecular Oncology (Vol. 15, Issue 3, pp. 790–800). John Wiley and Sons Ltd. https://doi.org/10.1002/1878-0261.12772

Galindo, R. J., Cheng, A. Y. Y., Longuet, C., Minrong, ·, Tamer Coskun, A. ·, Malik, R., Peleshok, J., Levine, J. A., Dunn, J. P., Galindo, R. J., Cheng, A. Y. Y., Longuet, C., Ai, M., Coskun, · T, Malik, · R, Peleshok, · J, Levine, J. A., & Dunn, · J P. (2025). Insights into the Mechanism of Action of Tirzepatide: A Narrative Review. Diabetes Therapy 2025, 1–22. https://doi.org/10.1007/S13300-025-01804-W

Hany, M., Zidan, A., Ibrahim, M., Sabry, A., Agayby, A. S. S., Mourad, M., & Torensma, B. (2024). Revisional One-Step Bariatric Surgical Techniques After Unsuccessful Laparoscopic Gastric Band: A Retrospective Cohort Study with 2-Year Follow-up. Obesity Surgery, 34(3), 814–829. https://doi.org/10.1007/s11695-023-07039-7

Hong, S., Kim, W. J., Kang, E. S., Jeong, I. K., Kim, C. H., Lee, K. Y., Kim, S., Oh, S. J., & Lee, C. B. (2025). Evaluation of the efficacy and safety of controlled-release phentermine/topiramate in adults with obesity in Korea: A randomized, double-blind, placebo-controlled, phase 4 trial (QUEEN’s study). Diabetes, Obesity and Metabolism, 27(3), 1242–1250. https://doi.org/10.1111/dom.16119

Janik, M. R., Sroczyński, P., & Major, P. (2024). Bariatric surgery in Poland, 2023: growth, trends, and impact of the KOS-BAR program. Wideochirurgia I Inne Techniki Maloinwazyjne, 19(4), 454–459. https://doi.org/10.20452/wiitm.2024.17913

Jayedi, A., Soltani, S., Emadi, A., Zargar, M. S., & Najafi, A. (2024). Aerobic Exercise and Weight Loss in Adults: A Systematic Review and Dose-Response Meta-Analysis. JAMA Network Open, 7(12), e2452185. https://doi.org/10.1001/JAMANETWORKOPEN.2024.52185

Jokela, M., & Laakasuo, M. (2023). Obesity as a causal risk factor for depression: Systematic review and meta-analysis of Mendelian Randomization studies and implications for population mental health. Journal of Psychiatric Research, 163, 86–92. https://doi.org/10.1016/J.JPSYCHIRES.2023.05.034

Karagul, S., Senol, S., Karakose, O., Uzunoglu, K., & Kayaalp, C. (2024). One Anastomosis Gastric Bypass versus Roux-en-Y Gastric Bypass: A Randomized Prospective Trial. Medicina (Lithuania), 60(2). https://doi.org/10.3390/medicina60020256

Kim, A., Nguyen, J., Babaei, M., Kim, A., Geller, D. H., & Vidmar, A. P. (2023). A Narrative Review: Phentermine and Topiramate for the Treatment of Pediatric Obesity. Adolescent Health, Medicine and Therapeutics, Volume 14, 125–140. https://doi.org/10.2147/ahmt.s383454

Lei, X. G., Ruan, J. Q., Lai, C., Sun, Z., & Yang, X. (2021). Efficacy and Safety of Phentermine/Topiramate in Adults with Overweight or Obesity: A Systematic Review and Meta-Analysis. Obesity, 29(6), 985–994. https://doi.org/10.1002/oby.23152

Lin, X., & Li, H. (2021). Obesity: Epidemiology, Pathophysiology, and Therapeutics. Frontiers in Endocrinology, 12. https://doi.org/10.3389/FENDO.2021.706978

Liu, Y., Han, F., Xia, Z., Sun, P., Rohani, P., Amirthalingam, P., & Sohouli, M. H. (2024). The effects of bupropion alone and combined with naltrexone on weight loss: a systematic review and meta-regression analysis of randomized controlled trials. Diabetology and Metabolic Syndrome, 16(1). https://doi.org/10.1186/s13098-024-01319-7

Lopez, P., Taaffe, D. R., Galvão, D. A., Newton, R. U., Nonemacher, E. R., Wendt, V. M., Bassanesi, R. N., Turella, D. J. P., & Rech, A. (2022). Resistance training effectiveness on body composition and body weight outcomes in individuals with overweight and obesity across the lifespan: A systematic review and meta-analysis. In Obesity Reviews (Vol. 23, Issue 5). John Wiley and Sons Inc. https://doi.org/10.1111/obr.13428

Madigan, C. D., Graham, H. E., Sturgiss, E., Kettle, V. E., Gokal, K., Biddle, G., Taylor, G. M. J., & Daley, A. J. (2022). Effectiveness of weight management interventions for adults delivered in primary care: systematic review and meta-analysis of randomised controlled trials. The BMJ, 377, e069719. https://doi.org/10.1136/BMJ-2021-069719

Masry, M. A. M. El, & Fiky, M. A. M. El. (2023). Long-Term Outcome of Laparoscopic Sleeve Gastrectomy (LSG) on Weight Loss in Patients with Obesity: a 5-Year and 11-Year Follow-Up Study. Obesity Surgery, 33(10), 3147–3154. https://doi.org/10.1007/s11695-023-06781-2

McClelland, P. H., Jawed, M., Kabata, K., Zenilman, M. E., & Gorecki, P. (2023). Long-term outcomes following laparoscopic Roux-en-Y gastric bypass: weight loss and resolution of comorbidities at 15 years and beyond. Surgical Endoscopy 2023 37:12, 37(12), 9427–9440. https://doi.org/10.1007/S00464-023-10366-6

Obesity and overweight. (n.d.). Retrieved November 21, 2025, from https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight

O’Brien, P. E., Hindle, A., Brennan, L., Skinner, S., Burton, P., Smith, A., Crosthwaite, G., & Brown, W. (2019). Long-Term Outcomes After Bariatric Surgery: a Systematic Review and Meta-analysis of Weight Loss at 10 or More Years for All Bariatric Procedures and a Single-Centre Review of 20-Year Outcomes After Adjustable Gastric Banding. Obesity Surgery, 29(1), 3–14. https://doi.org/10.1007/S11695-018-3525-0

Onakpoya, I. J., Lee, J. J., Mahtani, K. R., Aronson, J. K., & Heneghan, C. J. (2020). Naltrexone–bupropion (Mysimba) in management of obesity: A systematic review and meta-analysis of unpublished clinical study reports. In British Journal of Clinical Pharmacology (Vol. 86, Issue 4, pp. 646–667). John Wiley and Sons Inc. https://doi.org/10.1111/bcp.14210

Onzi, T. R., Salgado Júnior, W., Bastos, E. L. de S., Dantas, A. C. B., Silva, L. B., Oliveira Neto, A. A. de, Tristão, L. S., Santos, C. L. Dos, Bernardo, W. M., & Chavez, M. P. (2024). EFFICACY AND SAFETY OF ONE ANASTOMOSIS GASTRIC BYPASS IN SURGICAL TREATMENT OF OBESITY: SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS. In Arquivos Brasileiros de Cirurgia Digestiva (Vol. 37). Colegio Brasileiro de Cirurgia Digestiva. https://doi.org/10.1590/0102-6720202400021e1814

Patel, J. P., Hardaswani, D., Patel, J., Saiyed, F., Goswami, R. J., Saiyed, T. I., Patel, H., & Amin, T. H. (2025). Comparative Effectiveness of Semaglutide, Liraglutide, Orlistat, and Phentermine for Weight Loss in Obese Individuals: A Systematic Review. Cureus, 17(3), e80321. https://doi.org/10.7759/CUREUS.80321

Peri, K., & Eisenberg, M. (2024). Review on obesity management: bariatric surgery. BMJ Public Health, 2(2), e000245. https://doi.org/10.1136/BMJPH-2023-000245

Qureshi, H., Saeed, N., & Jovani, M. (2023). Updates in Endoscopic Bariatric and Metabolic Therapies. Journal of Clinical Medicine 2023, Vol. 12, Page 1126, 12(3), 1126. https://doi.org/10.3390/JCM12031126

Robert, M., Espalieu, P., Pelascini, E., Caiazzo, R., Sterkers, A., Khamphommala, L., Poghosyan, T., Chevallier, J. M., Malherbe, V., Chouillard, E., Reche, F., Torcivia, A., Maucort-Boulch, D., Bin-Dorel, S., Langlois-Jacques, C., Delaunay, D., Pattou, F., & Disse, E. (2019). Efficacy and safety of one anastomosis gastric bypass versus Roux-en-Y gastric bypass for obesity (YOMEGA): a multicentre, randomised, open-label, non-inferiority trial. The Lancet, 393(10178), 1299–1309. https://doi.org/10.1016/S0140-6736(19)30475-1

Rodrigo-Carbó, C., Madinaveitia-Nisarre, L., Pérez-Calahorra, S., Gracia-Rubio, I., Cebollada, A., Galindo-Lalana, C., Mateo-Gallego, R., & Lamiquiz-Moneo, I. (2025). Low-calorie, high-protein diets, regardless of protein source, improve glucose metabolism and cardiometabolic profiles in subjects with prediabetes or type 2 diabetes and overweight or obesity. Diabetes, Obesity and Metabolism, 27(1), 268–279. https://doi.org/10.1111/DOM.16013

Rubino, F., Cummings, D. E., Eckel, R. H., Cohen, R. V., Wilding, J. P. H., Brown, W. A., Stanford, F. C., Batterham, R. L., Farooqi, I. S., Farpour-Lambert, N. J., le Roux, C. W., Sattar, N., Baur, L. A., Morrison, K. M., Misra, A., Kadowaki, T., Tham, K. W., Sumithran, P., Garvey, W. T., … Mingrone, G. (2025). Definition and diagnostic criteria of clinical obesity. The Lancet Diabetes & Endocrinology, 13(3), 221–262. https://doi.org/10.1016/S2213-8587(24)00316-4

Safaei, M., Sundararajan, E. A., Driss, M., Boulila, W., & Shapi’i, A. (2021). A systematic literature review on obesity: Understanding the causes & consequences of obesity and reviewing various machine learning approaches used to predict obesity. Computers in Biology and Medicine, 136, 104754. https://doi.org/10.1016/J.COMPBIOMED.2021.104754

Sallam, M., Snygg, J., Ghandour, S. El, & Sallam, M. (2025). Efficacy and Safety of Tirzepatide for Weight Management in Non-Diabetic Obese Individuals: A Narrative Review. Obesities 2025, Vol. 5, Page 26, 5(2), 26. https://doi.org/10.3390/OBESITIES5020026

Shi, Q., Wang, Y., Hao, Q., Vandvik, O., Guyatt, G., Li, J., Chen, Z., Xu, S., Shen, Y., Ge, L., Sun, F., Li, L., Yu, J., Nong, K., Zou, X., Zhu, S., Wang, C., Zhang, S., Qiao, Z., … Li, S. (n.d.). Articles Pharmacotherapy for adults with overweight and obesity: a systematic review and network meta-analysis of randomised controlled trials. In www.thelancet.com. https://magicevidence.org/

Singh, S., Bazarbashi, A. N., Khan, A., Chowdhry, M., Bilal, M., de Moura, D. T. H., Jirapinyo, P., Thakkar, S., & Thompson, C. C. (2021). Primary obesity surgery endoluminal (POSE) for the treatment of obesity: a systematic review and meta-analysis. Surgical Endoscopy, 36(1), 252. https://doi.org/10.1007/S00464-020-08267-Z

Weitzner, Z. N., Phan, J., Begashaw, M. M., Mak, S. S., Booth, M. S., Shekelle, P. G., Maggard-Gibbons, M., & Girgis, M. D. (2023). Endoscopic therapies for patients with obesity: a systematic review and meta-analysis. Surgical Endoscopy 2023 37:11, 37(11), 8166–8177. https://doi.org/10.1007/S00464-023-10390-6

Westbury, S., Oyebode, O., van Rens, T., & Barber, T. M. (2023). Obesity Stigma: Causes, Consequences, and Potential Solutions. Current Obesity Reports, 12(1), 10. https://doi.org/10.1007/S13679-023-00495-3

Wharton, S., Kamran, E., Thabane, L., Yin, P., & Christensen, R. (2025). The real-world relationship between naltrexone/bupropion treatment and weight loss in Canada: A retrospective chart review. Clinical Obesity, 15(2). https://doi.org/10.1111/cob.12724

Wharton, S., Lau, D. C. W., Vallis, M., Sharma, A. M., Biertho, L., Campbell-Scherer, D., Adamo, K., Alberga, A., Bell, R., Boulé, N., Boyling, E., Brown, J., Calam, B., Clarke, C., Crowshoe, L., Divalentino, D., Forhan, M., Freedhoff, Y., Gagner, M., … Wicklum, S. (2020). Obesity in adults: a clinical practice guideline. CMAJ : Canadian Medical Association Journal = Journal de l’Association Medicale Canadienne, 192(31), E875–E891. https://doi.org/10.1503/CMAJ.191707

Wong, H. J., Sim, B., Teo, Y. H., Teo, Y. N., Chan, M. Y., Yeo, L. L. L., Eng, P. C., Tan, B. Y. Q., Sattar, N., Dalakoti, M., & Sia, C. H. (2025). Efficacy of GLP-1 Receptor Agonists on Weight Loss, BMI, and Waist Circumference for Patients With Obesity or Overweight: A Systematic Review, Meta-analysis, and Meta-regression of 47 Randomized Controlled Trials. Diabetes Care, 48(2), 292–300. https://doi.org/10.2337/DC24-1678

Zhang, X., Ha, S., Lau, H. C. H., & Yu, J. (2023). Excess body weight: Novel insights into its roles in obesity comorbidities. Seminars in Cancer Biology, 92, 16–27. https://doi.org/10.1016/j.semcancer.2023.03.008