Naravno — evo prevedene verzije članka na engleskom:

Obesity is a chronic, complex and often progressive condition characterized by excessive accumulation of body fat, particularly visceral fat. Today, obesity is increasingly recognized as a chronic disease, rather than merely a matter of appearance, self-discipline or lifestyle.

The most commonly used measure is the body mass index — BMI, calculated as body weight in kilograms divided by height in meters squared. Overweight is defined as a BMI of 25–29.9 kg/m², while obesity is defined as a BMI ≥30 kg/m². However, BMI is not a perfect marker, as it does not distinguish between fat and muscle mass and does not show fat distribution. Therefore, waist circumference, waist-to-height ratio, blood pressure, glucose levels, lipid profile, liver enzymes and overall cardiometabolic risk are also important.

Why Is Obesity Dangerous?

Obesity significantly increases the risk of many diseases. It is associated with arterial hypertension, type 2 diabetes, dyslipidaemia, fatty liver disease, obstructive sleep apnoea, osteoarthritis, gallbladder disease, infertility and certain types of cancer.

From a cardiology perspective, obesity is one of the most important risk factors. It increases the risk of high blood pressure, coronary artery disease, heart failure, atrial fibrillation and worsening of already existing cardiovascular disease. Obesity is therefore not only a cosmetic issue, but a serious medical condition with major long-term health consequences.

It is important to know that even moderate weight loss can bring significant health benefits. A reduction in body weight of 5–10% may improve blood pressure, blood glucose control, lipid profile, joint symptoms, sleep quality and overall energy levels. The goal of treatment is not only a lower number on the scale, but a reduction in health risk and an improvement in quality of life.

How Should Obesity Be Treated?

The treatment of obesity should be individual, medically supervised and long-term. Short-term diets often provide temporary results, but without sustained lifestyle changes, follow-up and professional support, weight regain is common.

Modern treatment includes several therapeutic levels.

1. Lifestyle Modification

The foundation of obesity treatment is healthy nutrition, increased physical activity, good sleep and behavioural change. There is no single ideal diet for every patient. The most important factor is that the nutrition plan is sustainable, medically appropriate and adapted to the individual.

In everyday practice, the following measures are usually recommended:

• moderate calorie deficit,
• increased intake of vegetables, legumes, whole grains and protein,
• reduced intake of sugar, sweetened beverages, alcohol and ultra-processed foods,
• regular physical activity,
• strength exercises to preserve muscle mass,
• adequate sleep,
• stress management.

In patients with cardiovascular disease, physical activity should be adapted to heart function, blood pressure, symptoms and current therapy.

2. Medical Assessment Before Treatment

Before starting obesity treatment, it is important to assess whether obesity-related complications are already present. This usually includes blood pressure measurement, ECG, laboratory tests, glucose/HbA1c, lipid profile, liver enzymes, kidney function, thyroid function, assessment of sleep apnoea risk and cardiology evaluation in patients with symptoms or known heart disease.

In some patients, obesity may be associated with medications, endocrine disorders, reduced physical activity due to other diseases, sleep disorders or psychological factors. For this reason, the patient should not be assessed only by body weight, but within the full medical context.

3. Pharmacological Treatment of Obesity

Today, several medications can help in the treatment of obesity. However, they are not a replacement for lifestyle modification. They are used as an addition to nutrition, physical activity and regular medical follow-up.

Pharmacological therapy is usually considered in patients with BMI ≥30 kg/m², or in patients with BMI ≥27 kg/m² who also have obesity-related complications such as hypertension, diabetes, dyslipidaemia, sleep apnoea or cardiovascular disease.

Available therapeutic options include:

Orlistat — a medication that reduces the absorption of fat in the intestine. It may be useful in selected patients, but gastrointestinal side effects are common.

Naltrexone/bupropion — a combination that acts on appetite and reward pathways in the brain. It is used together with diet and physical activity in adults with obesity or overweight with associated complications. It is not suitable for all patients and requires careful medical assessment, particularly in patients with high blood pressure, neurological or psychiatric conditions.

Liraglutide  — a GLP-1 receptor agonist administered once daily. It helps reduce appetite, increases satiety and supports weight loss.

Semaglutide — a GLP-1 receptor agonist administered once weekly. It is one of the most effective pharmacological options for obesity treatment. In addition to weight reduction, semaglutide has also shown cardiovascular benefit in patients with overweight or obesity and established cardiovascular disease without diabetes.

Tirzepatide — a medication acting through GIP and GLP-1 receptors, administered once weekly. Clinical studies have shown significant weight reduction in patients with obesity or overweight with associated comorbidities.

These medications may have side effects, most commonly nausea, vomiting, constipation, diarrhoea, bloating and reduced appetite. Potential gallbladder problems, pancreatitis, dehydration, loss of muscle mass and interactions with other medications should also be considered.

Treatment should never be started independently, especially not with products obtained from unverified internet sources.

4. Endoscopic and Surgical Treatment Options

In patients with more severe obesity or significant obesity-related complications, metabolic or bariatric surgery may be considered. The most common procedures include sleeve gastrectomy and gastric bypass.

Bariatric surgery is not an “easy solution”, but a serious therapeutic option that requires careful assessment, preparation and long-term follow-up. After surgery, regular monitoring of nutritional status, vitamins, minerals, body composition and associated diseases is necessary.

Conclusion

Obesity is a serious medical condition that increases the risk of cardiovascular disease, diabetes, stroke, sleep apnoea, joint disease and certain cancers. The good news is that obesity can be treated.

Today, there are more therapeutic options than ever before: structured lifestyle modification, modern medications, endoscopic procedures and surgical treatment.

The best results are achieved when treatment is individualized, medically supervised and based on realistic goals with long-term follow-up. The aim is not only weight loss, but also reduction of health risk, better functional capacity, improved quality of life and protection of the heart.

Ordinacija Dr Mačkić provides an individualized approach to the assessment of cardiometabolic risk, with a special focus on prevention, cardiology evaluation and modern management of patients with obesity and associated risk factors. In our private praxis patients can also get help from nutrition Almir Azabagic MD.

References

Busetto, L., Dicker, D., Frühbeck, G. et al. (2024) ‘A new framework for the diagnosis, staging and management of obesity in adults’, Nature Medicine, 30, pp. 2395–2399. doi: 10.1038/s41591-024-03095-3.

Eisenberg, D., Shikora, S.A., Aarts, E. et al. (2022) ‘2022 American Society for Metabolic and Bariatric Surgery and International Federation for the Surgery of Obesity and Metabolic Disorders: Indications for metabolic and bariatric surgery’, Surgery for Obesity and Related Diseases, 18(12), pp. 1345–1356. doi: 10.1016/j.soard.2022.08.013.

European Medicines Agency (n.d.) Mounjaro: European public assessment report. Amsterdam: European Medicines Agency. Accessed: 9 July 2026.

European Medicines Agency (n.d.) Mysimba: European public assessment report. Amsterdam: European Medicines Agency. Accessed: 9 July 2026.

European Medicines Agency (n.d.) Saxenda: European public assessment report. Amsterdam: European Medicines Agency. Accessed: 9 July 2026.

European Medicines Agency (n.d.) Wegovy: European public assessment report. Amsterdam: European Medicines Agency. Accessed: 9 July 2026.

European Medicines Agency (n.d.) Xenical: European public assessment report. Amsterdam: European Medicines Agency. Accessed: 9 July 2026.

Koskinas, K.C., Van Craenenbroeck, E.M., Antoniades, C. et al. (2024) ‘Obesity and cardiovascular disease: an ESC clinical consensus statement’, European Heart Journal, 45(38), pp. 4063–4098. doi: 10.1093/eurheartj/ehae508.

Lincoff, A.M. et al. (2023) ‘Semaglutide and cardiovascular outcomes in obesity without diabetes’, The New England Journal of Medicine, 389(24), pp. 2221–2232. doi: 10.1056/NEJMoa2307563.

National Institute for Health and Care Excellence (2026) Overweight and obesity management. NICE guideline NG246. London: NICE. Accessed: 9 July 2026.

World Health Organization (2025) Obesity and overweight. Geneva: World Health Organization. Accessed: 9 July 2026.