During the ACP 2025 Internal Medicine Reunion, Laura Davisson, MD, offered a practical roadmap to treat obesity using an individual approach and based on evidence. In this conversation, Dr. Davisson reviews the current landscape of pharmacological treatments, including the agonists of GLP-1 receptors, and addresses how to manage their most common side effects. It also emphasizes the lasting value of bariatric surgery and the non -negotiable foundation of the intervention on the lifestyle. Whether it is the treatment of patients with BMI thresholds for medical or surgical therapy, Dr. Davisson clearly indicates that sustainable results come from a complete and team -based strategy.
Dr. Davisson is professor of medicine at the West Virginia University School of Medicine.
The following transcription has been modified for more clarity, style and length.
Patient care: To start, can you give an overview of the most effective pharmacological approaches currently available for weight loss in obesity patients?
Laura Davisson, MD: We have a variety of treatment options, ranging from oral drugs to new injectable therapies. The injectable agonists of the GLP-1 receptor receive the most attention at the moment because they are the most effective, but we have several options through the spectrum. This is what I focused in my speech today – clinicians who help understand the full range of available pharmacological tools.
Patient care: What complications are generally associated with obesity drugs and what strategies do you recommend to manage these side effects?
Laura Davisson, MD: One of the most common problems we see with GLP-1 drugs is linked to their effect on gastric emptying. They slow it down, which often leads to a feeling of fullness, light nausea, occasional vomiting and constipation frequently. These gastrointestinal side effects are the most common we manage in our clinic.
Another problem we sometimes hear is the “sulfur rotations”, which, although unpleasant, can be easily managed with over -the -counter remedies, food adjustments and simple strategies. The key is to be proactive – education of initial patients and equip them with tools to manage symptoms.
Fortunately, most of these side effects improve over time because the body adapts to the drug. They could briefly return to each dose increase, but they usually solve again with continuous use. More serious complications are possible but rare.
Patient care: In your presentation at ACP 2025, you have discussed several obesity processing strategies beyond pharmacotherapy, including lifestyle programs and bariatric surgery. Based on your experience, what combination of treatments has shown the most promises?
Laura Davisson, MD: Medicines receive a lot of attention at the moment – and rightly so – but it is important not to neglect bariatric surgery. It has been there for a long time and always has the strongest data with regard to the quantity of lost weight and the sustainability of this weight loss. That said, not all patients want surgery, and not everyone qualifies for that. But it is an important tool, especially for patients with a BRI of 40 or more. I always make sure to mention it to these patients during the initial visit.
At first, many patients resist the idea of surgery. But after trying medical therapy and understanding that tools such as drugs or surgery can reduce the feeling of fighting their own biology, many are starting to change their point of view. They come to see obesity as a disease, and with this change of mentality, they often become more open to surgical options on the road.
Medical treatment is a good option for patients with a BMI of 30 and more, or 27 and more if they have weight -related comorbidities. But whether we use drugs, surgery or both, everything is based on a lifestyle change base. Food improvements, physical activity and behavioral strategies are essential components. For some patients, the lifestyle alone can be sufficient. For the most part, the combination of these fundamental changes with pharmacological or surgical interventions gives the best results.