| Obesity Perspectives Reframed |
Right drug, right patient:
A practical guide to personalising obesity pharmacotherapy
"Obesity management is shifting away from body mass index (BMI) alone toward a phenotype-driven approach that identifies the underlying drivers of weight gain in each patient. Individualised cardiometabolic risk assessment and tailored pharmacotherapy alongside lifestyle interventions are essential to improve precision and long-term outcomes."
– Dr Ankia Coetzee
Dr Coetzee, senior lecturer at Stellenbosch University and specialist endocrinologist, explores the shift toward phenotype-driven obesity care, highlighting the limitations of BMI, the importance of individualised cardiometabolic risk assessment, and how tailored pharmacotherapy alongside lifestyle interventions is reshaping modern obesity management to improve long-term patient outcomes.
To watch the interview with Dr Coetzee, click below
Key messages
- Obesity is a complex, heterogeneous disease driven by multiple biological and behavioural factors, not just excess weight.
- BMI alone is an insufficient tool for assessing metabolic risk and guiding treatment decisions.
- Phenotype-driven assessment helps identify whether appetite, metabolism, or behaviour is the dominant driver of weight gain.
- Individualised cardiometabolic risk profiling is essential for accurate diagnosis and treatment planning.
- Patients with similar BMI values may have very different metabolic risks and clinical needs.
- Waist measurements and body composition assessments provide more meaningful risk information than BMI alone.
- Obesity treatment should prioritise matching pharmacotherapy to the patient’s underlying phenotype.
- Lifestyle interventions remain essential but should be integrated with, not replace, pharmacotherapy when indicated.
- Treatment success should be defined by health outcomes, function, and metabolic improvement, not weight alone.
- Long-term obesity management requires a personalised, chronic disease approach with ongoing adjustment of therapy.
Dr Ankia Coetzee is a senior lecturer at Stellenbosch University and a specialist endocrinologist with extensive expertise in internal medicine and metabolic health. Her academic portfolio includes multiple postgraduate qualifications from Stellenbosch University, spanning Internal Medicine, Endocrinology, Diabetes and Metabolism, as well as a PhD in Endocrinology. She also holds a diploma in diabetes management from University of St Andrews. In 2025, she obtained SCOPE certification from the World Obesity Federation, recognising her expertise in obesity prevention and management. Dr Coetzee is known for translating complex endocrine science into practical, patient-centred solutions, with a strong focus on restoring metabolic balance. She is actively involved in international publications, speaker engagements, and media platforms.
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