| Obesity Perspectives Reframed |
After the weight loss:
Preventing regain in long-term obesity management
When people are trying to lose weight, they can do it initially, but then the successive appetite and the slowing of metabolic rate impair their ability to continue losing weight, people eventually give in. In other words, they do not fail, it is just the body fighting back. Weight goes down, but then is regained over the long term.
– Dr Wayne May
In this insightful interview, endocrinologist Dr Wayne May discusses obesity as a chronic relapsing disease influenced by appetite dysregulation and metabolic adaptation. He highlights the importance of long-term treatment, pharmacotherapy, exercise, and behavioural support to sustain weight loss, improve comorbidities, prevent weight regain, and achieve realistic, individualised health goals.
To watch the interview with Dr May, click below
Key messages
- Obesity is now recognised as a chronic relapsing disease rather than a failure of willpower.
- The modern definition of obesity focuses on excess body fat that impairs health and lifespan, not BMI alone.
- Dysregulated appetite is a key biological driver of weight gain and obesity.
- Weight loss attempts can trigger metabolic adaptation, including reduced metabolic rate and increased appetite hormones.
- Weight regain is often a biological response rather than patient non-compliance or failure.
- Anti-obesity pharmacotherapy primarily works by reducing appetite and food noise.
- Long-term or lifelong treatment may be necessary because obesity medications only work while they are being taken.
- Discontinuing pharmacotherapy may lead to weight regain and worsening of cardiometabolic risk factors.
- Exercise, behavioural modification, stress reduction, sleep optimisation, and dietary quality are important supportive contributors to long-term health and weight maintenance.
- Treatment goals should focus on improving comorbidities and overall health gain, with weight targets individualised for each patient.
Dr Wayne May is a specialist endocrinologist with extensive expertise in diabetes, obesity, and metabolic disorders. He obtained his MBChB from the University of Cape Town in 1994, followed by his Fellowship of the College of Physicians of South Africa (FCP(SA)) in 2002 and a Certificate in Endocrinology and Metabolism in 2004. He has been in full-time private practice since 2004 and is affiliated with leading clinical programmes including the Centre for Diabetes and Endocrinology, the Cape Town Bariatric Clinic (internationally accredited), and the Insulin Pump Centre. Dr May previously served on the executive committee of the South African Society for the Study of Obesity and Metabolism and has been a committee member of the Society for Endocrinology, Metabolism and Diabetes of South Africa. He is also a Health24 Diabetes Expert and an advisor to multiple pharmaceutical companies, with regular local and international presentations.
To access the quiz and earn 3 general CPDs and 1 ethics point, click here
Built with Shorthand