For people living with obesity, care doesn't happen in a single moment. It's a journey — one that starts with a diagnosis, moves through treatment, and continues long after weight is lost. Each step matters. And one step that often gets less attention than it deserves is maintaining progress over the long term.

More than two in five adults in the United States live with obesity, and roughly one billion people are living with the disease worldwide.^1,2 Despite how common it is, obesity is still misunderstood. Many people view it as a personal failing or a matter of willpower, rather than what it actually is: a chronic, progressive disease shaped by complex biological, genetic and environmental factors, many of which a person cannot control.^3,4,5 That misunderstanding contributes to stigma,⁶ limits insurance coverage,⁷ and reinforces one of the most persistent misconceptions in obesity care: that once weight is lost, the work is done.

It isn't.

The journey doesn't end at weight loss

Reaching a weight-loss goal is a meaningful milestone in the obesity journey — but it isn't the finish line. The biology of obesity doesn't go away when the weight does. Hormones, brain signaling and metabolism continue to influence how the body manages weight long after weight loss has been achieved, and many of those systems actively work to push weight back up.^8,9

This is why weight regain is so common.^9,10 It's not a failure of effort. It's the disease doing what chronic, progressive diseases do when they're not managed over the long term.

That reality has shaped how people experience the obesity journey. Many people who lose weight describe living with the fear of regaining it. Some blame themselves when weight returns. Others give up on care entirely. And without a clear plan for what comes next, even people who have made significant progress can find themselves back where they started — often with the same health risks they worked hard to reduce.¹¹

Maintenance is the next step

The next step in the obesity journey is maintenance: the ongoing work of sustaining weight loss and the health gains that came with it.

We don't ask people with type 2 diabetes or high blood pressure to manage their condition for a few months and then stop. We treat those diseases as long-term, because that's what they are. Obesity is no different.^3,4

Long-term care matters because the health benefits of weight loss depend on sustaining it. When weight is maintained, so are the gains that came with it.^11,12 When weight returns, those risks tend to return with it.^8,9

Treating obesity as a chronic disease means planning for maintenance from the start — not just for how to lose weight, but for how to keep it off. Maintenance isn't a separate phase of care. It's the next step in the same continuum, and it deserves the same attention, the same evidence base and the same support from a healthcare professional.

What the next step can look like

The path from starting treatment to reaching a goal to maintaining it isn't a straight line, and it doesn't have to look the same for everyone.

Obesity care is changing. Research continues to deepen our understanding of how the body responds to weight loss and how care can be designed for the long term. The conversation is shifting from whether people can lose weight to how they can sustain their progress over time.

For patients, that's a meaningful shift. Some people will continue with the care that helped them reach their goal. Others will adjust their approach over time, in partnership with their healthcare professional. What matters is that maintenance is treated as ongoing care — grounded in evidence, tailored to the individual, and recognized as a real and necessary chapter of the obesity journey.

Why this matters

People living with obesity deserve care that is bias-free, science-based, and built for every step of the journey.⁶ They deserve to have their disease taken seriously, and to be supported in managing it the way we support people managing any other chronic condition.

Obesity is not a short-term problem. It shouldn't be treated like one. Everyone living with obesity deserves a chance at long-term health — and the support to keep it.

References:

1. National Center for Health Statistics, Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/products/databriefs/db508.htm.
2. World Obesity Federation. World Obesity Atlas 2025. https://www.worldobesity.org/resources/resource-library/world-obesity-atlas-2025.
3. American Medical Association. Recognition of obesity as a disease (Resolution 420, A-13). 2013.
4. Bray GA, Kim KK, Wilding JPH; World Obesity Federation. Obesity: a chronic relapsing progressive disease process. Obes Rev. 2017;18(7):715-723.
5. Loos RJF, Yeo GSH. The genetics of obesity: from discovery to biology. Nat Rev Genet. 2022;23(2):120-133.
6. Rubino F, Puhl RM, Cummings DE, et al. Joint international consensus statement for ending stigma of obesity. Nat Med. 2020;26(4):485-497.
7. International Foundation of Employee Benefit Plans. (2022). Employee benefits survey: 2022 results. https://www.ifebp.org/resources---news/survey-reports.
8. Ochner CN, Barrios DM, Lee CD, Pi-Sunyer FX. Biological mechanisms that promote weight regain following weight loss in obese humans. Physiol Behav. 2013;120:106-113.
9. MacLean PS, Bergouignan A, Cornier MA, Jackman MR. Biology's response to dieting: the impetus for weight regain. Am J Physiol Regul Integr Comp Physiol. 2011;301(3):R581-R600.
10. Hall KD, Kahan S. Maintenance of lost weight and long-term management of obesity. Med Clin North Am. 2018;102(1):183-197.
11. Ryan DH, Yockey SR. Weight loss and improvement in comorbidity: differences at 5%, 10%, 15%, and over. Curr Obes Rep. 2017;6(2):187-194.
12. Garvey WT, Mechanick JI, Brett EM, et al; AACE/ACE. Comprehensive clinical practice guidelines for medical care of patients with obesity. Endocr Pract. 2016;22(suppl 3):1-203.