Medications or Diet & Exercise for Weight Loss?


A recent commentary by Dr. Yoni Freedhoff MD, challenges the idea that diet and exercise are superior to obesity medications for weight loss. While lifestyle changes are important for overall health, evidence suggests they simply don’t match the long-term results achieved with new weight loss drugs.



Here’s what the data says:


🔹 The SURMOUNT-4 trial found that adults on tirzepatide - a drug that works for weight loss by decreasing appetite and slowing the movement of food from the stomach into the small intestine, achieved a 25.3% weight loss after 88 weeks (a result comparable to bariatric surgery).


🔹 In contrast, intensive lifestyle interventions (like the Look AHEAD trial) achieved only 4.7% sustained weight loss over several years.


Dr. Freedhoff highlights an important point: For other chronic diseases (like hypertension or diabetes), we accept that medications are often the first-line treatment. Yet, when it comes to obesity, there’s a societal bias that people just “aren’t trying hard enough.”


Medications can play a vital role for many people, delivering greater, longer-lasting weight loss and improving other health risks like heart disease, diabetes, and fatty liver disease.


The Bottom Line?


Diet and exercise are essential for overall health at any weight. But for people with obesity, medications can provide the tools to achieve results that lifestyle changes alone rarely deliver.


Is Dr. Freedhoff Accurate in His Assessment?


Dr. Freedhoff’s perspective is evidence-based and justified based on the available data. The SURMOUNT-4 trial clearly demonstrates that weight loss achieved with tirzepatide (25.3% average reduction) far exceeds the results seen with diet and exercise alone (e.g., 4.7% in the Look AHEAD trial).


The significant weight regain observed when folks discontinued the medication highlights the complex and multi-factorial nature of overweight and obesity.


While lifestyle changes are foundational for overall health, research consistently shows that lifestyle interventions alone have limited long-term success in achieving substantial weight loss due to the body's adaptive mechanisms (e.g., increased hunger, slowed metabolism) that aim to preserve energy.


Dr. Freedhoff’s critique of societal weight bias is also fair: Obesity is often viewed as a failure of willpower, when in reality it is a complex, chronic condition requiring medical intervention for many individuals, much like hypertension or diabetes.


So, you now have two different (but valid) perspectives on the use of weight loss medications.


  • The First (SURMOUNT-4 findings) emphasized that medications can produce significant weight loss, but their effects may be temporary if discontinued. It encouraged a balanced approach combining drugs with lifestyle changes for long-term success.


  • The Second (Dr. Freedhoff’s perspective) argues that weight loss medications are superior to lifestyle interventions alone and should be recognized as the first-line treatment for obesity, just as medications are for other chronic diseases.


So what's the best approach here?


What’s most important is moving away from weight bias and toward evidence-based, compassionate care that helps people find the right tools to support their health.


Why Not Both? 🤝


Medications like the one used in the SURMOUNT-4 trial achieve dramatically greater weight loss compared to lifestyle interventions alone. But lifestyle changes—like diet, exercise, and behavioral support—offer broad health benefits, even with modest weight loss.


Here’s what I think: It’s not about choosing one approach over the other. For many people, combining medications with sustainable lifestyle changes provides the best path to lasting results.


Obesity is a complex condition, and there’s no one-size-fits-all solution—what works best is what works for you. Medications, lifestyle changes, and personalized strategies can all play a role, depending on individual needs. Every step toward improving your health matters.


What’s your take on this? Should we stop pitting lifestyle and medications against each other?


Research referenced


Aronne LJ, Sattar N, Horn DB, et al. Continued Treatment With Tirzepatide for Maintenance of Weight Reduction in Adults With Obesity: The SURMOUNT-4 Randomized Clinical Trial. JAMA. 2024;331(1):38–48. doi:10.1001/jama.2023.24945


Look AHEAD Research Group. Eight-year weight losses with an intensive lifestyle intervention: the look AHEAD study. Obesity (Silver Spring). 2014;22(1):5-13. doi:10.1002/oby.20662