Is science shaping the future of obesity care, or is pharmaceutical marketing now in the driver’s seat? After 15 years in bariatric surgery, I am witnessing a shift that should make us all pause. From the gold standard of laparoscopic results to the “liberal” use of new injections for runway aesthetics, we are at a crossroads. Are we truly treating a disease, or are we building a model of lifelong dependency? Obesity treatment is no longer just a medical field. It has evolved into a multibillion-dollar global industry. As a result, the search for solutions has become an intensely attractive and highly competitive arena, not only for the scientific community but also for industry giants, tech developers, and various actors within the health care ecosystem.
With the development of laparoscopic surgery, bariatric surgery experienced a monumental transformation. It evolved rapidly, becoming widely adopted due to its exceptional clinical results and safety profile. In parallel, we saw significant advancements in nonsurgical alternatives, such as intragastric balloons and other endoscopic procedures, offering new layers to patient care. And now, we find ourselves witnessing the “era of weight-loss injections.”
But this leads us to a fundamental question: Who is truly shaping obesity treatment today? Is it science? Or is it industry, technology companies, and pharmaceutical marketing? At a time when the patents for surgical staplers used in bariatric surgery are expiring, opening the door to more affordable, global alternatives, the sudden and massive popularization of weight-loss medications raises an important point. Is this purely a medical evolution, or is there another engine driving this change?
Something truly alarming is happening. Weight-loss injections are no longer confined to medical congresses or scientific journals. They have flooded our social media feeds through both overt and subtle advertising on every platform. Most concerning is the “liberal” and unregulated use of these products. In many countries, these medications can be obtained with surprising ease, sometimes even ordered online without a prescription. We are seeing a dangerous trend where individuals at a healthy weight use these drugs simply to achieve a “runway model” aesthetic.
This should make us pause. This is frightening. We are not talking about simple supplements. We are talking about powerful drugs that directly manipulate appetite regulation, metabolism, hormonal pathways, and long-term physiology. Using such “biological power” without medical necessity or supervision is a risk that is impossible to justify. The question we often ignore is: What happens when the treatment stops? Recent studies have revealed a staggering reality: After discontinuing GLP-1 therapies, the rate of weight regain can be up to four times faster than the weight regain typically seen after traditional dieting.
This leads to a necessary, albeit uncomfortable, question: Are we truly treating obesity, or are we creating a model of lifelong dependency? When a treatment requires continuous and indefinite use, it inevitably creates a continuous and indefinite market. This is exactly where we, as physicians, must be most vigilant. We cannot allow ourselves to become unintended amplifiers of industry narratives. Surgeons may emphasize surgery; internists and endocrinologists may promote pharmacotherapy. But obesity is not a battlefield between specialties. It is one of the most complex chronic diseases of our time.
After more than 15 years dedicated to obesity treatment, my perspective has become very clear: There should be no “war” between surgery, balloons, or medications. These are not competing ideologies. They are tools. The responsibility of medicine is simple yet profound:
- To use the right tool
- For the right patient
- At the right time
Our decisions must be guided by science, ethics, and patient-centered care, not by marketing trends, industry pressure, or social media aesthetics. In the end, obesity treatment should not be about what is most profitable or fashionable; it must be about what truly works for the human being standing in front of us.
Mani Habibi is a bariatric surgeon in Turkey.
