Professor Hong Tianpei of Peking University Third Hospital delivered a keynote report entitled Precision Therapy for Obesity: Opportunities and Challenges at the 2025 Peking University Diabetes Forum & Coastal Changqiao Metabolic Diseases Research Symposium. He shared insights on why precision represents the inevitable trend in future obesity management.
Professor Hong Tianpei pointed out that obesity has become a severe global public health challenge. In China, the prevalence of overweight and obesity continues to rise, with a clear trend toward younger age groups. Obesity is not simply an increase in body weight or body mass index (BMI), but a highly heterogeneous chronic disease closely associated with multiple metabolic disorders, including type 2 diabetes, non-alcoholic fatty liver disease, atherosclerotic cardiovascular disease (ASCVD), obstructive sleep apnea (OSA), and polycystic ovary syndrome. Its development is influenced by genetic, metabolic, environmental, behavioral, and psychological factors. Therefore, the traditional stepped-care model relying on BMI can no longer meet the needs of individualized diagnosis and treatment.
Current obesity management mainly includes lifestyle intervention, pharmacotherapy, and bariatric surgery. However, tailoring the most appropriate management strategy for individual patients has become a major clinical challenge. With an increasing number of weight-loss medications available, treatment decisions increasingly require integration of the patient’s clinical characteristics, body composition, metabolic status, and underlying disease mechanisms, as well as a comprehensive evaluation of drug properties and their effects on comorbidities. Meanwhile, the selection of indications for bariatric surgery also demands greater precision and scientific rigor.
Obesity treatment is undergoing a major paradigm shift from stepped care to precision care. For overweight or mildly obese individuals, a weight reduction of 5%–15% within 3–6 months can serve as a feasible target to improve metabolism; higher targets are needed for moderate to severe obesity. Traditional lifestyle intervention remains the foundation but has limited effectiveness in practice. Pharmacotherapy is often used as a supplement when lifestyle modification fails, reducing body weight and improving comorbidities. Bariatric surgery is currently the only effective approach to achieve significant and sustained weight loss, yet its application in China faces multiple barriers.
The introduction of precision medicine has enabled more individualized prevention, diagnosis, and treatment of obesity through stratified management based on individual differences to maximize therapeutic efficacy. Precision management requires the integration of multi-omics data, including genomics, epigenomics, transcriptomics, proteomics, metabolomics, and microbiomics, combined with lifestyle, social environment, and external factors to comprehensively assess individual traits. This allows the development of more scientific, effective, and sustainable personalized obesity treatment plans.