Who is it evaluated for?
A comprehensive evaluation may be beneficial for individuals who have difficulty losing weight, cannot maintain weight loss, have an increased waist circumference, have prediabetes–insulin resistance, or think that their weight change may be related to sleep, menopause, medications, or eating behavior.
How is it planned?
Body composition, waist circumference, nutrition, physical activity, sleep, and laboratory data are addressed together. Based on nutrition and exercise, behavioral support, medical therapies, and other medical options are planned on an individualized basis when necessary.
Key points
- Obesity is a chronic, relapsing, multifactorial disease; it cannot be explained merely as a lack of willpower.
- The inability to lose weight may be related to sleep, medications, menopause, muscle loss, eating behavior, thyroid diseases, and other medical factors, in addition to nutrition and physical activity.
- BMI is a useful screening tool, but waist circumference, fat distribution, muscle mass, and comorbid conditions should also be evaluated.
- The goal is not only to reduce the number on the scale, but to lower metabolic risk and maintain lost weight.
What is obesity?
The World Health Organization defines obesity as a chronic disease associated with excessive fat accumulation that adversely affects health. In adults, a BMI ≥30 kg/m² is a widely used threshold for obesity; however, BMI alone does not fully indicate fat distribution or individual metabolic risk.
Why can’t I lose weight?
Weight loss is regulated by many biological and behavioral systems. If results are not achieved despite weight loss attempts, the following areas are reviewed:
- Energy-dense dietary patterns that provide low satiety
- Inadequate protein and fiber intake
- Low physical activity and muscle mass
- Insufficient sleep or sleep apnea
- Stress and emotional eating
- Medications that may contribute to weight gain
- Menopause and age-related body composition changes
- Hypothyroidism or other endocrine disorders
- Binge eating or other eating disorders
- Biological adaptation and increased appetite following prior rapid weight loss
Which tests are required?
The same laboratory panel is not necessary for everyone. Depending on the clinical condition, fasting glucose, HbA1c, lipid profile, liver enzymes, kidney function tests, TSH, and other selected tests may be evaluated. Waist circumference, blood pressure, and body composition complete the clinical monitoring.
Does insulin resistance prevent weight loss?
Insulin resistance may be part of metabolic risk, but it does not make weight loss impossible. Weight loss, physical activity, sleep routine, and appropriate medical treatment can improve insulin sensitivity. The approach of “I have insulin resistance, therefore I cannot lose weight” is not accurate.
Why does weight change during menopause?
During menopause, hormonal changes can affect fat distribution, sleep quality, muscle mass, and energy expenditure. Muscle loss and decreased physical activity associated with aging also contribute to the picture. In this period, rather than restricting calories alone, resistance exercise, adequate protein, and sleep management gain importance.
When is medication considered?
Obesity medications are not an alternative to lifestyle modifications, but a part of comprehensive treatment in appropriate patients. BMI, comorbid conditions, previous treatment attempts, the benefit-risk profile of the medications, and the individual’s preferences are evaluated together. GLP-1/GIP-based medications can be effective options, but monitoring is required regarding side effects, muscle loss, nutritional adequacy, and long-term use.
Why does weight regain occur after losing weight?
Biological adaptations that increase appetite and reduce energy expenditure can develop after weight loss. For this reason, obesity is approached as a chronic disease. A weight maintenance plan should be designed from the very beginning of the weight loss plan.
When is a more prompt evaluation required?
If there is unexplained rapid weight gain or loss, marked edema, shortness of breath, severe fatigue, new endocrine symptoms, uncontrolled diabetes, or suspected eating disorders, a medical evaluation should be performed before starting a weight program.
Our approach at our Bodrum clinic
We do not approach obesity and the complaint of inability to lose weight with a diet sheet alone. Body composition, metabolic risk, sleep, muscle mass, physical activity, nutrition, current medications, and, if necessary, pharmacological treatment are evaluated together. For a detailed plan, you can refer to the Weight Management and Metabolic Health guide.
References
- World Health Organization. Obesity and overweight. December 8, 2025.
- American Diabetes Association Professional Practice Committee for Obesity. Pharmacologic Treatment of Obesity in Adults: Standards of Care in Overweight and Obesity. 2026.
- American Diabetes Association. Obesity and Weight Management for the Prevention and Treatment of Type 2 Diabetes: Standards of Care in Diabetes—2025.
Written and medically reviewed by: Dr. Kerem Çağlayan
Last medical review: September 9, 2026
Warning: This content is not personal diagnosis or treatment advice.
