World Obesity Federation
Looking beyond the BMI paradigm
The approach
BMI is a screening figure, not a diagnosis. Two people at the same BMI can carry entirely different metabolic risk depending on where fat is distributed, how the liver and kidneys are faring, and what the glucose and lipid profile shows.
Clinical evaluation therefore starts with the metabolic picture rather than the scale: fat distribution, glycaemic status, liver and kidney function, lipids, blood pressure, sleep, and the medicines already being taken — several of which promote weight gain in their own right.
Treatment is then matched to that assessment. Where lifestyle change alone has reached its limits, pharmacological options including GLP-1 receptor agonists and dual incretin therapies are discussed on their evidence — with realistic expectations of what each achieves, what it costs, and what happens when it is stopped.
Looking beyond the BMI paradigm was Dr. Bhaduri's faculty lecture at ACCD in collaboration with EASD, 2026.
What obesity medicine covers here
Scope of practice
Areas addressed within obesity and metabolic practice, drawn from Dr. Bhaduri's clinical work, research and faculty lectures.
Clinical evaluation of obesity
Structured assessment of metabolic risk rather than weight alone — the subject of a workshop he has run at international level.
GLP-1 receptor agonists
Semaglutide and related agents: appropriate selection, expected effect and known adverse effects.
Dual incretin therapies
Tirzepatide and the evidence from head-to-head trials, integrated into clinical practice.
Combination approaches
GLP-1 receptor agonists with SGLT2 inhibitors in type 2 diabetes with obesity.
Limits of lifestyle therapy
Recognising when diet and exercise alone are not going to be enough, and what the criteria for escalation are.
Peri-operative optimisation
Preparing patients with morbid obesity for surgery.
Sleep and obesity
Sleep dysregulation as a contributor to weight gain and metabolic dysfunction.
Obesity in women
Endocrine and reproductive dimensions, including whether women respond differently to GLP-1-based agents.
MASLD
Metabolic dysfunction-associated steatotic liver disease as a consequence and a driver of metabolic disease.
What these medicines can and cannot do
An honest note
Incretin-based therapies have changed obesity medicine substantially. They are also widely oversold.
They are treatments, not cures
Obesity is a chronic condition. Weight regain after stopping is common, and that has to be part of the conversation before starting, not after.
Weight loss is not the whole benefit
Organ protection and weight loss do not always travel together. Dr. Bhaduri has published on decoupling weight loss from organoprotective benefit across GLP-1 RA, dual agonists and SGLT2 inhibitors.
Side effects are real
Gastrointestinal effects are common and tolerability varies. Broader effects, including on mood, warrant attention — the subject of a systematic review and meta-analysis he co-authored.
They are not for everyone
Suitability depends on the individual metabolic picture, comorbidity and cost. For some patients the honest answer is that a different approach is better.
No guarantees are offered. Outcomes in obesity management vary between individuals. This page describes the scope of clinical practice and is not medical advice, nor a promise of any particular result. Weight-loss medications are prescription medicines that require medical assessment, monitoring and follow-up. In a medical emergency, call your nearest hospital or dial 112.
Discuss medical weight management
A first consultation covers assessment and options — including whether medication is the right route for you.