Evidence Briefs

Beyond Weight Loss: Building a More Sustainable Model for Obesity Care

Developed with input from leading clinicians and researchers, this evidence brief offers an accessible summary on the connections between nutrition, metabolic health, and obesity. Geared toward leaders in policy, public health, research, and clinical care, the brief summarizes the evidence on the impact of obesity, its relationship to metabolic health, the role of dietary interventions in prevention or treatment, and priorities for future research.

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Obesity affects more than 40% of U.S. adults and approximately one in five children and adolescents, making it one of the most prevalent chronic health conditions in the country.[1] 

With the emergence of glucagon-like peptide-1 (GLP-1) therapies, questions regarding treatment persistence, side effects, and maintaining benefits after discontinuation have become critical.[2,3] Combined with high costs and uneven access to GLP-1s, these challenges have intensified interest in sustainable, affordable strategies.

Recent research indicates that low-carbohydrate and ketogenic therapies (diets typically defined as less than 130 grams of total carbohydrates per day and less than 50 grams of total carbohydrates per day, respectively) are associated with clinically meaningful weight loss and reduced reliance on medications when delivered through structured, supported care programs.[4,5,6,7,8,9,10,11,12]

Disparities in Obesity

The burden of obesity is not experienced evenly across communities. Obesity prevalence exceeds 35% among Black adults in 38 states and Hispanic adults in 32 states compared with 14 states among non-Hispanic White adults.[13] Obesity is also substantially more common among adults with less education, affecting 44.6% of adults with a high school diploma or less versus 31.6% of adults with a bachelor’s degree or higher.[14] These patterns underscore the unequal burden of obesity across racial, ethnic, and socioeconomic groups.

The Costs of Obesity Extend Far Beyond the Scale

The burden of obesity extends well beyond excess body weight. Obesity is associated with increased risk of type 2 diabetes, cardiovascular disease, hypertension, and other chronic conditions. Many of these disorders share common metabolic roots and frequently occur together, contributing to worsening health, greater treatment needs, and rising healthcare costs.[2,12,15,16]

As a result, obesity is increasingly recognized not as an isolated disease state, but as part of a broader pattern of metabolic dysfunction.[2,12] This understanding highlights the need for approaches that address the underlying biological drivers of weight gain and metabolic disease. 

Why Metabolism—and Carbohydrates—Sit at the Center

Obesity is closely linked to insulin resistance, a metabolic state in which the body’s cells become less responsive to insulin, requiring the body to produce more of the hormone to regulate blood glucose. Because insulin plays a central role in regulating energy storage and glucose utilization, higher circulating insulin levels may promote fat storage and make sustained weight loss more difficult for some individuals.[4,7,12,17]

Low-carbohydrate and ketogenic therapies reduce insulin exposure and increase reliance on fat as a fuel source. As carbohydrate intake decreases, the body shifts toward utilizing stored fat for energy. This shift targets metabolic pathways implicated in obesity and helps explain the improvements in weight and metabolic health observed across clinical studies.[12,18,19,20]

Consistent Improvements Across Weight, Metabolic Health and Medication Use      

Meta-analyses involving thousands of adults with overweight or obesity consistently demonstrate that low-carbohydrate and ketogenic therapeutic approaches are associated with greater reductions in body weight, body mass index, body fat percentage, and visceral adiposity than higher-carbohydrate comparison diets.[8,21,22] A dose-response meta-analysis of 110 randomized controlled trials found that weight loss increased progressively as carbohydrate intake decreased, with the greatest reductions observed at ketogenic levels of carbohydrate restriction.[22]

These dietary strategies were also associated with improvements in triglycerides, blood pressure, and other cardiometabolic risk factors.[21,22] Although many of the underlying trials in these meta-analyses were relatively small and varied in design and duration, the overall pattern of results remained consistent across studies. This is also consistent with recent clinical guidance from the Obesity Medicine Association, which identifies low-carbohydrate and ketogenic therapies as viable nutrition strategies for managing obesity and obesity-related cardiovascular risk factors when implemented as part of comprehensive, individualized care.[23]

Translating these dietary approaches into sustained long-term behavior changes often requires ongoing support. Real-world studies suggest that structured care models combining clinical oversight, nutrition coaching, behavioral support, and remote monitoring can help patients maintain dietary adherence and achieve durable improvements in weight and metabolic health, as well as substantial decreases in medication use over one to two years of follow-up.[4,5,6,7,9] Evidence further suggests that low-carbohydrate and ketogenic therapies may help patients maintain weight and metabolic health improvements following GLP-1 discontinuation.[5,9]

What These Findings Mean for Obesity Care

The annual U.S. cost of overweight and obesity is estimated to exceed $1 trillion by 2030.[15] As the healthcare system faces growing obesity-related expenditures, low-carbohydrate and ketogenic therapies represent a scalable, complementary pathway to current treatments that can help broaden access to effective long-term obesity management.

With costs rising significantly, research priorities should focus on accelerating the translation into practice. In particular, the field should strengthen the evidence base to understand long-term adherence and cost-effectiveness and to evaluate how integrated care models can combine carbohydrate-reduced nutrition with GLP-1 therapies. 

Continued research can help clarify how evidence-based low-carbohydrate and ketogenic therapies can be incorporated into comprehensive obesity care, informing strategies that expand access to sustainable approaches for improving metabolic health and long-term weight management.

References
  1. National Center for Health Statistics. NCHS Releases Updates to Obesity Estimates. CDC NCHS Blog. February 25, 2026. Accessed July 10, 2026. 
  2. Wilding JPH, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes Obes Metab. 2022;24(8):1553-1564. 
  3. Jastreboff AM, et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022;387(3):205-216. 
  4. Athinarayanan SJ, et al. Long-term effects of a novel continuous remote care intervention including nutritional ketosis for the management of type 2 diabetes: a 2-year non-randomized clinical trial. Frontiers in Endocrinology. 2019;10:348. 
  5. Buchanan L, et al. TOWARD, a metabolic health intervention, demonstrates robust 1year weight loss and cost savings through deprescription. Frontiers in Nutrition. 2025;12:1548609. 
  6. Du Y, et al. Digitally enhanced ketogenic diet versus low-fat diet for cardio-renal-metabolic health in a predominantly Hispanic adult population with overweight or obesity: Pilot randomised clinical trial. Diabetes Obes Metab. 2025;27(11):6154-6166. 
  7. Hallberg SJ, et al. Effectiveness and safety of a novel care model for the management of type 2 diabetes at 1 year: an open-label, non-randomized, controlled study. Diabetes Therapy. 2018 Apr;9(2):583-612. 
  8. Leung LY, et al. Effects of ketogenic and low-carbohydrate diets on the body composition of adults with overweight or obesity: A systematic review and meta-analysis of randomised controlled trials. Clin Nutr. 2025;46:10-18.
  9. McKenzie AL, et al. Impact of glucagon-like peptide-1 agonist deprescription in type 2 diabetes in a real-world setting: a propensity score–matched cohort study. Diabetes Therapy. 2024;15(4):843-853. 
  10. McKenzie AL, et al. 5-Year effects of a novel continuous remote care model with carbohydrate-restricted nutrition therapy including nutritional ketosis in type 2 diabetes: an extension study. Diabetes Res Clin Pract. 2024 Nov;217:111898. 
  11. Silverii GA, et al. Effectiveness of low-carbohydrate diets for long-term weight loss in obese individuals: a meta-analysis of randomized controlled trials. Diabetes Obes Metab. 2022 Aug;24(8):1458-1468.
  12. Volek JS, et al. Expert consensus on nutrition and lower-carbohydrate diets: An evidence- and equity-based approach to dietary guidance. Front Nutr. 2024 Feb 29;11:1376098. 
  13. Centers for Disease Control and Prevention. Adult obesity prevalence maps. Updated December 3, 2025. Accessed September 3, 2026.
  14. Emmerich SD, et al. Obesity and Severe Obesity Prevalence in Adults: United States, August 2021-August 2023. NCHS Data Brief No 508. 2024. 
  15. Almandoz JP, et al. Healthcare resource utilisation and cost of obesity and related complications in the United States: A systematic literature review. Diabetes, Obesity and Metabolism. 2026;28(5):4121–4136. 
  16. Neeland IJ, Poirier P, Després J-P. Cardiovascular and metabolic heterogeneity of obesity: clinical challenges and implications for management. Circulation. 2018; 137(13): 1391-406. 
  17. Ludwig DS, et al. The carbohydrate-insulin model: a physiological perspective on the obesity pandemic. Am J Clin Nutr. 2021;114(6):1873-1885. 
  18. Basolo A, et al. Effects of 1-month very low-calorie ketogenic diet on 24-hour energy metabolism and body composition in women with obesity. J Clin Endocrinol Metab. 2025;110(12):e4158-e4168.
  19. Basolo A, et al. Six- and twelve-month changes in body composition and 24-hour energy expenditure after a very low-calorie ketogenic diet. Obesity. Published online June 15, 2026. 
  20. Petersen MC, et al. Effect of diet macronutrient content on the cardiometabolic response to weight loss: a randomized clinical trial. Cell Metab. 2026;38:1-12.
  21. Feng S, et al. Effects of carbohydrate-restricted diets and macronutrient replacements on cardiovascular health and body composition in adults: a meta-analysis of randomized trials. Am J Clin Nutr. 2025;122(5):1461-1478.
  22. Soltani S, et al. Effect of carbohydrate restriction on body weight in overweight and obese adults: a systematic review and dose-response meta-analysis of 110 randomized controlled trials. Front Nutr. 2023;10:1287987. 
  23. Bays HE, et al. Obesity and cardiovascular disease: an Obesity Medicine Association clinical practice statement. Obes Pillars. 2026;20:100283.