You Can’t Treat What You Don’t Understand: Obesity 101

Written by Dr. Ritva Mettänen, MD

In order for anyone to truly understand and treat obesity, they need to first understand the biology deeply (think of a medical doctor with deeper education on the subject), and secondly, be able to step into their patient’s shoes.

Weight-first mentality

Too often, I see obesity being treated with medication only — no lifestyle changes, no psychological support — focusing only on the number on the scale. Meaning that if the weight doesn’t come down, you simply raise the dose. And the results are usually disappointing. People either stop using the medicine or waste themselves away on an overly strict diet, resulting in health issues, significant muscle loss, and rapidly rebounding weight. Unfortunately, some doctors still think that once the weight is down, the medication is no longer needed. And within a year, we’re back to square one.

The Self-Proclaimed Real-life Experts

On the flip side, a well-meaning coach promises you the moon without any medical support, shunning obesity medications altogether. I’ve seen too many coaches spreading false information about these medicines – how they destroy your muscles, and create an Ozempic face (a harmless, perfectly normal aesthetic side effect of rapid weight loss) – while others try to scare you with half-truths or blatant misinformation. The problem that I often see is the lack of knowledge, leading to wrong, sometimes even dangerous advice, and false promises. Yes, there are a few people (mostly men) who can achieve permanent weight loss without medication. But unless you’re one of the rare statistical unicorns (and let’s face it, most of us aren’t), it’s not you.

In Both Cases, I Sigh Deeply

Because treating obesity requires a deep understanding of both the biology and the mind of an obese person. Medical school is a good starting point, and when followed by extensive, specialized education in obesity, you're on very solid ground.

But still, no one can truly understand obesity unless they’ve lived it. It is simply impossible to understand how it feels when food noise takes over your brain, day after day. How much willpower you actually have and how many times you’ve started, succeeded, and failed — again and again — only to realize your body is constantly trying to drag its weight back up to square one.

The depth of that despair is something you can’t fully describe — unless you’ve felt it in your bones.

When the Medications Arrived, Many of Us Breathed a Sigh of Relief

Finally — something that actually works.

But just as quickly, I began noticing a new, unhealthy trend: the medication became just another quick fix. A shiny new crash diet in injection form. Two or three months of medication, a 10-20kg weight loss, and then back to the old lifestyle with a leaner body. And I don’t blame you – when you're living with the pain of obesity, who wouldn’t want a quick fix? They are exactly what we’ve been sold for decades.

Don’t get me wrong, I truly understand the need to get rid of the extra weight as fast as possible. Because I understand the pain – your body is screaming for relief, and it doesn't have the time or the patience to wait for the results. And the only thing that really keeps us going is the results: we need to see the results, because how else would we find the motivation to keep starving ourselves?

The problem, however, is that these medicines usually work wonders the first time you start the medication. But that magic rarely lasts. Pretty soon you’ll notice that by the second or third time you try to restart the medication, weight loss is slower, harder — and nobody really knows why.

A Big Loss of Weight – or Health?

Another issue that pharmaceutical companies are still scrambling to solve is muscle loss. And naturally, people were quick to blame the meds.

Because we as humans are quite hesitant to search for the root cause of the problem within ourselves — our lifestyle, the guidance (or lack thereof), or the treatment plan.

It’s, however, a universal fact that when someone loses weight rapidly, a significant portion of it comes from muscle. No matter how you do it – if the weight comes down too fast, you’ll lose it.

Without adequate nutritional support and exercise guidance, up to 40% of your lost weight can come from lean mass. Yes, you read that right.

The Illusion of Health

This is why we’re already seeing a lot of people with the illusion of health — slim bodies, but low muscle mass, poor metabolic health, and fragile strength. On the surface, they might look like success stories. Their BMI sits within the “normal” range, their clothes fit better, and compliments come rolling in. And it feels soooo good.

But inside, their bodies tell a different story. The relief is temporary.

This is what we clinically now call normal-weight obesity — a condition where someone appears to have a healthy weight but carries too much fat and too little muscle. And it’s not harmless. These individuals face elevated risks for metabolic diseases, fatigue, immune dysfunction, and even mental health problems.

Because muscle isn’t just for strength or aesthetics — it’s your metabolic engine, your glucose storage system, and a critical player in mental health.

So while the scale might celebrate a lower number, the loss of muscle tells us what we’ve really lost: our long-term health.

Responsible Obesity Care

In a perfect world, every patient struggling with obesity would receive comprehensive care:

The right medication — without going bankrupt over it (because yes, it’s usually a lifelong treatment),
thorough lifestyle guidance, psychological support, and professional coaching for at least the first year.

But honestly, this version of care is about as close to reality as a human colony on Mars – maybe in a few hundred years.

Yet,  every change and every revolution starts with one person. Any doctor can prescribe you the medicine, but that is just the start. The other half of the success comes from the true transformation. And that’s why we’re here.

If you’re truly ready to let go of the old and finally reclaim your health and happiness for the rest of your days and years, we're here, ready to provide a loving, supportive space for healing — and walk this path with you.