Obesity is a disease which cannot be reliably prevented or cured with current frontline methods, according to a feature published in The Lancet.

Going forward, lifestyle change combined with bariatric surgery or weight loss drugs might be the only way to treat obesity.

The issue is that once someone is obese, biological adaptations occur, including increased fat storage capacity, which makes losing weight difficult and maintaining weight loss even harder.

Body weight seems to become biologically stamped in and defended, so the body will try to make compensatory adaptations to maintain the highest lifetime bodyweight.

The biological pressure to restore bodyweight to the highest sustained lifetime level gets stronger as weight loss increases, making it almost impossible to recover from obesity. Those that do attain a healthy bodyweight via diet and exercise have obesity in remission, according to the report.

Because of this, someone who was obese but lost weight will have to ingest 300 calories less (or burn off 300 calories more) than someone of the same weight who was never obese, just to maintain the same weight.

Because obesity is largely a biologically mediated disease, more biologically based interventions are needed, alongside lifestyle and behavioural change argues the report. Also a strategy is vital to maintain weight loss.

Biologically based interventions are anti-obesity drugs, bariatric surgery and more recently, intra-abdominal vagal nerve blockade, which uses an implanted pacemaker-like device to intermittently block signalling in the gut-brain axis via the abdomina vagus nerve, this alters the neural or hormonal signalling associated with appetite to reduce hunger and calorific intake.

It is also vital that those who are overweight should be prevented from becoming obese, as the biological adaptations which preserve the highest lifetime bodyweight do not seem to occur until obesity is sustained.