Teresa Branco
Director of TO BE.
On March 7, TO BE. brought together a panel of experts at the PLMJ auditorium in Lisbon to discuss an increasingly urgent issue: obesity as a chronic disease and the scientific tools available to treat it. Doctors, physiologists, nutritionists, and psychologists shared the same stage and the same conviction that the solution requires much more than one injection per week.
“Obesity Isn’t a Matter of Willpower”
The session began with a clear statement from Dr. Joana Costa, an endocrinologist at TO BE: obesity is a chronic, multifactorial, and recurrent disease.
It is not a character flaw, it is not laziness, and it is not a lack of willpower. On the contrary: it is a disease recognized by the WHO, characterized by a Body Mass Index (BMI) of 30 or higher. In Portugal, however, treatment for it is still not covered by health insurance, even though the country recognized it as a disease more than 20 years ago.
Adipose tissue, the expert explained, is the largest organ in the human body. It regulates, for example, energy and body temperature, and produces hormones and inflammatory substances. When it is present in excess, especially in the abdominal cavity, it triggers numerous serious metabolic consequences.
“We want people to be able to maintain their weight going forward. That’s our main goal—not weight loss itself, but maintaining a better quality of life.”
— Dr. Joana Costa, Endocrinologist
After all, what is obesity?
The answer is complex.
However, obesity, by definition according to the WHO, is a condition in which the body mass index is greater than or equal to 30. The body mass index is a practical, useful, and easy-to-use tool that relates weight to height. It is not, however, the ideal tool for assessing weight issues—but it is readily available and can be used in any situation.
Genetics accounts for more than 60% of a person’s predisposition to the disease. However, the environment in which we live amplifies this susceptibility: our food culture, structural sedentary lifestyles, stress, sleep patterns, and social pressure.
Factors identified by the TO BE team.
- Genetics and metabolic predisposition;
- An unbalanced diet and a culture centered around the dinner table;
- A sedentary lifestyle and lack of a regular exercise routine;
- Sleep disorders and chronic stress;
- Hormonal imbalances (including menopause and insulin resistance);
- Emotional and psychological component – emotional hunger vs. physiological hunger;
- Social and economic factors.
Psychologist Paulo Martins was particularly incisive on this point. According to him, each person’s cognitive-functional model—the way they think, feel, and self-regulate—is decisive. “We run the risk of changing behavior without changing psychological functioning,” he warned. And it is precisely this mismatch that leads to weight regain.
Why Is It Urgent to Treat Obesity?
Dr. Joana Costa listed the consequences of leaving the disease untreated: type 2 diabetes, hypertension, dyslipidemia, and sleep apnea. In addition, these include cardiovascular disease, colon, breast, and pancreatic cancer, polycystic ovary syndrome, infertility, and joint and psychological problems, notably depression and anxiety. Professor Sandra Martins, an exercise physiologist, added: “The risk of cancer is seven times higher in people with obesity.”
But the benefits of treatment are equally significant: a weight loss of just 2.5% already improves triglyceride levels and polycystic ovary syndrome. Starting at 15%, the cardiovascular benefits become measurable.
Solutions for Obesity: Medication, Exercise, Clinical Nutrition, and Psychology
The New Generation of Drugs
The main topic of the symposium was the new generation of GLP-1 analogs. Among them are drugs such as semaglutide (Ozempic/Wegovy) and tirzepatide (Mounjaro), which have revolutionized the treatment of obesity. Initially developed for diabetes, they have been shown to result in a 20–21% reduction in body weight over the course of a year —results comparable to those of bariatric surgery.
These drugs work on multiple fronts: they increase satiety, delay gastric emptying, reduce appetite, and improve glycemic control. Dr. Vanessa Mendes, a general and family medicine physician at TO BE., emphasized their approval for adolescents. Thus, semaglutide is approved for use in patients 12 years of age and older, and liraglutide for patients 6 years of age and older.
However, Dr. Joana Costa was clear about the limitations. These medications are indicated for a BMI of ≥ 30, or a BMI of ≥ 27 with comorbidities—that is, when there are two or more associated conditions, whether independent of or in addition to one another.
And without structured support, the results are temporary:“50% of people who start this medication stop taking it after a year—and without established healthy habits, they regain all the weight they lost in about a year and seven months.”
“This medication is extremely promising. But it’s not for everyone—it’s for those who make changes, who invest in themselves, and who want to lead the best possible lifestyle.”
— Prof. Teresa Branco, Director of TO BE.
The Indispensable Role of Clinical Nutrition
Teresa Branco, the clinic’s director and an exercise physiologist, presented data that often surprises patients. To preserve muscle mass during weight loss, it is necessary to consume between 1.6 and 2.2 grams of protein per kilogram of body weight per day—a goal rarely achieved without professional guidance.
The message was clear: “It’s not healthy to completely eliminate people’s hunger. When hunger is completely suppressed, something is being done wrong.” Thus, clinical nutrition is therapeutic; it is not a punishment, but neither is it a constant source of pleasure—above all, it is a strategy.
New U.S. Food Pyramid
Photo: NYT
The new food pyramid places proteins, healthy fats, and vegetables at the base, reversing decades of grain-centered guidance. In addition, adequate hydration and fiber intake round out the nutritional framework of a well-conducted intervention.
Exercise as Medicine
Professor Sandra Martins was unequivocal: exercise is a “superpill” with proven systemic benefits. These include the prevention and treatment of obesity, cancer, cardiovascular disease, and sarcopenia (loss of muscle mass). And, like any medication, it has a “dose”: frequency, intensity, duration, and type.
For those taking weight-loss medication, strength training is a priority. It is recommended to train each muscle group at least two to three times a week, with 48 hours of recovery between sessions. In fact, professional supervision is not a luxury—it’s what distinguishes sustained results from temporary ones.
“Participants who underwent an intervention combining medication and supervised exercise showed better weight maintenance rates one year after the end of follow-up, compared to those who received medication alone.” — Prof. Sandra Martins, Exercise Physiologist
A True Story: The Story of Filomena
The most impactful moment of the symposium was the testimony of Filomena Frias, a patient under the care of the TO BE team . Weighing 130 kg at the peak of her morbid obesity, she underwent bariatric surgery—a vertical gastrectomy—eight years ago. However, without structured follow-up care, she regained weight, reaching 102 kg.
When she began TO BE.’s multidisciplinary program—which included an endocrinologist, a nutritionist, an exercise physiologist, and a psychologist, and made use of Mounjaro—she lost 29 kg in a year. Today, she weighs 73 kg, and more than just her weight: she has found a new sense of self.
Read Filomena's testimonial
“I’m discovering a new Filomena and a new way of living my life—one filled with much more joy. You can see it in my daily life and even in the way I interact with others.”
— Filomena Frias, a real-life case TO BE.
Dr. Joana Costa used Filomena’s case to illustrate the complexity of the treatment: “Class 3 obesity, with type 2 diabetes and a history of surgery, requires a rigorous multidisciplinary strategy. Medication was crucial, but it only worked because there was a team supporting her.”
How TO BE. Can Help You
TO BE. is a medical clinic specializing in obesity, healthy longevity, and hormonal modulation. What sets the TO BE. approach apart is the true integration of specialties—not as external referrals, but as a multidisciplinary clinical team —to address a condition as complex as obesity. Each program begins with a comprehensive assessment: complete clinical tests, a hormonal profile, inflammation levels, body composition, and a psychological evaluation. Only then is the strategy defined.
The TO BE. multidisciplinary team includes
- Endocrinologist – Diagnosis and Prescription of Medications
- General and Family Medicine Physician – A Comprehensive and Integrated Approach
- Nutritionist – precision clinical nutrition and dietary counseling
- Exercise Physiologist – personalized training plans
- Psychologist – Functional Assessment and Behavioral Support
The use of anti-obesity medication, when clinically indicated, is always incorporated into this program—never used on its own. In addition, TO BE. also supports athletes in high-intensity competitions and women going through menopause, with properly monitored hormone replacement programs.
As such, the monthly online workshops and in-person symposia—such as the one held on March 7—are part of the clinic’s mission. The goal: to provide accurate information, demystify the topic of obesity, and empower people to make informed decisions about their health.
Watch the summary workshop from the Clinical Symposium on Medication for the Treatment of Obesity
