Obesity, A Multisystem Disease

In the first video of this series, PA Joseph Zucchi explains why obesity is a chronic, progressive, multifactorial disease rather than a matter of willpower. He describes how obesity is associated with more than 200 health complications, from obstructive sleep apnea and osteoarthritis to type 2 diabetes and liver steatosis.

PA Zucchi also discusses setting personalized treatment goals that reflect a patient’s overall health, the growing role of nutrient-stimulated hormone-based therapies, and the screenings PAs can use to identify comorbid conditions early.

Key Takeaways:

Obesity is associated with a significant number of comorbidities, which can be mechanical or physiological.
Treatment of obesity should be focused on improved overall health, not just a number on the scale.
PAs should screen for comorbidities of obesity regularly.

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Speaker

Click on the photo below to learn more about the speaker.

Joseph Zucchi, PA-C, MPAS

References and Additional Resources:

Alexander L, Purnell JQ, Burridge K, et al. Joint TOS/OMA/OAC expert guidance statement on the pharmacological management of united states adults with overweight or obesity using the GRADE approach. Obesity. 2026;34(4):851–870. https://onlinelibrary.wiley.com/doi/10.1002/oby.70164

Busebee B, Ghusn W, Cifuentes L, Acosta A. Obesity: a review of pathophysiology and classification. Mayo Clin Proc. 2023;98(12):1842-1857. https://pubmed.ncbi.nlm.nih.gov/37831039/

Centers for Disease Control and Prevention. Childhood Obesity Facts. May 6, 2026. Accessed September 17, 2026. https://www.cdc.gov/obesity/childhood-obesity-facts/childhood-obesity-facts.html

Garvey WT, Mechanick JI, Brett EM, et al. American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity. Endocr Pract. 2016;22(suppl 3):1-203. https://pubmed.ncbi.nlm.nih.gov/27219496/

Gustafson B, Smith U. Regulation of white adipogenesis and its relation to ectopic fat accumulation and cardiovascular risk. Atherosclerosis. 2015;241(1):27-35. https://pubmed.ncbi.nlm.nih.gov/25957567/

Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022;387(3):205-216. https://www.nejm.org/doi/full/10.1056/NEJMoa2206038

Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society Circulation. 2014;129:S102-S138. https://pubmed.ncbi.nlm.nih.gov/24222017/

Joynt Maddox KE, Elkind MSV, Aparicio HJ, et al; American Heart Association. Forecasting the burden of cardiovascular disease and stroke in the United States through 2050—prevalence of risk factors and disease: a presidential advisory from the American Heart Association. Supplemental material. Circulation. 2024;150(4):e65-e88. https://www.ahajournals.org/journal/doi/suppl/10.1161/CIR.0000000000001256

Kloock S, Ziegler CG, Dischinger U. Obesity and its comorbidities, current treatment options and future perspectives: challenging bariatric surgery? Pharmacol Ther. 2023;251:108549. https://pubmed.ncbi.nlm.nih.gov/37879540/

Lingvay I, Cohen RV, le Roux CW, Sumithran P. Obesity in adults. Lancet. 2024;404(10456):972-987. https://pubmed.ncbi.nlm.nih.gov/39159652/

Sumithran P, Prendergrast LA, Delbridge E, et al. Long-term persistence of hormonal adaptations to weight loss. N Engl J Med. 2011;365(17):1597-1604. https://www.nejm.org/doi/full/10.1056/NEJMoa1105816

Tondt J, Orr M, Damian A, et al. Obesity Algorithm 2026. https://obesitymedicine.org/resources/obesity-algorithm/. Accessed September 1, 2026.

Vohra MS, Benchoula K, Serpell CJ, Hwa WE. AgRP/NPY and POMC neurons in the arcuate nucleus and their potential role in treatment of obesity. Eur J Pharmacol. 2022;915:174611. https://pubmed.ncbi.nlm.nih.gov/34798121/

Wadden TA, Chao AM, Machineni S, et al. Tirzepatide after intensive lifestyle intervention in adults with overweight or obesity: the SURMOUNT-3 phase 3 trial. Nat Med. 2023;29(11):2909-2918. https://pubmed.ncbi.nlm.nih.gov/37840095/

Wharton S, Freitas P, Hjelmesæth, et al. Once-weekly semaglutide 7·2 mg in adults with obesity (STEP UP): a randomised, controlled, phase 3b trial. Lancet Diabetes Endocrinol. 2025;13(11):949-963. https://pubmed.ncbi.nlm.nih.gov/40961952/

Yuen MMA. Health complications of obesity: 224 obesity-associated comorbidities from a mechanistic perspective. Gastroenterol Clin North Am. 2023;52(2):363-380. https://pubmed.ncbi.nlm.nih.gov/37197879/

Supported by

Joseph Zucchi, PA-C, MPAS

Joseph Zucchi is the Clinical Supervisor and physician associate at Transition Medical Weight Loss in Salem, New Hampshire, where he leads a multidisciplinary obesity medicine program dedicated to comprehensive care. Under his clinical leadership, Transition has helped patients achieve more than 60,000 pounds of collective weight loss while making meaningful improvements in their health.

PA Zucchi serves on the board of the New England Obesity Society and as a clinical preceptor for physician associate students at MCPHS University. He is also a national speaker and advisor in obesity medicine, educating healthcare professionals on obesity as a chronic disease, anti-obesity medications, cardiometabolic health, and strategies to improve patient outcomes.

A passionate advocate for people living with obesity, PA Zucchi is actively involved in efforts to improve treatment access, advance obesity care, and challenge the stigma and misconceptions surrounding the disease. He has authored numerous articles and op-eds, appeared on podcasts and professional educational programs, and his expertise has been featured in The Wall Street Journal, The New York Times, Bloomberg, USA Today, Forbes Health, Medscape, The Boston Globe, and other national media.