Union Minister Nitin Gadkari recently spoke about reducing his weight from around 135 kg to 89 kg and exercising for nearly two-and-a-half hours every day. His experience is a reminder that reaching the target is only half the job; the bigger challenge is maintaining weight over the years.
This is particularly relevant after substantial weight loss, whether achieved through bariatric surgery (as in Gadkari’s case for diabetes) or newer obesity medicines such as semaglutide and tirzepatide. These treatments can produce weight loss that would have been difficult to achieve with lifestyle measures alone. But neither surgery nor medication makes the biology of obesity disappear. Obesity is a chronic disease with a strong tendency to relapse. Treatment may give someone a powerful push towards a healthier weight; maintaining that weight is a different challenge.
The body is not a passive calorie counter. When a person loses a substantial amount of weight, the body responds by trying to conserve energy. Hunger tends to increase; signals of fullness change and energy expenditure may fall beyond what would be expected simply because the person now has a smaller body. This phenomenon is known as metabolic adaptation.
The brain and several hormones involved in appetite and energy regulation participate in this response. After weight loss, changes in signals such as leptin, ghrelin and other gut hormones can favour increased hunger and reduced satiety. Some of these changes may persist long after the initial weight loss. This explains why someone who has lost 20 or 30 kg may find maintaining the new weight surprisingly difficult. The biological pressures that contributed to obesity do not necessarily disappear when the weighing scale reaches the desired number.
Bariatric or metabolic surgery is sometimes misunderstood as simply making the stomach smaller. Its effects are much more complex. Procedures such as sleeve gastrectomy and gastric bypass alter appetite, satiety, gastrointestinal signalling and several metabolic pathways. In people with type 2 diabetes, blood glucose can improve remarkably quickly, sometimes before the full weight loss has occurred.
But surgery is not a permanent shield against weight regain. Over time, some patients regain part of the weight they initially lost. Diabetes that went into remission can also return, particularly with weight regain. Surgery therefore works best when viewed as the beginning of long-term obesity management rather than the end of it.
Food quality, portion size, adequate protein intake, physical activity, sleep and regular medical follow-up continue to matter. Nutritional surveillance is particularly important after bariatric surgery because deficiencies of iron, vitamin B12, vitamin D, calcium and other nutrients may develop.
Two-and-a-half hours of exercise every day are far more than most people need, or can realistically fit into their lives. It should certainly not become the benchmark by which successful weight maintenance is judged.
For most adults, a more achievable approach is regular moderate-to-vigorous aerobic activity combined with resistance exercise. But the example of prolonged daily exercise illustrates why physical activity becomes particularly valuable after major weight loss. Regular aerobic activity improves insulin sensitivity, helps muscles take up glucose and reduces visceral fat. Resistance exercise helps preserve or rebuild muscle, which becomes particularly important during substantial weight loss because some lean tissue is inevitably lost along with fat.
Muscle is also a major site for glucose disposal. When muscles contract during exercise, they can take up more glucose, and regular physical activity improves their response to insulin. For somebody who previously had diabetes or prediabetes, maintaining muscle and remaining physically active can therefore help preserve the metabolic benefits achieved through weight loss.
Exercise also helps increase total daily energy expenditure. This provides greater flexibility with food intake while maintaining energy balance.
However, exercise cannot compensate for any diet. It takes surprisingly little time to consume several hundred calories and considerably longer to expend them through exercise. Keep to a sustainable eating pattern, one that can still be followed on a busy Monday, during travel, at a wedding and five years later. Adequate protein, vegetables, fruits, whole grains and minimally processed foods make maintaining an appropriate calorie intake easier because they generally provide greater satiety. Sugary beverages, frequent snacking and calorie-dense ultra-processed foods can quietly reverse the energy deficit that produced the weight loss.
The goal is not maximum effort, but a routine that lasts. When deciding your regime, ask yourself: Can I still do this five years from now?
Someone may enjoy walking for an hour every morning. Another person may manage 30 minutes on most days and strength training three times a week. Someone else may swim, cycle, play badminton or simply accumulate far more steps during the working day. The precise activity matters less than finding something that can become part of everyday life.
The same principle applies to obesity medication. Some people will require long-term pharmacotherapy. Others may eventually reduce or discontinue treatment under medical supervision. Bariatric surgery remains an effective option for selected people with severe obesity and metabolic disease. These are not competing approaches. They are different tools for treating the same chronic disease.