As I stated almost a decade ago in my book, Toxic Fat, I consider obesity to be a form of cancer that can metastasize to other organs. The first line of treatment is to reduce the constant hunger in these patients by reducing the severity of a “Fat Trap” caused by insulin resistance. The best “drug” for that purpose is the Zone Diet that is based on reduction of inflammation using improved hormonal control.
The difficulties range from scales and scanners, like M.R.I. machines that are not built big enough for very heavy people, to surgeons who categorically refuse to give knee or hip replacements to the obese, to drug doses that have not been calibrated for obese patients.