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Boundaries in weight programs: when a physician is needed
A lifestyle program supports adults in losing weight – it does not treat a disease. Experts consider obesity a chronic disease; its diagnosis and treatment belong in a physician’s hands. The same applies to eating disorders, to weight questions during pregnancy and breastfeeding or in children and adolescents, and to any treatment with medications such as GLP-1 drugs. Your role: pay attention, refer in time and – with the physician’s consent – support everyday life. Professional societies see nutrition and lifestyle as a key component even alongside drug treatment.
A good mountain guide knows when to call mountain rescue
In early 2025, a commission of 58 experts from various disciplines and countries drew a new line – among them people who live with obesity themselves (Rubino et al., Lancet Diabetes & Endocrinology, 2025). It distinguishes two states. Preclinical obesity: excess body fat, but organs and tissues work normally; the risk of later disease is generally increased. Clinical obesity: a chronic disease of the whole body in which excess fat changes how tissues and organs function.
For your program, this distinction is worth its weight in gold. It shows: not all excess weight is a disease – but some of it is. A weight program is like a good mountain guide: it knows the route, sets the pace and motivates. And it knows when to call mountain rescue. This article gives you clear criteria for that. It does not replace a physician’s assessment in the individual case.
Obesity is a disease – treating it is a physician’s job
The World Obesity Federation describes obesity as a chronic, relapsing and progressive disease process: an abundance of food, low physical activity and other environmental factors interact with a person’s genetic susceptibility (Bray et al., Obesity Reviews, 2017). German lawmakers, too, have required the Federal Joint Committee (G-BA) to issue guidelines for a structured treatment program for the chronically ill that explicitly include the treatment of obesity (Section 137f(1) SGB V).
This leads to the most important boundary: anyone who diagnoses, cures or alleviates diseases is practicing medicine.
- Germany: The practice of medicine (Heilkunde) is any professional or commercial activity to diagnose, cure or alleviate diseases; anyone who is not a physician needs a license for it (Section 1(1) and (2) HeilprG).
- Austria: The medical profession includes, in particular, examining for diseases and treating them (Section 2(2) Nos. 1 and 3 ÄrzteG 1998); practicing it independently is reserved for physicians (Section 3(1)).
- Switzerland: Nutrition counseling is a health profession in its own right (Art. 2(1)(e) GesBG); anyone practicing it on their own professional responsibility needs a license from the canton (Art. 11 GesBG).
In practice: your program supports weight loss. It does not diagnose obesity and does not treat it. BMI is not a diagnosis either: the Lancet commission recommends using it only as a surrogate measure at population level, in studies or for screening – not as a measure of an individual’s health.
Lifestyle program or therapy? The difference at a glance
| Lifestyle program | Medical treatment | |
|---|---|---|
| For whom | Adults who want to lose weight or maintain their weight – with no signs of a disease requiring treatment | People with obesity as a disease, related conditions or eating disorders |
| What it is about | Habits, nutrition, exercise, motivation | Diagnosis, therapy, medication, surgery if needed |
| Tools | Lifestyle genetic analysis, nutrition plan, coaching, optional food supplements | Medical examination, lab values, medicines, procedures |
| Language | Report, tendency, logical conclusion | Medical finding, diagnosis, therapy |
The two do not exclude each other – quite the opposite. A good lifestyle program can complement medical treatment in everyday life, as long as the roles are clear.
Clear criteria: when to refer
These situations belong in a physician’s hands before or during the program. Ask about them in the first consultation and write down the answers:
| Situation | What you do |
|---|---|
| Diagnosed obesity with related conditions, or ongoing medical treatment for obesity | continue only in coordination with the treating physician |
| Very high BMI – above a BMI of 40, the Lancet commission assumes excess body fat without further measurement | have a physician assess first whether clinical obesity is present |
| Known conditions, such as diabetes or heart, kidney or thyroid conditions, or regular medication | before starting, have a physician clarify whether and how a change in diet fits |
| Weight-loss medications such as GLP-1 drugs, planned or completed obesity surgery | support only in coordination with the treatment team; no advice on medication |
| Signs of an eating disorder | no diet program; raise the topic gently and refer to a physician or psychotherapist |
| Pregnancy or breastfeeding | no weight-loss program; weight questions are for a physician or midwife |
| Children and adolescents | refer to a pediatrician; your weight-loss program is for adults |
| Unintended, unexplained weight change or new symptoms | have a physician check before you continue |
And if you are unsure? Then refer once too early rather than once too late.
Eating disorders: look closely instead of planning ahead
For most people, a nutrition plan is a help. With an eating disorder, food and weight belong in the hands of specialists – a diet program is the wrong tool. Short questionnaires tested in studies help you notice the signs. A well-known example is the five-question SCOFF questionnaire (Morgan et al., BMJ, 1999). Its topics make good warning signals for your program:
- vomiting after eating because of feeling uncomfortably full
- feeling that you have lost control over how much you eat
- losing a lot of weight in a short time
- feeling fat when others find you too thin
- food dominating your life
A questionnaire does not replace a diagnosis. It helps you pay attention – and then take the right step: pause the program and refer to a physician or psychotherapist. Four US professional societies even recommend asking about disordered eating at the very start of treatment with GLP-1 medications (Mozaffarian et al., American Journal of Clinical Nutrition, 2025).
“Weight-loss shots” and more: support, don’t treat
GLP-1-based medications are changing the treatment of obesity. The joint advisory of the four US professional societies reaches a clear conclusion: nutrition and lifestyle play a pivotal role in addressing the key challenges of this treatment (Mozaffarian et al., 2025). Among the challenges, the experts list gastrointestinal side effects, nutrient deficiencies due to lower calorie intake, loss of muscle and bone mass, and low long-term adherence followed by weight regain. Supportive strategies include nutrition counseling, group visits and digital offerings.
For you, this means: there is a real opportunity for good support here – with clear roles.
- Medication: Prescribing, dosing, monitoring and stopping are solely the physician’s responsibility.
- Coordination: You support the client only with the knowledge and consent of the treating practice.
- No medication advice: Questions about side effects go back to the practice.
- Keep muscle in view: According to the advisory, preserving muscle and bone mass through resistance training and an appropriate diet is a priority. You set the framework together with the treatment team.
- Advertising: no advertising of prescription drugs to lay people – see Advertising weight loss.
Pregnancy, breastfeeding and children: not a case for a weight-loss program
Pregnancy and breastfeeding: A physician or midwife sets weight goals during this time. A weight-loss program is not the right format here – pause it and resume later after consulting them. Research programs draw the same line: in the NOW trial on gene-based weight counseling, pregnancy and breastfeeding were exclusion criteria (Horne et al., Obesity, 2020).
Children and adolescents: Their bodies are still growing. Weight questions belong with a pediatrician, not in a weight-loss program for adults. For minors, Novogenia performs only non-medical analyses, and only with the written consent of their legal guardians. In Switzerland, genetic testing on persons who lack capacity of judgment may only be performed if it is necessary to protect their health (Art. 16(1) GUMG).
Switzerland: where the law draws the medical line
Switzerland draws the line for genetic analyses especially clearly. Analyses of eating behavior, physical activity and general well-being are outside the medical field (Art. 37(1) GUMV). Only health professionals listed in Art. 40 GUMV may order them – such as physicians, pharmacists, druggists with a federal diploma (HF) or nutrition counselors with a university of applied sciences degree (FH) – and the sample is taken in their presence (Art. 34(3) GUMG). Analyses that provide information on metabolic disorders or diseases, among other things, count as medical (Art. 37(2) GUMV) and are ordered by physicians (Art. 20 GUMG).
For your program, this means: in Switzerland, coaches and studios work with a listed professional, and the conversation is about eating behavior and lifestyle – not metabolic disorders. More in Who may offer genetic tests?
How to refer without unsettling your client
A referral is not a dismissal. It shows that you take responsibility. Three sentences that help:
- “I don’t want to assess what you’re describing on my own. Please have a doctor look at it – then we’ll plan the next steps together.”
- “Your program should fit your treatment. With your permission, may I briefly coordinate with your doctor?”
- “During pregnancy, your doctor and your midwife set the goals. If you like, we’ll continue afterward.”
Write down the referral and the response. Information about conditions, medications or a pregnancy is health data, which the GDPR specially protects (Art. 4(15) and Art. 9(1)); in Switzerland, it is sensitive personal data (Art. 5(c) FADP/DSG).
Checklist for your team
- In the first consultation, you ask about conditions, medications (including GLP-1), pregnancy or breastfeeding, eating behavior and age.
- Everyone on the team knows the referral criteria.
- You have a list of physicians and psychotherapy services in your region.
- Referrals and agreements are documented, and consent forms are on file.
- No diagnoses, no medication advice, no promises of cure.
- Switzerland: a professional listed in Art. 40 GUMV orders the analysis, and the sample is taken in their presence.
Frequently asked questions
Can I support clients who have obesity?
What do I do if a client gets “weight-loss shots”?
How do I recognize a possible eating disorder?
Can I accept pregnant women or teenagers into my program?
Is a high BMI already a disease?
Related: Who may offer genetic tests? · Advertising weight loss: what is allowed · Explaining genetic reports clearly
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Request a project →Lifestyle analysesNote: This guide is general information for businesses and professionals and does not replace medical or legal advice. The genetic traits determined in a genetic analysis are well documented (each gene included is backed by at least three independent studies); recommendations derived from them are logical conclusions, not scientifically proven. Regulations can change; errors and changes excepted.