Study Design Design: Multicenter, randomized controlled trial across 26 obesity-treatment hospitals in Japan. Participants: 294 adults aged 18–74 years with a body mass index of at least 25 kg/m² and two or more obesity-related disorders. Duration: 24 months. Primary outcome: Weight reduction accompanied by improvement in at least two obesity-related disorders at 12 months.

Secondary outcomes: Disorder remission, improvement in individual health conditions, visceral fat reduction, medication use, and treatment motivation. Treatment Approaches Standard treatment: Japanese Guidelines for the Management of Obesity Disease 2016 The standard group followed the Japan Society for the Study of Obesity recommendations: Weight loss target: at least 3% for body mass index below 35 kg/m² and at least 5% for body mass index of 35 kg/m² or higher. Calorie restriction to no more than 25 kcal/kg of…