ACP issues new living clinical guideline on using weight loss medications

The American College of Physicians (ACP) has issued a new living clinical guideline to help physicians choose medications with lifestyle modifications to manage overweight and obesity in adults. The guideline, ‘Pharmacologic Treatments with Lifestyle Modifications in Nonpregnant Adults with Overweight or Obesity in Outpatient Settings: A Living Clinical Guideline from the American College of Physicians’, was is published in Annals of Internal Medicine.

More than half (59%) of the world’s population has overweight or obesity, chronic conditions that increase the risk of serious health problems including type 2 diabetes, high blood pressure, heart disease, and some cancers. In the US alone, more than two-thirds (68.5%) of adults have overweight or obesity.

For nonpregnant adults with obesity (BMI≥30 kg/m2), ACP recommends semaglutide and tirzepatide as first-line options when initiating pharmacologic treatment with lifestyle modifications for weight management. ACP recommends phentermine-topiramate as a second-line treatment, liraglutide as a third-line treatment, and naltrexone-bupropion as a fourth-line treatment. For nonpregnant adults with overweight (BMI ≥27 to 30 kg/m2) and at least one comorbid condition (type 2 diabetes, dyslipidaemia, hypertension, obstructive sleep apnoea, or cardiovascular disease), ACP recommends semaglutide or tirzepatide as a first-line treatment and liraglutide as a second-line treatment with lifestyle modifications. Lifestyle modifications include improved nutrition and physical activity.

ACP emphasises that when initiating a recommended medication for weight management or switching to another recommended medication because of an inadequate response, physicians and patients should discuss benefits, harms, costs, access and availability, clinical comorbidities, weight loss goals, life expectancy, values and preferences, and contraindications and warnings. ACP also says physicians should counsel patients about possible unintended side effects of weight loss, including nutritional deficiencies and muscle and bone density loss, especially in older adults.

“Overweight and obesity are chronic, progressive conditions that raise the risk of significant health complications and reduce life expectancy,” said Dr Jan K Carney, President of ACP. “While first-line management for overweight and obesity with lifestyle changes such as improved nutrition and increased physical activity remain essential, many adults still struggle to achieve clinically meaningful weight loss. With physician oversight, evidence suggests that pharmacologic treatments can positively impact people’s health and help them achieve safe weight loss.”  

ACP designated this as a “living guideline,” which means recommendations will be updated as new evidence becomes available as weight management medications are an area of active research.

To access these guidelines, please click here