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New AGA Guidelines Recommend Use of Antiobesity Medications for Weight Management


Adults with obesity who have an inadequate response to lifestyle interventions alone should be offered 1 of 4 suggested medications.

The American Gastroenterological Association (AGA) released new evidence-based guidelines recommending long-term pharmacological therapy for adults with obesity who do not respond adequately to lifestyle interventions alone.

“There have been changes in obesity treatment in recent years. This guideline is the first since diabetes drugs were approved for obesity treatment and provides clear information for doctors and their adult patients who struggle to lose weight or keep it off with lifestyle changes alone,” said Perica Davitkov, MD, guideline coauthor and associate program director of gastroenterology fellowship training at Case Western Reserve University, in a press release.

To develop the guidelines, Davitkov and colleagues used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. The following medications, paired with lifestyle interventions, were recommended as first-line treatment options:

  • Semaglutide 2.4 mg (Wegovy®)
  • Phentermine-topiramate ER (Qsymia®)
  • Liraglutide 3 mg (Saxenda®)
  • Naltrexone-bupropion ER (Contrave®)

The AGA recommended against the use of orlistat because of its moderate potential benefit for weight loss and higher incidence of treatment discontinuation due to side effects. The AGA also acknowledged a “knowledge gap” on the use of Gelesis100 oral superabsorbent hydrogel, recommending that it only be used in the context of a clinical trial.

“These medications treat a biological disease, not a lifestyle problem,” said lead author Eduardo Grunvald, MD, director of the weight management program at the University of California San Diego, in the release. “Obesity is a disease that often does not respond to lifestyle interventions alone in the long-term. Using medications as an option to assist with weight loss can improve weight-related complications like joint pain, diabetes, fatty liver and hypertension.”

The authors noted that these guidelines will be updated no later than 2025 and the AGA may issue rapid guidance updates until then as new evidence emerges.

Reference: Grunvald E, Shah R, Davitkov P, et al. AGA clinical practice guideline on pharmacological interventions for adults with obesity. Gastroenterology. 2022;163:1198-1225.

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