AGA Clinical Practice Guideline on Pharmacological Interventions for Adults With Obesity

Oct 23, 2022Gastroenterology

Medical Treatments for Adults with Obesity: Clinical Guidelines

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Abstract

The guideline panel made 9 recommendations for the pharmacological management of obesity.

Pharmacotherapy is strongly recommended alongside lifestyle changes for adults with a body mass index of ≥30 kg/m or ≥27 kg/m with weight-related complications who do not respond adequately to lifestyle interventions.
Semaglutide 2.4 mg, liraglutide 3.0 mg, phentermine-topiramate extended-release, and naltrexone-bupropion extended-release are suggested for long-term management based on moderate certainty evidence.
Phentermine and diethylpropion are suggested for long-term management based on low certainty evidence.
The use of orlistat is suggested against due to insufficient support.
Gelesis100 oral superabsorbent hydrogel is identified as a knowledge gap in the current guidelines.

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BACKGROUND & AIMS: Pharmacological management of obesity improves outcomes and decreases the risk of obesity-related complications. This American Gastroenterological Association guideline is intended to support practitioners in decisions about pharmacological interventions for overweight and obesity.

METHODS: A multidisciplinary panel of content experts and guideline methodologists used the Grading of Recommendations Assessment, Development and Evaluation framework to prioritize clinical questions, identify patient-centered outcomes, and conduct an evidence synthesis of the following agents: semaglutide 2.4 mg, liraglutide 3.0 mg, phentermine-topiramate extended-release (ER), naltrexone-bupropion ER, orlistat, phentermine, diethylpropion, and Gelesis100 oral superabsorbent hydrogel. The guideline panel used the evidence-to-decision framework to develop recommendations for the pharmacological management of obesity and provided implementation considerations for clinical practice.

RESULTS: The guideline panel made 9 recommendations. The panel strongly recommended the use of pharmacotherapy in addition to lifestyle intervention in adults with overweight and obesity (body mass index ≥30 kg/m, or ≥27 kg/mwith weight-related complications) who have an inadequate response to lifestyle interventions. The panel suggested the use of semaglutide 2.4 mg, liraglutide 3.0 mg, phentermine-topiramate ER, and naltrexone-bupropion ER (based on moderate certainty evidence), and phentermine and diethylpropion (based on low certainty evidence), for long-term management of overweight and obesity. The guideline panel suggested against the use of orlistat. The panel identified the use of Gelesis100 oral superabsorbent hydrogel as a knowledge gap. 2 2

CONCLUSIONS: In adults with overweight and obesity who have an inadequate response to lifestyle interventions alone, long-term pharmacological therapy is recommended, with multiple effective and safe treatment options.

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AGA Clinical Practice Guideline on Pharmacological Interventions for Adults With Obesity

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