American Gastroenterological Association Releases Guidelines for Pharmacologic Management of Obesity

Eduardo Grunvald, MD, of the University of California San Diego

The American Gastroenterological Association has released new guidance outlining the organization’s stance on evidence-based approaches to management of obesity using pharmacological interventions.

Released on October 20, the document, which was composed by a multidisciplinary panel of content experts and guideline methodologists using the GRADE framework, endorses multiple semaglutide 2.4 mg (Wegovy), phentermine-topiramate ER (Qsymia), lirgalutide 3 mg (Saxenda), and naltrexone-bupropion ER (Contrave) as first-line medical therapies in addition to diet and exercise for weight loss in people with obesity.

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

Citing the rising rates of obesity, which the aforementioned statement highlighted has increased from 30.5% to 41.9% in the US over the last 20 years, the AGA’s clinical practice guideline was created to support clinicians in decision-making related to pharmacological interventions for overweight and obesity in the wake of recent advancements in therapies and knowledge base surrounding obesity management. Consisting of Grunvald and a team of 9 additional colleagues, the guideline writing committee used the GRADE framework to prioritize clinical questions, identify patient-centered outcomes, and conduct an evidence synthesis for semaglutide 2.4 mg, liraglutide 3.0 mg, phentermine-topiramate extended-release (ER), naltrexone-bupropion ER, orlistat, phentermine, diethylpropion, and Gelesis100 oral superabsorbent hydrogel.

Based on this evidence synthesis, the writing committee created 9 recommendations for inclusion in the clinical practice guidelines:

1. The AGA recommends adding pharmacological agents to lifestyle interventions over continuing lifestyle interventions alone in adults with obesity or overweight with weight-related complications, who have an inadequate response to lifestyle interventions (Strong recommendation, moderate certainty evidence).
2. The AGA recommends using semaglutide 2.4 mg with lifestyle interventions, compared with lifestyle interventions alone, in adults with obesity or overweight with weight-related complications (Conditional recommendation, moderate certainty evidence).
3. The AGA recommends using liraglutide 3 mg with lifestyle interventions, compared to lifestyle interventions alone in adults with obesity or overweight with weight-related complications (Conditional recommendation, moderate certainty).
4. The AGA recommends using phentermine-topiramate ER with lifestyle interventions, compared with lifestyle interventions alone, in adults with obesity or overweight with weight-related complications (Conditional recommendation, moderate certainty).
5. The AGA suggests using naltrexone-bupropion ER with lifestyle interventions, compared to lifestyle interventions alone, in adults with obesity or overweight with weight-related complications (Conditional recommendation, moderate certainty).
6. The AGA recommends against the use of orlistat in adults with obesity or overweight with weight-related complications (Conditional recommendation, moderate certainty).
7. The AGA recommends using phentermine with lifestyle interventions, compared to lifestyle interventions alone, in adults with obesity or overweight with weight-related complications (Conditional recommendation, low certainty).
8. The AGA recommends using diethylpropion with lifestyle interventions, compared to lifestyle interventions alone, in adults with obesity or overweight and weight-related complications (Conditional recommendation, low certainty).
9. The AGA recommends using Gelesis100 oral superabsorbent hydrogel only in the context of a clinical trial adults with BMI between 25-40 kg/m2 (Knowledge gap).

Underneath the 9 recommendations included in the AGA’s guideline, the writing committee provides clinicians with insight into a summary of the current evidence base for each recommendation, benefits and harms of the recommendation, special clinical considerations, and a discussion section containing further insights from the writing committee.

“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,” added guideline author Perica Davitkov, MD, of Baylor College of Medicine, in the aforementioned statement.

This document, “AGA Clinical Practice Guideline on Pharmacological Intervention for Adults with Obesity,” was published in Gastroenterology.