Treatment
1. In adults with obesity or overweight with weight-related complications,
who have had an inadequate response to lifestyle interventions,
American Gastroenterological Association (AGA) recommends adding
pharmacological agents to lifestyle interventions over continuing lifestyle
interventions alone. (Strong recommendation, moderate certainty
evidence)
Implementation considerations:
• Anti-obesity medications (AOMs) generally need to be used chronically, and the
medication selection or intervention should be based on the clinical profile and
needs of the patient, including, but not limited to, obesity-related complications,
patient preferences, costs, and access to the therapy.
2. In adults with obesity or overweight with weight-related complications,
AGA suggests using semaglutide 2.4 milligrams (mg) with lifestyle
modifications, compared with lifestyle modifications alone. (Conditional
recommendation, moderate certainty evidence)
Implementation considerations:
• Given the magnitude of net benefit, semaglutide 2.4 mg may be prioritized over
other approved AOMs for the long-term treatment of obesity for most patients.
• Semaglutide has glucoregulatory benefits and is also approved for the treatment of
T2DM.
• Semaglutide may delay gastric emptying with adverse effects of nausea and vomiting.
Gradual dose titration may help mitigate these adverse effects.
• Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been associated with
increased risk of pancreatitis and gallbladder disease.
• Contraindicated in multiple endocrine neoplasia type 2 (MEN2) and history of
medullary thyroid cancer.
3. In adults with obesity or overweight with weight-related complications,
AGA suggests using liraglutide 3.0 mg with lifestyle modifications,
compared with lifestyle modifications alone. (Conditional
recommendation, moderate certainty evidence)
Implementation considerations:
• Liraglutide has glucoregulatory benefits and is also approved for the treatment of
T2DM.
• Liraglutide may delay gastric emptying with adverse effects of nausea and vomiting.
Gradual dose titration may help mitigate these adverse effects.
• Liraglutide has been associated with an increased risk of pancreatitis and gallbladder
disease.
• Contraindicated in MEN2 and history of medullary thyroid cancer.
