AGA Clinical Practice Guideline on Pharmacological Interventions for Adults With Obesity

AGA Clinical Guidelines Committee

doi:10.1053/j.gastro.2022.08.045

AGA Clinical Practice Guideline on Pharmacological Interventions for Adults With Obesity

AGA Clinical Guidelines Committee

Research output: Contribution to journal › Article › peer-review

131 Scopus citations

Abstract

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/m², or ≥27 kg/m² with 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. 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.

Original language	English (US)
Pages (from-to)	1198-1225
Number of pages	28
Journal	Gastroenterology
Volume	163
Issue number	5
DOIs	https://doi.org/10.1053/j.gastro.2022.08.045
State	Published - Nov 2022

Bibliographical note

Funding Information:
This document represents the official recommendations of the AGA and was developed by the AGA Clinical Guideline Committee and approved by the AGA Governing Board. These guidelines were developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework and adhere to best practices in guideline development as outlined by the National Academy of Medicine (formerly Institute of Medicine) using a process outlined previously. 9 Development of this guideline was fully funded by the AGA Institute without additional outside funding.

Publisher Copyright:
© 2022

Keywords

Adiposity
Cardiovascular Risk
Insulin Resistance

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1053/j.gastro.2022.08.045

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@article{7516c74e36144d43acecbb62c76a0859,

title = "AGA Clinical Practice Guideline on Pharmacological Interventions for Adults With Obesity",

abstract = "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/m2, or ≥27 kg/m2 with 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. 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.",

keywords = "Adiposity, Cardiovascular Risk, Insulin Resistance",

author = "{AGA Clinical Guidelines Committee} and Eduardo Grunvald and Raj Shah and Ruben Hernaez and Chandar, {Apoorva Krishna} and Octavia Pickett-Blakely and Teigen, {Levi M.} and Tasma Harindhanavudhi and Shahnaz Sultan and Siddharth Singh and Perica Davitkov",

note = "Funding Information: This document represents the official recommendations of the AGA and was developed by the AGA Clinical Guideline Committee and approved by the AGA Governing Board. These guidelines were developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework and adhere to best practices in guideline development as outlined by the National Academy of Medicine (formerly Institute of Medicine) using a process outlined previously. 9 Development of this guideline was fully funded by the AGA Institute without additional outside funding. Publisher Copyright: {\textcopyright} 2022",

year = "2022",

month = nov,

doi = "10.1053/j.gastro.2022.08.045",

language = "English (US)",

volume = "163",

pages = "1198--1225",

journal = "Gastroenterology",

issn = "0016-5085",

publisher = "W.B. Saunders",

number = "5",

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T1 - AGA Clinical Practice Guideline on Pharmacological Interventions for Adults With Obesity

AU - AGA Clinical Guidelines Committee

AU - Grunvald, Eduardo

AU - Shah, Raj

AU - Hernaez, Ruben

AU - Chandar, Apoorva Krishna

AU - Pickett-Blakely, Octavia

AU - Teigen, Levi M.

AU - Harindhanavudhi, Tasma

AU - Sultan, Shahnaz

AU - Singh, Siddharth

AU - Davitkov, Perica

N1 - Funding Information: This document represents the official recommendations of the AGA and was developed by the AGA Clinical Guideline Committee and approved by the AGA Governing Board. These guidelines were developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework and adhere to best practices in guideline development as outlined by the National Academy of Medicine (formerly Institute of Medicine) using a process outlined previously. 9 Development of this guideline was fully funded by the AGA Institute without additional outside funding. Publisher Copyright: © 2022

PY - 2022/11

Y1 - 2022/11

N2 - 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/m2, or ≥27 kg/m2 with 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. 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.

AB - 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/m2, or ≥27 kg/m2 with 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. 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.

KW - Adiposity

KW - Cardiovascular Risk

KW - Insulin Resistance

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AGA Clinical Practice Guideline on Pharmacological Interventions for Adults With Obesity

Abstract

Bibliographical note

Keywords

UN SDGs

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