New Guidelines Endorse Semaglutide and Tirzepatide as First-Line Treatments for Obesity

The European Association for the Study of Obesity (EASO) has released new guidelines recommending that semaglutide and tirzepatide be the primary pharmacological treatments for obesity and its associated complications. This recommendation is based on their significant efficacy in promoting weight loss and improving health outcomes. The guidelines were published in the journal *Nature Medicine* and emphasize the importance of these medications in clinical practice.

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Semaglutide, marketed as Wegovy and Ozempic, and tirzepatide, known as Mounjaro, have demonstrated substantial weight loss results in clinical trials. Patients using semaglutide lost approximately 14% of their body weight over 72 weeks, while those on tirzepatide achieved a loss of around 20%. The EASO guidelines suggest these medications should be the first choice for patients requiring significant weight loss, particularly in cases linked to obesity-related complications such as obstructive sleep apnea and knee osteoarthritis.

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The EASO's framework categorizes obesity-related complications into two types: "fat mass disease," which includes conditions like obstructive sleep apnea, and "sick fat disease," which encompasses metabolic and cardiovascular issues. For "fat mass disease," tirzepatide is recommended for obstructive sleep apnea, while semaglutide is preferred for knee osteoarthritis. In cases of metabolic dysfunction, semaglutide is advised for patients with a history of heart disease or stroke, and tirzepatide is suggested for those with non-alcoholic fatty liver disease.

European Association for the Study of Obesity Endorses Semaglutide and

Despite the effectiveness of these medications, their high costs pose significant barriers to access. The EASO authors argue that the long-term costs associated with untreated obesity and its complications should be weighed against the economic implications of providing these treatments. Health Secretary Wes Streeting has expressed a commitment to making these medications more accessible through the National Health Service (NHS), highlighting the disparity in access between wealthier individuals and those unable to afford private prescriptions.

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While the EASO guidelines present a structured approach to obesity treatment, they acknowledge that many medications have not been specifically evaluated for individual complications. Critics point out that the reliance on pharmacological treatments alone may overlook the necessity of lifestyle changes and comprehensive patient care. The American College of Lifestyle Medicine and other organizations emphasize that GLP-1 treatments should be combined with nutritional and lifestyle strategies for optimal effectiveness.

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The EASO plans to regularly update its treatment algorithm to incorporate new evidence and emerging therapies. As the landscape of obesity management evolves, the integration of medications like semaglutide and tirzepatide into broader treatment strategies will be crucial in addressing the global obesity crisis.

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• “The reality is that semaglutide is so effective that it should be the first choice in almost all cases.” — Dr. Andreea Ciudin, Co-author of the EASO guidelines

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• “thus enabling the progression to complications and end-organ damage, should be weighed equally in health policy and clinical decision-making,” — EASO guideline authors

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• “He added 'Weight-loss jabs could help us finally defeat obesity.” — Wes Streeting, UK Health Secretary

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This comprehensive framework marks a significant shift in obesity treatment, prioritizing effective pharmacological interventions while recognizing the need for a holistic approach to patient care.

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