Updated guidance from the American Gastroenterological Association (AGA) will help clinicians navigate the growing number of weight management options.

This update to the AGA’s landmark POWER (Practice Guide on Obesity and Weight Management, Education, and Resources) framework reflects changes in the obesity care landscape, particularly with the advent of new obesity medications (OMs) and expanded treatment options. It positions gastroenterologists and hepatologists as key players in a more personalized approach to obesity management.

In addition to new OMs, several other developments prompted the update, including publications in which endoscopic bariatric and metabolic therapies were found to be safe and effective; new indications for metabolic and bariatric surgery; understanding how genetics of obesity might predict response to diets and OMs; publication of an AGA Obesity Episode of Care and Bundle Initiative Work Group white paper, which introduced a care model engaging specialists toward fee-for-value; and a Congressional Budget Office estimate that forecast increased federal spending on OMs by roughly $35 billion from 2026-2034.

The update was published online on June 17 as a commentary in Gastroenterology.

Key Updates

“POWER 2.0 is a live document with state-of-the-art information to adopt obesity care in practice,” according to the new guidance. Highlights include:

• Importance of treating obesity in gastroenterology and hepatology clinics. The specialists who commonly encounter obesity-related gastrointestinal comorbidities can now leverage both medical and endoscopic therapies to offer patients a continuum of obesity care options, with new procedural billing codes improving access to endoscopic interventions.
• Obesity care is moving toward a multidisciplinary, stepped-care model. Rather than a one-size-fits-all approach, the updated framework emphasizes the need for personalized treatment combining lifestyle interventions, OMs, endoscopic therapies, and surgery. Team-based care involving physicians, dietitians, behavioral health specialists, and peer-support groups has been shown to be essential for promoting sustained weight loss.
• Phased approach to diet, behavioral change, and physical activity. The original POWER Wheel established a framework for the continuum of care for patients with obesity, with diet, behavioral change, and physical activity as the cornerstones of obesity management. Since the 2017 release, multiple systematic reviews and guidance documents have reinforced that comprehensive care, including nutrition therapy, improves health outcomes.
• Bariatric surgery remains the gold standard for durable weight loss and survival benefit. Perioperative and long-term safety evaluations have demonstrated low rates of minor and major complications, as well as decreased mortality, cost, and failure-to-rescue postsurgical complications, when metabolic and bariatric surgery is performed by experienced surgeons in a comprehensive bariatric treatment center.
• The update aligns with AGA’s guidance on the use of GLP-1 receptor agonists (RAs) for obesity management. Combining GLP-1 RAs with endoscopic sleeve gastroplasty or other endobariatric and surgical interventions yields superior outcomes to monotherapies, with better long-term results. Recent multisociety guidance recommends multidisciplinary decision making for periprocedural GLP-1 RA management, balancing metabolic needs with aspiration risk.
• Need to treat child and adolescent obesity. FDA-approved OMs for patients older than 12 years include phentermine-topiramate, liraglutide, and semaglutide. When combined with intensive health behavior and lifestyle treatment, these OMs can decrease BMI by up to 16%. There has also been a continuing increase in referral to and use of bariatric surgical procedures (predominantly vertical sleeve gastrectomy) in the pediatric population.

Many of the coauthors disclosed conflicts of interest, which are available at the end of the commentary. 

Marilynn Larkin, MA, is an award-winning medical writer and editor whose work has appeared in numerous publications, including Medscape Medical News and its sister publication MDedge, The Lancet (where she was a contributing editor), and Reuters Health.