In this installment of Med Op-Ed: What guardrails are needed as the GLP-1 era unfolds? Why should gastroenterologists lead obesity care? And should patients start obesity medications at the same time as lifestyle management?

Guardrails Urged as Ozempic Era Unfolds

GLP-1 prescribing is growing fast, and it’s changing who can access these drugs, how they’re marketed, and the food environment. Without pairing fair-access policies with food-system reforms and placing limits on commercial influence, this growth risks widening health inequities. Governments and health leaders need to act now, wrote Luc L. Hagenaars, PhD, MSc, and Laura A. Schmidt, PhD, MSW, MPH, in Science.

The Context

• World Health Organization (WHO) issued its first-ever global guidelines recommending GLP-1s for obesity treatment, alongside a commitment to build a global framework for “fair access” to these medicines. Obesity affects an estimated 1 billion people worldwide. The guidelines also call for “robust population-level policies” to address the root causes of obesity in unhealthy food environments.
• Equitable GLP-1 prescribing could reduce health inequalities but is dependent on healthcare systems having adequate financial and legal resources; recent experience with COVID vaccine access reflects entrenched commercial priorities. High costs of patented GLP-1 drugs are also fueling demand for unapproved generic versions with possible safety risks and dangerous weight-loss products, such as slimming teas containing banned substances.
• Commercialization accelerates: Amazon and online wellness platforms (including Weight Watchers) market telemedicine programs and same-day delivery at prices out of reach for most; Eli Lilly became the first healthcare company to reach a $1 trillion valuation which heightens equity challenges.

In Their Own Words

“…The Ozempic era could recalibrate power and profit across the food, pharmaceutical, and wellness industries in ways that suppress access to both GLP-1s and healthier food environments. To ensure that GLP-1s reduce rather than deepen health inequities, governments and healthcare leaders must erect guardrails for commercial forces jumping on the GLP-1 bandwagon.”

Read it:  (Un)intended consequences of mass-prescribing GLP-1s

Gastroenterologists Urged to Treat Obesity

Effective obesity care extends beyond lifestyle therapy alone — it means combining FDA-approved medications, endoscope-based procedures such as intragastric balloons and stomach-remodeling techniques (endoscopic bariatric and metabolic therapies), and bariatric-metabolic surgery. Gastroenterologists are well-positioned to lead this care and guide patients through combination strategies via shared decision-making, Shelby Sullivan, MD; Ali Tavakkoli, MD; and W. Scott Butsch, MD; wrote in Gastroenterology.

The Context

• Gastroenterologists routinely encounter obesity-related gastrointestinal diseases, such as metabolic dysfunction-associated steatotic liver disease, gastroesophageal reflux disease, Barrett’s esophagus, and colon cancer. They are trained in gut-based procedures and prescribing GLP-1 medications, positioning them to bridge treatment gaps.
• FDA-approved medications are indicated for BMI ≥ 30 or ≥ 27 with comorbidities; first-generation agents include phentermine and orlistat, with data supporting extended phentermine use and modest long-term efficacy for orlistat.
• Combining medications modestly augments weight loss in randomized clinical trials of intragastric balloons, and retrospective data suggest additive benefits with endoscopic gastroplasty.

In Their Own Words

“Gastroenterologists and hepatologists are uniquely suited for treating obesity, not only because of the risk obesity poses to the most common diseases they treat but also because they are well trained to manage adverse events associated with all of the adjunctive therapies presented in this review.”

Read it: Management of Obesity: Review of Adjunctive Therapies and Clinical Management Pearls

Lifestyle-First Rule Lacks Evidence Base

Requiring lifestyle intervention before starting obesity drugs isn’t backed by prospective evidence. Instead, medications and lifestyle support should start together, with timing tailored to each patient’s complication burden and how long they’ve had obesity, wrote Luiz F. Viola, MD, and colleagues in Metabologia.

The Context

• Guidelines now back concomitant treatment. Major 2025-2026 guidelines (European Association for the Study of Obesity, American College of Cardiology, Obesity Canada, Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO) have dropped the mandatory lifestyle-first sequence. Pharmacotherapy and lifestyle support should start together at the first diagnostic visit.
• Early response signals cut both ways. Poor lifestyle response by week 4 predicts failure and warrants prompt drug escalation; poor GLP-1 response by week 20 does not. Most nonresponders still achieve significant loss with continued treatment.
• Delay has real costs. Longer obesity duration independently raises cardiometabolic risk, and isolated lifestyle-only programs see up to 62% dropout. Waiting periods risk losing patients from care altogether, not just delaying benefit.

In Their Own Words

“Lifestyle interventions remain essential, but their optimal role is alongside anti-obesity drugs, not as a gatekeeping condition for accessing them.”

Read it: Is mandatory lifestyle intervention before pharmacological obesity management needed?

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.