Three obesity associations have issued the latest guidance on pharmacologic treatment of obesity, based on the published evidence to date for all medications currently available in the US. 

The new guidancewas published March 5, 2026 in the journal Obesity. The three organizations are The Obesity Society (TOS), Obesity Medicine Association (OMA), and the Obesity Action Coalition (OAC). 

The document provides answers to 15 clinical questions. The first seven ask whether a given agent should be used in adults aged 18 years and older with overweight and at least one complication or obesity compared to placebo. Strong recommendations are given for bupropion-naltrexone, semaglutide, and tirzepatide, while conditional recommendations — phrased as “suggest” rather than “recommend” — are given for orlistat, phentermine, phentermine-topiramate, and liraglutide. 

Two other strong recommendations are for continuing obesity medications in adults undergoing medical obesity treatment during the weight maintenance phase and for use of setmelanotide in adults aged 18 and older with certain monogenic obesity syndromes. 

Further conditional “suggestions” are for GLP-1 drugs in adults aged 18 years and older with overweight and at least one complication or obesity who also have obstructive sleep apnea, heart failure with preserved ejection fraction, metabolic dysfunction-associated steatohepatitis, osteoarthritis (compared to lifestyle interventions), and in those with type 2 diabetes. 

“Our hope is that it [this guidance] will be used to help with informed decision-making discussions with patients that will achieve three key messages: that this is a chronic medical condition, not a failure of willpower, that the obesity medications are safe and effective, and that improvement of health is part of the goal, along with improvement in quality of life,” co-author and TOS vice president Jonathan Q. Purnell, MD, told Medscape Medical News. 

In addition, Purnell, who is professor of medicine and director of the Center for Preventive Cardiology at Oregon Health & Science University, Portland, noted that the document is also aimed at policymakers and payers, so that they “will have a document that allows them to see a rigorous evaluation of the current state of the literature, so they can make decisions, whether we agree with them or not. At least it’s there.”

However, it’s not the first such document. In January 2026, the American Diabetes Association (ADA) published its own set of guidelines on pharmacologic obesity management, as have several other professional societies. 

Asked to comment, W. Timothy Garvey, MD, the Charles E. Butterworth, Jr professor and university professor at The University of Alabama at Birmingham, told Medscape Medical News, “they have adopted an approach of hierarchies of preferred medicines for patients with specific complications largely based on phase 3 clinical trial data where improvement in that complication is the primary outcome. This is complication-centric care in its fullest expression, first explicitly recommended in the [American Association of Clinical Endocrinologists, AACE] 2016 guidelines.”

And in the modern GLP-1 era, the European Association for the Study of Obesity also used that approach in its 2024 framework followed by an AACE algorithm update, noted Garvey, who is an author on both the ADA and AACE guidelines. 

“Everyone…is reviewing the same data and working from a more advanced and more evolved understanding of obesity as a disease within the conceptual framework of adiposity-based chronic disease,” Garvey said. 

However, Purnell pointed out that the joint TOS/OMA/OAC guidelines are unique in that they incorporate the patient voice by inclusion of the OAC, a patient advocacy group. “One of the most eye-opening things was that quality of life was as important, if not more important to patients, as total weight loss,” Purnell said. 

Garvey noted, “Patient input and commentary is always a good thing, and this is positive. An evidence-based guideline considers the strength of evidence from scientific investigations to make recommendations for patient care. Patient input should not influence recommendations but is valuable in how the recommendations are executed.”

The paper includes a table of outcomes prioritized by patient input that was used in weighting the guidelines. Outcomes ranked at the top are all-cause mortality, cardiovascular mortality, and major adverse cardiovascular events, followed by health-related quality of life, diabetes risk reduction, weight maintenance, and weight regain, among others. Body weight was farther down the list. 

Purnell noted, “their feeling was, if I can tie my shoe or go out and walk with my grandchild, they prioritize things that the weight loss has allowed them to do that they didn’t have before. It definitely adds a new angle on the BMI debate…What the patients are saying is it’s not just about BMI, but how do I feel and what can I do.” 

Purnell reports grants from NIH; consulting fees from Novo Nordisk, Regeneron, Boehringer Ingelheim, Zealand Pharmaceuticals; payment or honoraria from TOS; meetings/travel support from TOS; participation on advisory board for NIH Metformin in Alzheimer Dementia Prevention. 

Garvey has been a consultant on advisory boards for AbbVie, Allurion, Alnylam Pharmaceuticals, Boehringer Ingelheim, Carmot/Roche, Corcept, Eli Lilly, Fractyl Health, Gan & Lee, Inogen, Keros Therapeutics, Metsera, Neurocrine, Novo Nordisk, Pfizer, Regeneron, Terns Pharmaceuticals, and Zealand. He has also served as a site principal investigator for multicentered clinical trials sponsored by his university and funded by Carmot/Roche, Eli Lilly, Epitomee, Neurovalens, Novo Nordisk, Terns Pharmaceuticals, Viking Therapeutics, and Zealand. 

Miriam E. Tucker is a freelance journalist based in the Washington DC area. She is a regular contributor to Medscape, with other work appearing in the Washington Post, NPR’s Shots blog, and Diatribe. She is on X (formerly Twitter) @MiriamETucker and BlueSky @miriametucker.bsky.social