Canada Issues Sweeping Updates for Obesity Pharmacotherapy

Medscape

17 hours ago

TOPLINE:
Canada has released an updated guideline on pharmacotherapy for obesity management in adults that includes six new and seven revised recommendations, reflecting the latest evidence through May 2025.
METHODOLOGY:
Researchers conducted a systematic literature review from January 2022 to July 2024, supplemented by relevant trials published through May 2025, to identify studies assessing the efficacy of pharmacotherapy for weight management.
They also conducted 13 targeted searches on managing weight-related complications in 13 subpopulations with adiposity-related health issues, including cardiovascular disease, heart failure, prediabetes, obstructive sleep apnea, and osteoarthritis, among others.
Primary care physicians, obesity medicine specialists, and people with lived experience of obesity provided feedback on the recommendations.
TAKEAWAY:
Measures of central adiposity, in addition to ethnicity-specific BMI and adiposity-related complications, should be used to guide the decision to initiate pharmacotherapy.
Obesity pharmacotherapy should be used in conjunction with health behavior changes and individualized based on a person's specific health needs, values, and preferences.
The recommendations include two new medications, tirzepatide and setmelanotide, that were not included in previous versions of the guideline, as well as new recommendations for obesity-related complications.
The researchers recommend against the use of compounded medications or medications other than those approved for weight loss in people with excess adiposity.
IN PRACTICE:
Obesity pharmacotherapy 'is one of three pillars of treatment outlined in the full Canadian Adult Obesity Clinical Practice Guideline, with other pillars being behavioral and psychological and surgical approaches,' said the author in a press release. 'Obesity treatment should always be tailored to each person's specific health needs, values, and preferences.'
SOURCE:
The study, led by Sue Pedersen, MD, endocrinologist and obesity medicine specialist in Calgary and lead author of the guideline, was published online in the Canadian Medical Association Journal.
LIMITATIONS:
The guideline has limitations, in that it includes only medications currently approved in Canada, although other medications are approved for obesity management in other countries. Also, there are more than 200 health complications associated with obesity, and it was not feasible to search the literature for all of them.
DISCLOSURES:
Pedersen reported receiving grants for clinical trials from Novo Nordisk, AstraZeneca, Sanofi, Eli Lilly and Company, Boehringer Ingelheim, Prometric, and Pfizer, and consulting fees from AstraZeneca, Bausch Health, Eli Lilly and Company, Novo Nordisk, Janssen, Boehringer Ingelheim, Sanofi, Merck, Abbott, Dexcom, HLS, Bayer, AbbVie, Roche, Amgen, and Pfizer. She has also received payment for medical education lectures and speakers bureaus from AstraZeneca, Bausch, Eli Lilly and Company, Novo Nordisk, Janssen Pharmaceuticals, Boehringer Ingelheim, Sanofi, Merck, Abbott, Dexcom, HLS, Bayer, and Pfizer, and has received travel support from AstraZeneca, Bausch, Eli Lilly and Company, Novo Nordisk, Boehringer Ingelheim, Abbott, and Dexcom. In addition, Pedersen reported participating on a data safety monitoring board for Regeneron. The other coauthors also report receiving fees from multiple commercial entities. These competing interests are included in the paper.
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.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.