New Canadian guideline highlights expanded role of obesity medications

"Pharmacotherapy can help people living with obesity improve overall health, not just lose weight," says Dr. Sue D. Pedersen, MD, endocrinologist and obesity medicine specialist in Calgary, and lead author of this guideline. "The goal of obesity medications is to improve metabolic, mechanical, and/or mental health, and improve quality of life, incorporating treatment goals that are important to each individual patient."

The guideline includes 6 new and 7 revised recommendations, reflecting the latest evidence since the 2022 and 2020 versions of the guideline. It takes the emphasis off body mass index (BMI) and focuses on an individualized approach that uses additional indicators, such as waist circumference, waist-to-hip ratio, waist-to-height ratio, adjusted for sex and ethnicity where appropriate, and the presence of obesity-related complications.

Obesity pharmacotherapy is a safe and effective option to support long-term obesity care. It is one of three pillars of treatment outlined in the full Canadian Adult Obesity Clinical Practice Guideline, with other pillars being behavioural and psychological and surgical approaches. Obesity treatment should always be tailored to each person's specific health needs, values, and preferences. Recommendations also support sustained use of obesity pharmacotherapy as part of a long-term strategy to maintain improvements in health and quality of life."

Dr. Sue D. Pedersen, MD, endocrinologist and obesity medicine specialist in Calgary

Recommendations include two new medications, tirzepatide and setmelanotide, as well as new recommendations for obesity-related complications such as atherosclerotic cardiovascular disease, heart failure with preserved ejection fraction, osteoarthritis, and more.

The guideline recommends against using compounded obesity medications because of concerns about content, safety, efficacy, and quality.

The guideline panel notes that only Alberta recognizes obesity as a chronic disease. Barriers to access - such as cost, stigma, and limited drug plan coverage - continue to prevent Canadians from receiving medication and support.

"The lack of recognition of obesity as a chronic disease by public and private payers, health systems, the public, and media has a trickle-down effect, limiting access to treatment (e.g., related to medication costs)," the authors conclude.