Clinical Scorecard: ACP Suggests First-Line Obesity Drugs

At a Glance

Key Highlights

• Semaglutide and tirzepatide recommended as first-line treatments based on moderate-certainty evidence.
• Phentermine-topiramate, liraglutide, and naltrexone-bupropion recommended as second to fourth-line treatments based on lower-certainty evidence.
• Both semaglutide and tirzepatide improved weight-loss outcomes and hemoglobin A1c.
• Phentermine-topiramate is suggested only for nonpregnant adults without established cardiovascular disease.
• All medications carry specific warnings and potential adverse effects.

Guideline-Based Recommendations

Diagnosis

• Obesity defined as BMI ≥ 30 kg/m².
• Overweight defined as BMI 27-<30 kg/m² with weight-related comorbidities.

Management

• First-line: Semaglutide and tirzepatide.
• Second-line: Phentermine-topiramate for obesity; liraglutide for overweight with comorbidities.
• Third-line: Liraglutide.
• Fourth-line: Naltrexone-bupropion.

Monitoring & Follow-up

• Monitor for weight loss, hemoglobin A1c, and adverse events.

Risks

• Potential thyroid C-cell tumor risk with semaglutide, tirzepatide, and liraglutide.
• Teratogenic risk with phentermine-topiramate.

Patient & Prescribing Data

Adults with obesity or overweight and weight-related comorbidities.

Discuss benefits, harms, costs, access, and contraindications before initiating treatment.

Clinical Best Practices

• Use lifestyle modifications alongside pharmacologic treatments.
• Consider patient-specific factors such as comorbidities and preferences.

Related Resources & Content

• American College of Physicians Guidelines