Study wrapper · #183
Pharmacologic Treatments With Lifestyle Modifications in Nonpregnant Adults With Overweight or Obesity in Outpatient Settings: A Living Clinical Guideline From the American College of Physicians (April 2026).
Editor's note
This is a clinical guideline from the American College of Physicians (April 2026), built on the accompanying systematic reviews, rather than a primary study. Guidelines synthesise evidence into practice guidance, and this one uses GRADE and issues only conditional recommendations, signalling genuine uncertainty and a strong role for patient preference. For adults with obesity (BMI 30 or higher), ACP positions semaglutide and tirzepatide as first-line options, both on moderate-certainty evidence, with phentermine-topiramate, liraglutide and naltrexone-bupropion as later lines on low-certainty evidence. The guidance is careful about harms and access: it foregrounds contraindications and warnings (cardiovascular contraindication and monthly pregnancy testing for phentermine-topiramate, suicidal ideation with naltrexone-bupropion) and directs clinicians and patients to weigh benefits, harms, cost, availability, comorbidities and values together. For readers, the takeaway is that the two peptide agents here now sit at the top of a mainstream professional-society algorithm, but as conditional suggestions paired with shared decision-making, not directives.
Plain-language abstract
This is treatment guidance from the American College of Physicians, published in April 2026, for doctors who care for adults with overweight or obesity in outpatient clinics. It is based on the group's reviews of the evidence and rates how confident that evidence is. For adults with obesity (BMI 30 or above), the guidance suggests, as a conditional recommendation, starting one weight-management drug alongside lifestyle changes. It names semaglutide and tirzepatide as first-choice options (both backed by moderate-confidence evidence), followed by phentermine-topiramate, then liraglutide, then naltrexone-bupropion (all backed by lower-confidence evidence). Similar advice is given for people with overweight (BMI 27 to 30) who also have conditions such as type 2 diabetes, high blood pressure, sleep apnoea or heart disease. The guidance stresses that clinicians and patients should discuss benefits, harms, cost, availability, other health conditions, goals, life expectancy, personal values and specific warnings, for example the need for monthly pregnancy tests with phentermine-topiramate, its avoidance in people with heart disease, and the risk of suicidal thoughts with naltrexone-bupropion. The recommendations are conditional, meaning choices should be shared between patient and clinician.