Updated Canadian guideline highlights expanded role of obesity medications

Key Takeaways: 

• New Canadian recommendations highlight obesity pharmacotherapy as a safe, effective, and long-term treatment option, focusing on improving overall health rather than weight loss alone.
• The guideline moves away from sole reliance on body mass index (BMI), advocating a more individualised approach that incorporates multiple health indicators and personal treatment goals.
• Updated recommendations include new medicines such as tirzepatide and setmelanotide, and address obesity-related complications including cardiovascular disease, osteoarthritis, and heart failure with preserved ejection fraction.
  

Focus on Health, Not Just Weight Loss

“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 the updated 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 updated recommendations reflect the evolving understanding of obesity as a complex, chronic disease that requires a personalised treatment approach. Rather than focusing solely on weight reduction, the guideline emphasises outcomes that matter most to each person, including improvements in energy, mobility, mental wellbeing, and the management of related health conditions.

Updated and Expanded Recommendations

This latest update introduces six new and seven revised recommendations, building on evidence published since the 2022 and 2020 versions of the guideline.

Key changes include:

• Recognition of new medications – tirzepatide and setmelanotide are now included as treatment options.
• Expanded scope – the guideline now addresses pharmacological approaches for obesity-related complications such as atherosclerotic cardiovascular disease, heart failure with preserved ejection fraction, and osteoarthritis.
• Revised assessment criteria – moving away from BMI as the sole measurement, the guideline recommends using additional indicators such as waist circumference, waist-to-hip ratio, and waist-to-height ratio. These should be adjusted for sex and ethnicity where appropriate and interpreted alongside the presence of obesity-related complications.
  

Pharmacotherapy as a Core Pillar of Obesity Care

“Obesity pharmacotherapy is a safe and effective option to support long-term obesity care,” says Dr Pedersen. “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.”

This long-term strategy underscores the importance of maintaining health gains rather than viewing weight loss as a one-time intervention. By integrating medication into a comprehensive care plan, healthcare providers can help people sustain improvements in physical and mental health over time.

Safety and Quality Considerations

The guideline also cautions against the use of compounded obesity medications due to concerns about content, safety, efficacy, and quality. These risks highlight the importance of using approved medications with established quality controls and safety profiles.

CCH Insight:

This new guidance is very welcome, and reflects the rapid advances in this area of obesity treatment over the last few years. The recommendations should be applauded for several reasons. Firstly, the recognition that pharmacotherapy offers more than weight loss alone; it is an important tool in improving the overall health of people living with obesity, improving metabolic function, reducing cardiovascular disease risk and enhancing mental well-being, all tailored to the unique circumstances of each individual. Secondly, they emphasise the fact that these drugs are meant to be used as an adjunct to diet and lifestyle advice, not an alternative to it, which is a message that often seems to get lost in the hype around them. Thirdly, the use of central adiposity indicators (such as waist circumference) as well as BMI for assessing suitability for GLP-1 therapy, and finally the recommendation that these drugs be considered for anyone with a BMI > 30 (or the equivalent adjusted for ethnicity), with or without the presence of obesity-related conditions.