AGA Clinical Practice Guideline on Pharmacological Interventions for Adults With Obesity

Gastroenterology. 2022 Nov;163(5):1198-1225. doi: 10.1053/j.gastro.2022.08.045. Epub 2022 Oct 20.


Background & aims: Pharmacological management of obesity improves outcomes and decreases the risk of obesity-related complications. This American Gastroenterological Association guideline is intended to support practitioners in decisions about pharmacological interventions for overweight and obesity.

Methods: A multidisciplinary panel of content experts and guideline methodologists used the Grading of Recommendations Assessment, Development and Evaluation framework to prioritize clinical questions, identify patient-centered outcomes, and conduct an evidence synthesis of the following agents: semaglutide 2.4 mg, liraglutide 3.0 mg, phentermine-topiramate extended-release (ER), naltrexone-bupropion ER, orlistat, phentermine, diethylpropion, and Gelesis100 oral superabsorbent hydrogel. The guideline panel used the evidence-to-decision framework to develop recommendations for the pharmacological management of obesity and provided implementation considerations for clinical practice.

Results: The guideline panel made 9 recommendations. The panel strongly recommended the use of pharmacotherapy in addition to lifestyle intervention in adults with overweight and obesity (body mass index ≥30 kg/m2, or ≥27 kg/m2 with weight-related complications) who have an inadequate response to lifestyle interventions. The panel suggested the use of semaglutide 2.4 mg, liraglutide 3.0 mg, phentermine-topiramate ER, and naltrexone-bupropion ER (based on moderate certainty evidence), and phentermine and diethylpropion (based on low certainty evidence), for long-term management of overweight and obesity. The guideline panel suggested against the use of orlistat. The panel identified the use of Gelesis100 oral superabsorbent hydrogel as a knowledge gap.

Conclusions: In adults with overweight and obesity who have an inadequate response to lifestyle interventions alone, long-term pharmacological therapy is recommended, with multiple effective and safe treatment options.

Keywords: Adiposity; Cardiovascular Risk; Insulin Resistance.

Publication types

  • Practice Guideline

MeSH terms

  • Adult
  • Anti-Obesity Agents* / adverse effects
  • Bupropion / therapeutic use
  • Diethylpropion / therapeutic use
  • Humans
  • Hydrogels / therapeutic use
  • Liraglutide / therapeutic use
  • Naltrexone / therapeutic use
  • Obesity / complications
  • Obesity / diagnosis
  • Obesity / therapy
  • Orlistat / therapeutic use
  • Overweight / drug therapy
  • Phentermine / therapeutic use
  • Topiramate / therapeutic use
  • Weight Loss


  • Orlistat
  • Anti-Obesity Agents
  • Liraglutide
  • Bupropion
  • Naltrexone
  • Topiramate
  • Diethylpropion
  • Phentermine
  • Hydrogels