The Obesity Association, a division of the American Diabetes Association (ADA), released an update to its Standards of Care in Overweight and Obesity guideline. The update includes a new section on the pharmacologic treatment of obesity in adults. When used alongside lifestyle interventions, obesity medications were shown to support weight reduction while also improving obesity-related complications and diseases. The guideline emphasizes a person-centered, shared decision-making approach when selecting obesity medications, with careful consideration of an individual's preferences and needs.

The recommendations below are divided into seven sections and included a total of 34 new recommendations. Refer to the full-text version for the most thorough explanation of these recommendations. 

Key Elements of the 2026 Update:


Discussing Obesity Medications

  • Select obesity medications using a person-centered approach that incorporates shared decision-making and is grounded in the best available evidence.
  • Prioritize obesity medications most likely to achieve and maintain intended treatment goals while considering cost, access, tolerability, risk for adverse effects, and individual preferences.
  • Nutrition, physical activity, and behavioral therapy should be used in combination with obesity medications to achieve health goals.
  • Whenever clinically appropriate, minimize use of weight promoting medications used to treat other conditions, particularly among adults with obesity.

Setting Treatment Goals With Obesity Medications

  • Treatment goals should be incremental and individualized, based on the severity of obesity, obesity-related diseases and complications, and individuals’ needs, life circumstances, and preferences.
  • Aim for a sustained reduction in baseline body weight of ≥5% for adults treated with obesity medications, which may achieve some clinically meaningful health benefits. Aim for a sustained weight reduction of ≥10% to manage many obesity-related diseases or complications A; in some cases, a ≥15% weight reduction may be indicated to achieve greater therapeutic benefit.

Selecting Obesity Medications

  • In adults with obesity who do not have obesity-related diseases or complications, consider obesity medications as part of the treatment plan to promote weight reduction, prevent further weight gain, and reduce the risk of developing obesity-related diseases and complications. 
  • Obesity medications should be offered as part of initial treatment for obesity to adults with or at high risk of obesity-related diseases or complications. 
  • In adults with overweight or obesity and prediabetes, the treatment plan should prioritize obesity medications with demonstrated evidence for preventing progression to type 2 diabetes. 
  • In adults with overweight or obesity and type 2 diabetes, the preferred obesity medication should be a glucagon-like peptide 1 receptor agonist (GLP-1RA) or a dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide 1 receptor agonist (dual GIP/GLP-1RA) given their weight reduction and glucose-lowering efficacy. If a preferred obesity medication is unable to be used, other obesity medications with demonstrated glucose-lowering efficacy may be considered within the context of their risks and adverse effects. 
  • In adults with overweight or obesity and essential hypertension, the treatment plan should prioritize obesity medications with demonstrated blood pressure reduction benefit. 
  • In adults with overweight or obesity and established atherosclerotic cardiovascular disease, the treatment plan should include a GLP-1RA with demonstrated benefits or a dual GIP/GLP-1RA with potential benefits in reducing cardiovascular events. 
  • In adults with overweight or obesity and heart failure with preserved ejection fraction, the treatment plan should include a GLP-1RA or dual GIP/GLP-1RA with demonstrated improvements in heart failure-related symptoms or reduction in heart failure events. 
  • In adults with overweight or obesity and metabolic dysfunction–associated steatohepatitis (MASH) with moderate or advanced fibrosis, the treatment plan should include a GLP-1RA or a dual GIP/GLP-1RA with demonstrated or potential benefits on MASH. 
  • In adults with overweight or obesity and moderate-tosevere obstructive sleep apnea, the treatment plan should prioritize obesity medications with demonstrated improvements in sleep apnea. 
  • In adults with overweight or obesity and moderate osteoarthritis, the treatment plan should prioritize a GLP-1RA or dual GIP/GLP-1RA with potential improvements in osteoarthritis symptoms.

Long-term Management of Obesity Medications

  • Obesity medications requiring dose escalation should be initiated at a low dose and uptitrated gradually, as needed, based on tolerability and clinical response. 
  • Continue obesity medications after reaching treatment goals to maintain health benefits, as discontinuation often results in weight recurrence and worsening or reemergence of cardiometabolic risk factors or obesity-related diseases and complications. The individualized maintenance dose should balance efficacy, health benefits, and tolerability and therefore may not necessarily be the maximum approved dose.
  • In individuals with an inadequate response to current obesity medication, intensify treatment to improve outcomes. Dose escalation to maximum dose is recommended. If maximum tolerable dose is already used, then consider switching to an alternative obesity medication, adding intensive lifestyle therapy, combining obesity medications, or referring to metabolic-bariatric surgery.

Lifestyle Intervention With Obesity Medications

  • Nutrition recommendations should be tailored to individuals’ preferences and nutritional needs. Consider referral to a registered dietitian nutritionist.
  • Counsel and regularly monitor individuals using obesity medications to ensure adequate nutritional intake, with particular attention to preventing protein insufficiency and micronutrient deficiencies during the active phase of weight reduction.
  • Counsel individuals treated with obesity medications on the need for adequate protein intake and muscle strengthening activities to minimize muscle loss that occurs with weight reduction.

Special Populations and Circumstances

  • Obesity medications should not be used during pregnancy, in individuals actively trying to become pregnant, or during lactation. 
  • Individuals of childbearing potential with obesity being considered for obesity medication should be counseled on contraception options and the impact of some obesity medications on contraception efficacy. 
  • Preconception planning should address the time frame for discontinuing obesity medications, and optimal treatment of obesity and related diseases and complications in preparation for pregnancy. 
  • Use of compounded products that are not approved by the FDA is not recommended due to uncertainty about their content and resulting concerns about safety, quality, and effectiveness. 
  • If an obesity medication is unavailable (e.g., in shortage), a switch to a different FDA-approved obesity medication is recommended, as clinically appropriate. Upon resolution of the unavailability, reassess the appropriateness of resuming the original FDA-approved obesity medication.

Clinical Practice Considerations With Obesity Medications

  • Clinical practices that are unable to implement the recommended infrastructure to support the pharmacologic treatment of obesity should consider referring people to health care professionals with competency in obesity medicine. 
  • Health care professionals who prescribe obesity medications should be knowledgeable on their efficacy, indications, contraindications, adverse effects, benefits, and financial costs. 
  • Health care professionals should complete a comprehensive evaluation for obesity and obesity-related diseases and complications on each person before prescribing an obesity medication. 
  • Clinical practices should provide behavioral and lifestyle therapy for people prescribed obesity medications. If in-house services are unavailable, refer to and collaborate with structured lifestyle programs, registered dietitian nutritionists, or other qualified health care professionals with expertise in delivering these interventions. 
  • After initiating an obesity medication, health care professionals should arrange for follow-up with individuals at least monthly during the first 3 months of treatment to support positive medication-taking behavior by assessing efficacy, managing adverse effects, and monitoring health status. Follow-up can be delivered via telehealth or delivered by interprofessional members of the treatment team, such as registered dietitian nutritionists or nurses, to facilitate timely and effective care. 
  • For the remainder of the first year of obesity medication treatment, individuals should have follow-up visits at least every 3 months with trained health care professionals to continue monitoring efficacy and safety. Thereafter, follow-up visit frequency may be reduced to every 6 months for long-term management. 
  • Clinical practices should consider allocating resources to manage prior authorizations for obesity medications as a strategy to reduce the likelihood that these requirements alter health care professionals’ treatment decisions.

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