The American College of Cardiology (ACC) recently released new guidelines, Medical Weight Management for Optimization of Cardiovascular Health. The guidelines feature sections on the diagnosis, etiology, and pathophysiology of obesity, risks associated with obesity, the evolution and current landscape of obesity medications, pharmacological options, and more.

Obesity greatly elevates the risk of cardiovascular disease through various physiological pathways, and can also contribute to hypertension causing additional stress to the cardiovascular system. Helping patients manage obesity through medication and non-pharmacological interventions is certainly critical in helping them manage their cardiovascular health as well.

Due to the increasing relevance of obesity medications, the ACC’s new guidelines help clinicians by providing guidance on this major topic. The following rundown represents a summary of key components from the full-text version of the guidelines.

Section 4.1 NuSH Therapies: Rationale and Eligibility

The ACC supports NuSH (nutrient-stimulated hormone) therapies (including GLP-1 and GIP) as critical components of comprehensive obesity care because it is more effective and desirable for patients than lifestyle therapy and bariatric surgery, respectively. These therapies also help curb appetite and allow for dosing to provide individualized care.

Based on data from recent clinical trials, the ACC supports the notion that patients should not need to try lifestyle changes before the use of obesity medications, but such changes should be suggested along with NuSH therapies.

Section 4.3 Pharmacological Options
  • NuSH therapies are noted to be the most effective FDA-approved obesity medications; semaglutide and tirzepatide are the medications of choice.
  • This section features a table (Table 2) that outlines medication, indications, dosages, contraindications, and more.
  • Compound NuSH therapy use is discouraged due to the potential of impurity-containing counterfeit agents and dosing errors.
Section 4.5 General Treatment Considerations
  • Generally, patients should be educated on the risks of nonevidence-based options (such as OTC supplements and compound peptides) and encouraged to pursue evidence-based interventions.
  • Clinicians should implement person-first language that reduces stigma and weight bias to help validate the patient’s unique health challenges with obesity. 
  • Weight-loss goals should be unique to each patient and take into account BMI and comorbid conditions. The ACC notes that a good initial goal is ≥5% weight loss from baseline. A ≥10% weight-loss goal should be used for patients attempting to resolve weight-related comorbid conditions.
  • All weight-loss goals should take into consideration the patient’s quality of life, including psychosocial health and functional status. 
Section 4.6 Multidisciplinary Care Approaches

Patients should meet with behavioral therapists early on to investigate the presence of stressors, identify available social support systems, and help set reasonable, long-term goals. Meeting with exercise physiologists and dietitians has also been observed to help patients reach their goals. Pharmacy support from clinicians also helps with monitoring for any side effects the medications may cause.

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