The American College of Physicians (ACP) recently released a clinical guideline for adults with overweight or obesity. The guideline, Pharmacologic Treatments with Lifestyle Modifications in Nonpregnant Adults with Overweight or Obesity in Outpatients Settings, presents a couple of clinical recommendations on first-, second-, third-, and fourth-line pharmacological treatments for adults with overweight (BMI 27 to 30 kg/m2) or obesity (BMI ≥30 kg/m2) in the outpatient setting, based on the latest evidence.
The recommendations apply to nonpregnant adult patients who have no experience with pharmacologic or surgical weight loss interventions, along with those who have tried lifestyle modifications and did not achieve the desired results. The ACP stated their intention to maintain the guideline as a living guideline, due to it being an active area of research and a priority topic for clinical care. For the complete look at the rationale for the following recommendations, view the full-text version.
Recommendations from the 2026 Guideline:
ACP suggests initiating one of the following pharmacologic treatments with lifestyle modifications for weight management in nonpregnant adults with obesity (body mass index ≥30 kg/m2) in outpatient settings:
- First-line: Semaglutide, tirzepatide.
- Second-line: Phentermine-topiramate
- Third-line: Liraglutide
- Fourth-line: Naltrexone-bupropion
ACP suggests initiating one of the following pharmacologic treatments with lifestyle modifications for weight management in nonpregnant adults with overweight (body mass index ≥27 to 30 kg/m2) and type 2 diabetes, dyslipidemia, hypertension, obstructive sleep apnea, or cardiovascular disease:
- First-line: Semaglutide, tirzepatide
- Second-line: Liraglutide
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