The European Association for the Study of Obesity (EASO) has unveiled a new management algorithm, reaffirming the scientific consensus that obesity is a chronic, relapsing disease requiring sustained, long-term care. The updated guidelines provide a comprehensive, evidence-based framework that moves beyond short-term interventions, advocating for a personalized and multi-faceted management strategy for patients.
The EASO algorithm promotes a modern care model grounded in core lifestyle interventions, including nutrition, physical activity, and behavioural therapy. Recognizing that lifestyle changes alone are often insufficient for sustained results, the guidelines highlight the essential role of obesity management medications (OMMs) and, where appropriate, metabolic bariatric surgery.
A key focus of the new framework is the guidance on tailoring treatment according to a patient’s specific health complications. The algorithm reviewed a range of approved OMMs, noting their differing efficacy and benefits. These medications include orlistat, naltrexone/bupropion, liraglutide, semaglutide, and tirzepatide. The guideline specifies that “semaglutide and tirzepatide should be considered OMMs of choice when a substantial total body weight loss is needed.”
Semaglutide is highlighted as a cornerstone therapy for a broad spectrum of patients with obesity and multiple co-existing health conditions. It delivers “substantial weight loss of over 10%” and has demonstrated benefits in reducing all-cause mortality and achieving type 2 diabetes remission.
The guideline also provides condition-specific recommendations:
Obesity with cardiovascular disease: “Semaglutide was the only recommended OMM due to its proven ability to reduce Major Adverse Cardiovascular Events (MACE).”
Obesity with heart failure: “Both semaglutide and tirzepatide should be considered as first-line treatments.”
Obesity with knee osteoarthritis: “Semaglutide should be considered as the first-line treatment as it reduces pain associated with this condition.”
Obesity with type 2 diabetes or prediabetes: “Semaglutide and tirzepatide are first-choice medications and liraglutide and naltrexone–bupropion are second-line treatments.”
Obesity with liver disease or obstructive sleep apnoea: “Tirzepatide was the recommended OMM.”
The algorithm underscores that “obesity management must be continuous,” noting that discontinuing medication often results in weight regain. This approach reflects a broader shift towards managing obesity with the same long-term commitment as other chronic diseases, combining lifestyle adjustments and pharmacotherapy to enhance patient health and quality of life.