In recent years, numerous pharmacological treatments have been developed that are transforming the approach to obesity, such as semaglutide, tirzepatide or orfoglipron. The aim of these therapies is to control obesity and prevent and/or reduce associated complications. Recently, the European Association for the Study of Obesity, in collaboration with other European associations, has published two evidence-based guidelines offering recommendations to support clinicians’ decision-making and achieve the best outcomes for patients. Dr. Andreea Ciudin, coordinator of the Comprehensive Obesity Treatment Unit at the Vall d’Hebron University Hospital and principal investigator of the Diabetes and Metabolism group at the Vall d’Hebron Research Institute (VHIR), has coordinated both.

Guideline for the pharmacological treatment of obesity and its complications

One of the guidelines promoted by EASO is an update of a publication of late 2025. The document has been published in Nature Medicine and presented by Dr. Andreea Ciudin at the European Congress on Obesity on May 13 as coordinator of the guideline and co-chair of the EASO Obesity Management Working Group.

As in the original work, the aim of these recommendations is to propose a practical algorithm for personalized pharmacological treatment regarding the use of medications depending on each patient. In this regard, the expert panel considers that the focus should be on real improvements in people’s health and not only on weight loss.

The document especially highlights new developments regarding liver disease, which shifts from being a secondary outcome to becoming a relevant criterion for clinical decision-making. For example, it is detailed that drugs such as semaglutide and tirzepatide have benefits for the liver, especially in the resolution of metabolic dysfunction-associated steatohepatitis (MASH) and in the improvement of liver fibrosis. MASH is a severe form of non-alcoholic fatty liver disease, often associated with obesity and diabetes and which, if it progresses, can cause cirrhosis and hepatocellular carcinoma.

“It is essential that we work to regularly review and update these guidelines based on new studies and clinical trials that are carried out. In this way, we ensure that research findings translate into real improvements for patients”, says Dr. Ciudin.

The importance of a nutritional, functional and psychological perspective

EASO, the European Federation of the Associations of Dietitians (EFAD), and the European Coalition for People Living with Obesity (ECPO) have promoted a second guideline, published in The Lancet Diabetes & Endocrinology, focusing on how to support patients during treatment with the new obesity drugs. This document highlights that these drugs cannot be understood as a standalone solution, but must be integrated into a comprehensive approach that includes healthy eating, physical activity, and psychological support.

In this regard, the guideline warns that the appetite reduction caused by these drugs may entail nutritional risks. Eating less does not always mean eating better, and it can lead to deficiencies in essential nutrients. In addition, digestive side effects are common, often appearing at the start of treatment and which can be minimized with dietary adjustments and a gradual introduction of medication. Therefore, the role of dietitians and nutritionists is key to ensuring a balanced diet, rich in fiber and vitamins and low in fats, and to help manage digestive disturbances.

The guideline also highlights the importance of preserving muscle mass during weight loss. To achieve this, it recommends ensuring adequate protein intake and incorporating physical exercise, especially strength training, as an essential part of the treatment.

Furthermore, the effect that these drugs may have on the relationship with food and on emotional well-being is relevant. Although many patients experience improvements in quality of life, difficulties may also arise, such as the loss of coping mechanisms linked to eating or changes in self-perception. For this reason, psychological support is recommended when necessary.

“Patients taking these drugs need continuous and personalized follow-up. This involves monitoring nutritional status, physical function, and psychological well-being, and adapting treatment based on each person’s progress and experience. The goal is to ensure not only the effectiveness of the drugs, but also their safety and long-term adherence to therapy in order to improve the quality of life of people with the disease”, concludes Dr. Ciudin.