Obesity is a complex, long-term health condition that affects millions of people in Canada and around the world.
Medications, when used alongside other treatments, can be a safe and effective way to improve health in people living with obesity.
A newly updated Canadian guideline for the use of obesity medications reflects the latest research, newly approved treatments, and a stronger focus on personalized care.
The updated document, Pharmacotherapy for Obesity Management in Adults: 2025 Clinical Practice Guideline Update, was published in the Canadian Medical Association Journal.
Lead author Dr. Sue D. Pedersen, an endocrinologist and obesity medicine specialist in Calgary, says the purpose of these medications goes far beyond just helping people lose weight.
“The goal of obesity medications is to improve metabolic, mechanical, and mental health, and enhance quality of life,” Dr. Pedersen explains.
“Treatment plans should reflect what is most important to each individual patient.”
Since the last updates in 2022 and 2020, the guideline has added six new recommendations and revised seven others.
It shifts away from relying solely on body mass index (BMI) as a measure of obesity and instead uses additional indicators like waist circumference, waist-to-hip ratio, and waist-to-height ratio.
These measures can be adjusted based on sex and ethnicity, and the presence of obesity-related health problems—such as diabetes, heart disease, or sleep apnea—are considered in planning treatment.
The guideline also reaffirms that obesity pharmacotherapy is one of the three main pillars of obesity treatment in Canada, alongside behavioural and psychological approaches and, in some cases, surgery.
For many people, medications can help support long-term improvements in health, function, and quality of life when used as part of a comprehensive, individualized plan.
Two new medications—tirzepatide and setmelanotide—are now recommended, and the guideline includes updated advice for treating obesity in people with certain complications, including atherosclerotic cardiovascular disease, heart failure with preserved ejection fraction, and osteoarthritis.
However, the guideline warns against using compounded obesity medications—custom-mixed drugs made outside of standard manufacturing—because of concerns about safety, consistency, and effectiveness.
Despite the growing evidence that obesity is a chronic disease that requires ongoing management, the authors note that access to treatment remains a major issue in Canada.
Only Alberta formally recognizes obesity as a chronic disease, and many public and private drug plans do not cover obesity medications. Cost, stigma, and limited health system support mean that many Canadians who could benefit from these treatments are unable to get them.
“The lack of recognition of obesity as a chronic disease by payers, health systems, the public, and media limits access to treatment,” the authors write.
They hope the updated guideline will encourage more health care providers and policymakers to support evidence-based obesity care, reduce barriers, and help more people receive the treatment they need.
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Source: KSR.
