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Practice Guideline
. 2025 Aug 10;197(27):E797-E809.
doi: 10.1503/cmaj.250502.

Pharmacotherapy for obesity management in adults: 2025 clinical practice guideline update

Sue D Pedersen  1 , Priya Manjoo  1 , Satya Dash  1 , Akshay Jain  1 , Nicole Pearce  2 , Megha Poddar  1
Affiliations
Practice Guideline

Pharmacotherapy for obesity management in adults: 2025 clinical practice guideline update

Sue D Pedersen et al. CMAJ. .

Abstract

Background: Pharmacotherapy is a key component of comprehensive obesity management, alongside behavioural therapy and metabolic and bariatric surgery. In this guideline, we update the pharmacotherapy recommendations in the 2020 Canadian clinical practice guideline on obesity in adults and in the 2022 pharmacotherapy for obesity management revision to provide current recommendations for clinicians on the efficacy, safety, and appropriate use of pharmacotherapy in the management of obesity in adults.

Methods: This guideline update follows the same methodology as the 2020 Canadian guideline on obesity in adults, adhering to the Appraisal of Guidelines for Research and Evaluation instrument and using the Shekelle framework to assess and grade evidence and to formulate recommendations. Building on the search conducted for the 2022 pharmacotherapy revision, we conducted a systematic literature review (search dates January 2022 to July 2024), supplemented by relevant trials published through May 2025, to identify studies assessing the efficacy of pharmacotherapy for weight management. We also conducted 13 targeted searches on the management of weight-related complications in 13 subpopulations with important adiposity-related health issues. We engaged primary care physicians, obesity medicine specialists, and people with lived experience of obesity to provide feedback on the recommendations.

Recommendations: This update includes 6 new and 7 revised recommendations since the 2022 pharmacotherapy guideline revision (all 2020 pharmacotherapy recommendations are updated). Measures of central adiposity, in addition to ethnicity-specific body mass index and adiposity-related complications, should be used to guide the decision to initiate pharmacotherapy. Obesity pharmacotherapy should be used in conjunction with health behaviour changes and individualized based on a person's specific health needs and in keeping with their values and preferences. Recommendations support long-term use of obesity pharmacotherapy for sustained weight loss and maintenance of weight loss. We provide recommendations for use of specific obesity pharmacotherapies with proven benefit in specific subpopulations - atherosclerotic cardiovascular disease, heart failure with preserved ejection fraction, metabolic dysfunction-associated steatohepatitis, prediabetes, type 2 diabetes, obstructive sleep apnea, osteoarthritis - and for those with certain specific monogenic causes of obesity. We recommend against the use of compounded medications or medications other than those approved for weight loss in people with excess adiposity.

Interpretation: Pharmacotherapy in obesity facilitates clinically meaningful weight loss and important improvements in obesity-related health complications. Clinicians who treat people with obesity with or without obesity-related health complications should appropriately use pharmacotherapy as an integral part of their treatment paradigm.

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Conflict of interest statement

Competing interests:: Sue Pedersen reports receiving grants for clinical trials from Novo Nordisk, AstraZeneca, Sanofi, Eli Lilly, Boehringer Ingelheim, Prometic, and Pfizer, and consulting fees from AstraZeneca, Bausch Health, Eli Lilly, Novo Nordisk, Janssen, Boehringer Ingelheim, Sanofi, Merck, Abbott, Dexcom, HLS, Bayer, AbbVie, Roche, Amgen, and Pfizer. Dr. Pedersen has also received payment for medical education lectures and speakers bureaus from AstraZeneca, Bausch, Eli Lilly, Novo Nordisk, Janssen, Boehringer Ingelheim, Sanofi, Merck, Abbott, Dexcom, HLS, Bayer, and Pfizer, and has received travel support from AstraZeneca, Bausch, Eli Lilly, Novo Nordisk, Beohringer Ingelheim, Abbott, and Dexcom. In addition, Dr. Pedersen reports participating on a data safety monitoring board for Regeneron. Priya Manjoo reports receiving consulting fees from Rhythm Pharmaceuticals, Amgen, HLS Therapeutics, and Merck, and for participating in advisory board meetings for Eli Lilly, Bausch Health, and Novo Nordisk. Satya Dash reports receiving research grants from the Canadian Institutes of Health Research and the Heart & Stroke Foundation Canada; consulting fees from Eli Lilly, Novo Nordisk, Medison, and Rhythm Pharmaceuticals; and honoraria from Eli Lilly and Novo Nordisk. Akshay Jain reports receiving grants for clinical trials from Abbott, Amgen, AstraZeneca, Eli Lilly, Novo Nordisk and Sanofi, and consulting fees for advisory board participation from Abbott, Amgen, AstraZeneca, Eli Lilly, Novo Nordisk, Bausch Health, Bayer, Boehringer Ingelheim, Eisai, Dexcom, Embecta, Gilead Sciences, GSK, HLS Therapeutics, Insulet, Medtronic, Novartis, Roche, Sandoz, Takeda, Ypsomed, and Sanofi. Dr. Jain has also received honoraria for lectures or presentations from Abbott, AbbVie, Antibody, Amgen, AstraZeneca, Eli Lilly, Novo Nordisk, Bausch Health, Bayer, Boehringer Ingelheim, Care to Know, the Canadian Collaborative Research Network (CCRN), Connected in Motion, CPD Network Association, Diabetes Canada, Eisai, Dexcom, Embecta, EOCI Pharmacomm, GSK, HLS Therapeutics, Insulet, Janssen, Master Clinician Alliance, MDBriefCase, Medtronic, Merck, Novartis, Partners in Progressive Medical Education, PocketPills, Pfizer, Roche, Sandoz, Six Degrees, Timed Right, Unik, WebMD, and Sanofi. Dr. Jain reports holding personal stocks in Amgen, Eli Lilly, and Novo Nordisk (total value of less than Can$10 000). Nicole Pearce is a full-time employee of Obesity Canada and owns the Global Obesity Learning Centre, Go Learn. Megha Poddar reports receiving royalties or licences from the Medical Weight Management Centre of Canada; consulting fees and honoraria for education in obesity and diabetes management from Bausch Health, Novo Nordisk, Eli Lilly, EOCI Pharmacomm, CCRN, Janssen, Merck, Antibody Solutions, CPD Network Association, Johnson & Johnson, Boehringer Ingelheim, Rhythm Pharmaceuticals, and the College of Physicians and Surgeons of Ontario; and travel support from Bausch Health, Novo Nordisk, and Eli Lilly. Dr. Poddar has participated on the data safety monitoring board for the OK-TRANSPLANT-2 clinical trial and serves as medical advisor for Nymble Health and Shoppers Drug Mart.

Figures

Figure 1:
Figure 1:
Summary of the guideline recommendations. See Related Content tab for accessible version. Note: BMI = body mass index.
See this image and copyright information in PMC

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