GLP-1 medications have changed the conversation around weight loss, but obesity care is not becoming a one-treatment field. A new peer-reviewed commentary from the American Gastroenterological Association argues that the future of obesity treatment will likely depend on a broader, more personalized approach that may include medications, lifestyle support, endoscopic procedures, bariatric surgery and better ways to measure health risk.
The article, published in Gastroenterology, is not a new clinical trial and does not test whether one treatment works better than another. Instead, it updates a 2017 obesity care framework called POWER, short for Practice Guide on Obesity and Weight Management, Education and Resources, in light of major changes in the field. Several authors reported financial ties to companies involved in obesity medications, nutrition, medical devices or related therapies, including Novo Nordisk, Medtronic, Amgen, General Mills, Nestlé and others.
The timing matters because medications such as semaglutide and tirzepatide have quickly shifted public expectations around weight loss. These drugs can be highly effective for some people, but the commentary emphasizes that medications alone may not address the full complexity of obesity as a chronic disease.
One major theme is that body mass index, or BMI, is too limited to serve as the only measure of obesity-related health risk. BMI can describe weight in relation to height, but it does not show where body fat is stored, how a person’s metabolism is functioning or whether obesity-related complications are already present. The commentary incorporates the emerging idea of “clinical obesity,” which looks beyond BMI and considers how excess body fat may be affecting organs, daily function or long-term health.
That distinction could matter for patients who have the same BMI but very different health profiles. One person may have metabolic dysfunction-associated steatotic liver disease, type 2 diabetes, reflux disease or joint pain, while another may not have the same complications. The authors argue that obesity care should increasingly account for those differences rather than relying on weight alone.
The commentary also highlights a larger role for gastroenterologists and hepatologists. These specialists often see patients with conditions linked to obesity, including fatty liver disease, gallbladder disease, gastroesophageal reflux disease and gastrointestinal complications. Because of that, the authors suggest GI specialists may be well positioned to help identify obesity-related risks and connect patients with appropriate treatment options.
For some people, that may include anti-obesity medications. For others, the care plan may involve endoscopic bariatric and metabolic therapies, such as endoscopic sleeve gastroplasty, or bariatric surgery. The article also discusses the possibility that combining GLP-1 medications with endoscopic or surgical procedures may produce more durable weight loss than using one approach alone.
That idea is still an evolving part of obesity care. The commentary does not prove that combination treatment is the right choice for most people, and it does not replace individualized medical guidance. Rather, it reflects a broader shift toward matching treatment to a person’s biology, health risks, preferences and previous response to care.
Precision medicine is another area the authors identify as part of obesity treatment’s next chapter. As researchers learn more about genetics, metabolism, appetite regulation and gut-brain signaling, doctors may eventually be able to better predict which patients are most likely to respond to specific medications, procedures or other interventions.
The conflict-of-interest disclosures for this article included: Andres Acosta reported licensing relationships involving research technologies and companies including Gila Therapeutics and Phenomix Sciences; consulting fees from companies including Structure Therapeutics, Rhythm Pharmaceuticals, Gila Therapeutics, Amgen, General Mills, Regeneron, Boehringer Ingelheim, Novo Nordisk, Currax Pharmaceuticals, Nestlé, Phenomix Sciences, Busch Health and RareDiseases; speaker honoraria and funding support from the National Institutes of Health, the Delaney Foundation, the Dairy Management Institute, Vivus, Apollo Endosurgery, Satiogen Pharmaceuticals, Spatz Medical, Rhythm Pharmaceuticals, Regeneron, Boehringer Ingelheim and Novo Nordisk. Janese Laster-Butler reported being a speaker for Novo Nordisk. Naresh Gunaratnam reported being a co-founder and chief medical officer of Lean Medical, an endoscopic obesity device startup. Rohit Kohli reported a research grant from Epigen, consulting work for Ipsen, Mirum Pharmaceuticals and Madrigal Pharmaceuticals and service on a Data and Safety Monitoring Board for iECure. John Magaña Morton reported consulting for Medtronic, Olympus, Novo Nordisk, Regeneron, Boehringer Ingelheim and Teleflex.