The Endocrine Society's Clinical Practice Guideline on the Pharmacological Management of Obesity provides comprehensive recommendations for the use of medications in the treatment of obesity. The guideline is based on evidence from systematic reviews and is developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Key recommendations include: 1. **Comprehensive Management Approaches**: Diet, exercise, and behavioral modification should be included in all obesity management approaches for BMI ≥ 25 kg/m². Pharmacotherapy and bariatric surgery can be used as adjuncts for BMI ≥ 27 kg/m² with comorbidities or BMI > 30 kg/m². 2. **Weight Loss Medications**: Approved weight loss medications can improve long-term weight maintenance and comorbidities in individuals with BMI ≥ 30 kg/m² or BMI ≥ 27 kg/m² with at least one associated comorbidity. Regular assessments of efficacy and safety are recommended. 3. **Contraindications and Cautions**: Sympathomimetic agents like phentermine and diethylpropion are contraindicated in patients with uncontrolled hypertension or a history of heart disease. Other medications should be chosen carefully, considering their potential weight effects. 4. **Off-Label Use**: The guideline discourages the off-label use of medications approved for other indications solely for weight loss, except in research or under expert supervision. 5. **Drugs Causing Weight Gain**: Clinicians should be aware of medications that can cause weight gain and choose alternatives that are weight-neutral or promote weight loss. For example, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and calcium channel blockers are recommended over β-adrenergic blockers for hypertension in obese patients. 6. **Diabetes Management**: For patients with type 2 diabetes (T2DM) who are overweight or obese, antidiabetic medications with additional weight loss effects, such as GLP-1 analogs or SGLT-2 inhibitors, are recommended over metformin alone. 7. **Cardiovascular Disease**: For patients with cardiovascular disease seeking pharmacological weight loss, medications like lorcaserin and orlistat are recommended over sympathomimetic agents. The guideline emphasizes the importance of balancing clinical efficacy with side effects and emphasizes the need for frequent assessments and monitoring to ensure patient safety and effectiveness.The Endocrine Society's Clinical Practice Guideline on the Pharmacological Management of Obesity provides comprehensive recommendations for the use of medications in the treatment of obesity. The guideline is based on evidence from systematic reviews and is developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Key recommendations include: 1. **Comprehensive Management Approaches**: Diet, exercise, and behavioral modification should be included in all obesity management approaches for BMI ≥ 25 kg/m². Pharmacotherapy and bariatric surgery can be used as adjuncts for BMI ≥ 27 kg/m² with comorbidities or BMI > 30 kg/m². 2. **Weight Loss Medications**: Approved weight loss medications can improve long-term weight maintenance and comorbidities in individuals with BMI ≥ 30 kg/m² or BMI ≥ 27 kg/m² with at least one associated comorbidity. Regular assessments of efficacy and safety are recommended. 3. **Contraindications and Cautions**: Sympathomimetic agents like phentermine and diethylpropion are contraindicated in patients with uncontrolled hypertension or a history of heart disease. Other medications should be chosen carefully, considering their potential weight effects. 4. **Off-Label Use**: The guideline discourages the off-label use of medications approved for other indications solely for weight loss, except in research or under expert supervision. 5. **Drugs Causing Weight Gain**: Clinicians should be aware of medications that can cause weight gain and choose alternatives that are weight-neutral or promote weight loss. For example, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and calcium channel blockers are recommended over β-adrenergic blockers for hypertension in obese patients. 6. **Diabetes Management**: For patients with type 2 diabetes (T2DM) who are overweight or obese, antidiabetic medications with additional weight loss effects, such as GLP-1 analogs or SGLT-2 inhibitors, are recommended over metformin alone. 7. **Cardiovascular Disease**: For patients with cardiovascular disease seeking pharmacological weight loss, medications like lorcaserin and orlistat are recommended over sympathomimetic agents. The guideline emphasizes the importance of balancing clinical efficacy with side effects and emphasizes the need for frequent assessments and monitoring to ensure patient safety and effectiveness.