ACP issues new living clinical guideline on using medications to manage overweight and obesity

Embargoed for release until 5:00 p.m. ET on Monday 15 June 2026   

Follow @Annalsofim on X, Facebook, Instagram, Bluesky, and Linkedin             
Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.   
----------------------------    

1. ACP issues new living clinical guideline on using medications to manage overweight and obesity

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-02714

Summary for Patients: https://www.acpjournals.org/doi/10.7326/ANNALS-25-02714-PS

URL goes live when the embargo lifts             

The American College of Physicians (ACP) has issued a new living clinical guideline to help physicians choose medications with lifestyle modifications to manage overweight and obesity in adults. The guideline is published in Annals of Internal Medicine. 

More than half (59%) of the world’s population has overweight or obesity, chronic conditions that increase the risk of serious health problems including type 2 diabetes, high blood pressure, heart disease, and some cancers. In the United States alone, more than two-thirds (68.5%) of adults have overweight or obesity. 

For nonpregnant adults with obesity (BMI≥30 kg/m²), ACP recommends semaglutide and tirzepatide as first-line options when initiating pharmacologic treatment with lifestyle modifications for weight management. ACP recommends phentermine-topiramate as a second-line treatment, liraglutide as a third-line treatment, and naltrexone-bupropion as a fourth-line treatment. For nonpregnant adults with overweight (BMI ≥27 to 30 kg/m²) and at least one comorbid condition (type 2 diabetes, dyslipidemia, hypertension, obstructive sleep apnea, or cardiovascular disease), ACP recommends semaglutide or tirzepatide as a first-line treatment and liraglutide as a second-line treatment with lifestyle modifications. Lifestyle modifications include improved nutrition and physical activity.

ACP emphasizes that when initiating a recommended medication for weight management or switching to another recommended medication because of an inadequate response, physicians and patients should discuss benefits, harms, costs, access and availability, clinical comorbidities, weight loss goals, life expectancy, values and preferences, and contraindications and warnings. ACP also says physicians should counsel patients about possible unintended side effects of weight loss, including nutritional deficiencies and muscle and bone density loss, especially in older adults. 

ACP designated this as a “living guideline,” which means recommendations will be updated as new evidence becomes available as weight management medications are an area of active research. 

Related Evidence Reviews:

Benefits and Harms of Pharmacologic Treatments in Adults With Overweight or Obesity: A Living Systematic Review and Network Meta-analysis for the American College of Physicians

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-03764

Cost-Effectiveness of Pharmacologic Treatments in Adults With Overweight or Obesity: A Systematic Review for the American College of Physicians

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-03766  

Editorial: https://www.acpjournals.org/doi/10.7326/ANNALS-26-01972

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To speak with someone at ACP, please email Angela Collom at acollom@acponline.org.

---------------------------- 

2. Pre-surgery rehab program linked to fewer complications after spinal fusion in older adults

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-05205

URL goes live when the embargo lifts             

A randomized clinical trial of older adults undergoing elective spinal fusion surgery found that adding a four-week pre-surgery program consisting of exercise, nutrition, and psychological support reduced postoperative complications within 90 days compared with undergoing standard enhanced recovery care alone. Because older adults have an elevated risk for postoperative complications after surgery, the findings suggest that prehabilitation could further benefit this population in addition to enhanced postoperative care. The findings are published in Annals of Internal Medicine.

Researchers from the Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, and colleagues conducted a randomized controlled trial across three tertiary hospitals in China to evaluate whether a structured prehabilitation program in addition to enhanced postoperative care could improve outcomes for older adults undergoing elective spinal fusion surgery. The researchers randomly assigned 164 patients aged 75 years and older to either standard enhanced recovery after surgery (ERAS) care or ERAS plus a four-week, multimodal prehabilitation program that included supervised exercise, nutrition support, and psychological interventions (PREERAS). The researchers found that about 74.7% of patients in the PREERAS group had at least one complication in the 90 days following surgery compared to about 91.2% of patients in the ERAS group. The authors concluded that prehabilitation may help reduce postoperative complications in this population, though considerations such as resources and local care practices may affect how easily the approach can be adopted elsewhere.

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Shibao Lu, MD, PhD please email spinelu@163.com.

---------------------------- 

3. Shingles vaccine linked to lower dementia risk in older adults, study suggests

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-04689

Summary for Patients: https://www.acpjournals.org/doi/10.7326/ANNALS-25-04689-PS

URL goes live when the embargo lifts             

A target trial emulation of older adults entering skilled-nursing facilities found that those who received the recombinant shingles vaccine (RZV) had a lower risk of developing dementia over the following four years compared with those who were not vaccinated. Older adults admitted to skilled nursing facilities are at higher risk for both dementia and shingles, so the findings warrant further research to establish more definitive evidence of the reduced risk for dementia after a shingles vaccination in this population. The study is published in Annals of Internal Medicine.

Researchers from Brown University School of Public Health and colleagues examined whether receiving RZV is associated with dementia risk among adults age 66 and older newly admitted to skilled-nursing facilities. They analyzed Medicare and electronic health record data from more than 500,000 patients and compared those who received at least one vaccine dose within 12 months of admission (including after discharge) with those who did not. The researchers found that those who received RZV had a 24% relative reduction in risk and 6–percentage point absolute reduction in risk for dementia after four years compared with those who did not receive the vaccine. The authors concluded that shingles vaccination was associated with reduced dementia risk, though they also note the study highlights the low uptake of RZV, especially among adults at skilled-nursing facilities.

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Kaleen N. Hayes, PharmD, PhD please email Juan Siliezar at juan_siliezar@brown.edu.

----------------------------