ADA's Obesity Association publishes 2026 standards for obesity medications

The Obesity Association, a division of the American Diabetes Association, published a new guideline on January 13, 2026, that calls for offering obesity medications as part of an initial treatment plan for adults who have obesity along with a high risk of, or existing, related diseases and complications ^[1][2].

The document, "Pharmacologic Treatment of Obesity in Adults," is the next section of the Standards of Care in Overweight and Obesity. It runs 23 pages and appears in the inaugural edition of Diabetes, Obesity, and Cardiometabolic CARE and in BMJ Open Diabetes Research & Care ^[1][3].

"Through the Standards of Care in Overweight and Obesity, we continue to build the body of trusted, evidence-based guidelines in obesity care," said Samar Hafida, MD, vice president of the Obesity Association ^[1][3].

Weight-loss targets and drug choices

The guideline sets thresholds rather than one goal for everyone: at least 5% of body weight for all adults treated with obesity medications, at least 10% for managing complications such as MASH (a form of fatty liver disease), heart failure with preserved ejection fraction and knee osteoarthritis, and at least 15% for greater benefit in certain cases, particularly moderate-to-severe obstructive sleep apnea ^[2]. HCPLive reports that a 10% to 15% reduction improved blood sugar, blood pressure and cholesterol measures more than a 5% to 10% reduction ^[3]. Goals should be individualized and reassessed about every three months, the guideline says ^[2].

The drug-selection table pairs options with specific conditions ^[2]:

• Prediabetes: tirzepatide and semaglutide have demonstrated benefit; phentermine-topiramate, liraglutide and orlistat have potential benefit.
• Type 2 diabetes: GLP-1 receptor agonists and dual GIP/GLP-1 receptor agonists are preferred, with tirzepatide, semaglutide and liraglutide listed as demonstrated.
• High blood pressure: tirzepatide, semaglutide and orlistat have demonstrated benefit.
• Atherosclerotic cardiovascular disease: semaglutide has demonstrated benefit; liraglutide and tirzepatide have potential benefit.
• Heart failure with preserved ejection fraction, and MASH with moderate or advanced fibrosis: semaglutide has demonstrated benefit.
• Moderate-to-severe obstructive sleep apnea: tirzepatide has demonstrated benefit.
• Moderate osteoarthritis: no drug was listed with demonstrated benefit; semaglutide, tirzepatide and liraglutide were listed as having potential benefit.

Other provisions

Clinicians should minimize or substitute medications that promote weight gain where possible, but should not withhold them if they are needed to reach treatment goals, the guideline says ^[2]. Obesity medications should be prescribed only alongside behavioral therapy and lifestyle changes ^[2]. Because many of these drugs suppress appetite, the authors call for counseling on protein and micronutrient intake and attention to risks such as muscle loss ^[2][3]. Use of non-FDA-approved compounded products is not recommended ^[1]. The guideline states that all approved obesity medications are contraindicated during pregnancy or when a person is trying to conceive, and suggests stopping at least two months before a planned pregnancy; it notes topiramate has been linked to major congenital malformations ^[3]. For people with limited responses to one drug, low-dose combination therapy is described as an option ^[3].

Why it matters for patients

The guideline gives clinicians a condition-by-condition ranking of which drugs have the strongest evidence, so the recommended medication may depend on whether a person has diabetes, sleep apnea, heart disease or liver disease, not on weight alone ^[2]. It frames obesity medication as long-term treatment with regular monitoring rather than a short course ^[1][2]. It also recommends against compounded versions of these products, which have been a lower-cost alternative for some patients ^[1]. In its announcement, the ADA said obesity accounts for up to 53% of new cases of type 2 diabetes each year and that 136 million Americans live with diabetes or prediabetes ^[1].

The standards are guidance for health care professionals, not a coverage decision, and no information was disclosed about whether insurers or pharmacy benefit managers will adopt them.