TOS, OMA and OAC give continuing medication during maintenance a strong recommendation

The Obesity Society (TOS), the Obesity Medicine Association (OMA) and the Obesity Action Coalition (OAC) have published a joint expert guidance statement on obesity medications for US adults, and it gives a strong recommendation to continuing those medications during weight maintenance ^[1][2]. The statement appeared in Obesity on March 5, 2026, in Volume 34, Issue 4, pages 851–870 ^[2].

The panel used the GRADE approach, a standard method that rates both how certain the evidence is and how strongly a recommendation should be worded ^[1]. Evidence synthesis was done through the Epistemonikos databases, and outcomes were chosen for clinical relevance, including weight reduction, quality of life, adverse events and improvements in obesity complications ^[1]. Recommendations came out of consensus workshops and were graded as strong or conditional using the GRADE Evidence-to-Decision framework, weighing certainty, benefits, harms, equity and feasibility ^[1].

What the panel recommended

The statement covers eight FDA-approved obesity medications: orlistat, bupropion-naltrexone, phentermine, phentermine-topiramate, liraglutide, semaglutide, tirzepatide and setmelanotide ^[1]. Strong recommendations were issued for bupropion-naltrexone, semaglutide (sold as Wegovy for weight management and Ozempic and Rybelsus for type 2 diabetes), tirzepatide (Zepbound and Mounjaro) and setmelanotide, each on moderate-certainty evidence ^[1]. The other agents received conditional recommendations, as did use for specific obesity complications: obstructive sleep apnea, heart failure with preserved ejection fraction, metabolic dysfunction-associated steatotic liver disease and steatohepatitis, osteoarthritis, major adverse cardiovascular events and type 2 diabetes ^[1].

Separately from any single drug, the panel gave a strong recommendation to continuing obesity medications during weight maintenance ^[1][2]. In its key messages for clinicians, the statement says obesity medications "are safe and effective when used long-term" and that discontinuing comprehensive obesity care, including medications, without cause — it gives side effects and pregnancy as examples of cause — "can result from inadequate understanding of obesity as a chronic disease, often leading to treatment failure and exacerbating bias and stigma directed at the patients" ^[2].

The panel's stated rationale is framed around access. The authors note that obesity affects more than 40% of US adults, with severe obesity rising, and that the disease remains underdiagnosed and undertreated ^[1]. They list barriers including socioeconomic disparities, limited clinician training, stigma, and "restrictive or absent reimbursement policies" ^[1]. Their conclusion calls for expanding access, reducing stigma and "ensuring equitable coverage," plus head-to-head trials and updates as evidence evolves ^[1].

Why it matters for patients

The practical significance is that a strong GRADE recommendation is a different kind of statement than a conditional one. Under GRADE, a strong recommendation signals that the panel judged the benefits clearly to outweigh the harms for most people in the situation described — here, staying on a medication that is working rather than stopping it once weight has come down ^[1]. That language is what makes guidance documents useful when a treatment plan is being discussed or when a coverage decision is being reviewed.

What the sources do not establish is how insurers will respond. The statement is expert guidance from three professional and advocacy organizations, not a regulation or a coverage rule, and nothing in the published abstract or article front matter says that any health plan has changed its policy because of it ^[1][2]. Whether plans that currently limit duration of coverage will treat this document differently is not yet known from these sources.

Readers weighing the guidance should also know who wrote and paid for it. Funding came from TOS, OMA and OAC ^[1]. Many panel members disclosed financial ties to drugmakers, including consulting fees, honoraria or advisory board roles with Novo Nordisk and Eli Lilly, the makers of semaglutide and tirzepatide ^[1]. The authors say conflicts were managed under ICMJE policies, that recusal procedures were set for members with significant direct financial conflicts such as employment or equity in products under review, and that under that benchmark no recusals were made ^[1].

What happens next

The paper was jointly developed by Obesity Pillars and Obesity and jointly published by Elsevier and Wiley; the two versions are identical apart from minor style differences, and either citation can be used ^[2]. A companion commentary by Beverly G. Tchang and Donna H. Ryan, titled "TOS/OMA/OAC Expert Guidance Statement on Obesity Pharmacotherapy: A Humbling Call to Action," was published the same day at pages 765–769 ^[2]. A correction to an author's name was added on March 7, 2026 ^[2]. The panel says future priorities include integrating obesity care into primary care, improving affordability, filling research gaps, and updating the guidance as new evidence arrives, though no date for an update is given ^[1].