Yesterday the Canadian Medical Association Journal and Obesity Canada published new clinical guidance for obesity medicines – a leap forward that reflects great clinical progress in pharmacotherapy.

This is the second revision to the chapter on pharmacotherapy since the Canadian guideline for adult obesity care was first published in 2020. The chapter was also updated in 2022 to reflect the approval of semaglutide for obesity treatment in Canada.

The new chapter has six new and seven revised recommendations since the 2022 revision. In comparison to the original recommendations, all are new or revised.

Practical Guidance for Clinicians

One obvious point of reference for this guidance is the Lancet Commission on Clinical Obesity. Now let’s be clear. These publications have radically different objectives. The Lancet Commission aimed very narrowly to define the clinical disease state of obesity. In contrast, the Canadian guidance aims to tell people how to treat the disease of obesity. But the overlap is simple – it is the disease of obesity.

And yet, we see a disconnect. Through the lens of the Lancet Commission, a person with only type 2 diabetes and excess adiposity does not have “clinical obesity.” Type 2 diabetes did not make the cut to be a diagnostic criterion for clinical obesity in the Lancet Commission report. But in the Canadian guidance, someone with obesity and type 2 diabetes has a clear indication for pharmacotherapy.

We asked obesity medicine physician Beverly Tchang about this seeming inconsistency. She told us that this dissonance comes from distinctly different approaches:

“The Canadian guidelines were written by clinicians for clinicians. But the Lancet Commission report was written with scientific, surgical, and clinical inputs as an academic exercise.

“Lancet’s omission of diabetes as a reason to treat obesity doesn’t make sense to many clinicians. It’s at odds with science, clinical insight, and patient experiences.”

More to Come

It is clear that the discussion about the expanding role for pharmacotherapy in obesity has only just begun. So too has the response to the Lancet Commission definition for clinical obesity. We hear widely differing views about it and are confident that people will find ways to bridge those differences.

Interesting work lies ahead.

Click here for the new Canadian Guidance and here for further perspective from the lead author, Dr. Sue Pedersen.

The Missed Leap, lithograph by John Steuart Curry / Smithsonian American Art Museum