The European Association for the Study of Obesity (EASO) has issued new guidance recommending semaglutide and tirzepatide as first-line pharmacological treatments for obesity and its major complications, signalling a significant shift in how the condition is managed across Europe. The guidance highlights the growing role of GLP-1 receptor agonists in addressing obesity, a condition that continues to affect millions and contributes to a wide range of serious health issues.
Traditionally, obesity treatment has focused on lifestyle changes such as diet and exercise, with medication reserved for a smaller subset of patients. However, EASO’s new recommendations mark a turning point, emphasising the efficacy of semaglutide and tirzepatide not only in promoting weight loss but also in improving other obesity-related health outcomes. Clinical trials have shown these medications can produce substantial reductions in body weight, improve blood sugar control, and provide cardiovascular benefits.
The guidance is notable for its tailored approach to specific complications. For individuals with obstructive sleep apnoea, tirzepatide is recommended due to evidence showing it can significantly reduce the severity of the condition. Patients suffering from knee osteoarthritis may benefit more from semaglutide, which has been shown to alleviate pain and improve joint function. For those with prediabetes or type 2 diabetes, both medications are suggested, reflecting their dual role in weight management and glycaemic control. In patients at risk of cardiovascular disease, semaglutide is preferred because of its proven ability to reduce major adverse cardiovascular events. For individuals with metabolic dysfunction-associated steatohepatitis (MASH), tirzepatide is currently recommended, although emerging evidence suggests semaglutide may also be beneficial in this context.
The impact of this guidance on the healthcare system could be considerable. At present, around 1.6 million people are prescribed GLP-1 receptor agonists, predominantly through private healthcare. The National Health Service is exploring ways to expand access, with plans to make these treatments more widely available through pharmacies and digital platforms. Health Secretary Wes Streeting has indicated that broader distribution is a priority, though experts warn that reaching all 3.4 million people who could benefit may take up to 12 years.
Despite the potential benefits, EASO’s guidance also underscores the need for caution. Both semaglutide and tirzepatide can cause side effects, most commonly gastrointestinal issues such as nausea and diarrhoea, and in rare cases, pancreatitis. Additionally, the high cost of these medications remains a significant barrier, particularly for publicly funded healthcare systems. The association stresses that pharmacological interventions should complement, rather than replace, lifestyle changes to achieve the best long-term outcomes.
The emergence of semaglutide and tirzepatide as first-line treatments reflects the broader evolution in obesity care, recognising it as a complex, chronic disease rather than a matter of personal choice. Researchers and policymakers are hopeful that wider access to these therapies could substantially improve public health, reducing the incidence of diabetes, cardiovascular disease, and other complications linked to obesity. However, the practicalities of delivering these treatments to large populations, while managing costs and ensuring patient safety, remain a challenge.
Experts have welcomed the guidance as a positive development. Dr Rachel Batterham, a leading obesity researcher, noted that the medications “represent a step change in how we can support people living with obesity,” particularly those who have struggled with conventional interventions. She added that while the drugs are not a cure, they can provide patients with a critical window to make sustainable lifestyle changes and improve overall health.
The EASO recommendations also come at a time of growing public interest in pharmacological weight management, with media coverage highlighting the potential of these drugs to transform treatment options. There is increasing debate over whether the NHS should provide wider access, given the rising prevalence of obesity and its associated healthcare costs. While private clinics currently offer these treatments, broader access through the public system could help ensure that more people benefit from the latest scientific advances.
Ultimately, the new EASO guidance positions semaglutide and tirzepatide at the forefront of obesity management, signalling a more proactive approach to a condition that has long been under-treated. As research continues and access gradually expands, these medications could play a key role in reducing the burden of obesity-related disease and improving the quality of life for millions of people living with the condition.
