Obesity in adults: FORCE and the GCC-CSO publish the 1st reference position paper on the support of drug treatments for obesity

In France, nearly one adult in two is overweight or obese, a chronic disease associated with major metabolic, cardiovascular, respiratory and osteo-articular complications. The recent arrival of new drug treatments for obesity, with unprecedented efficacy on weight loss and certain comorbidities, marks a major turning point in the management of this pathology, while raising numerous clinical, organizational and ethical questions.

In this context, the Groupe de Concertation et de Coordination des Centres Spécialisés de l'Obésité (GCC-CSO) and the FORCE (French Obesity Center of Excellence) national clinical research network, with F-CRIN accreditation, are publishing a reference position, intended to provide a framework for the use of OMTs in adults and specify the conditions for their support in clinical practice.

Framing the use of TMOs within a global, personalized care strategy

Adapting treatment to the patient's profile

New-generation TMOs enable average weight loss of up to 15-21% of initial weight, depending on dose and molecule used, once weight has stabilized, with variable results depending on molecule and patient. Their benefits go beyond weight reduction alone, however, with positive effects on several complications of obesity.

The document recommends adapting the choice of treatment to the patient's profile, in particular:

• In people with previous cardiovascular disease, without diabetes, semaglutide (2.4 mg per week) is recommended, in view of the available scientific data.
• For people with obesity associated with moderate to severe sleep apnea, tirzepatide (15 mg per week) is recommended, given its marked effect on reducing nocturnal breathing disorders.
• For people with obesity and significant knee pain (osteoarthritis), semaglutide (2.4 mg per week) is also recommended.

Securing prescriptions through nutritional support

The document stresses the importance of structured nutritional support, provided by a trained healthcare professional, throughout the course of treatment.

Digestive side effects (nausea, diarrhea, vomiting), common during dose escalation, are generally transient, but must be anticipated and actively managed, including dietary adaptations.

Several situations require particular vigilance:

• Weight loss that is too rapid or too significant (>10% at three months or >20% at six months), which may expose the patient to a risk of undernutrition;
• The need to maintain a sufficient protein intake (at least 60 g per day) and to practice muscle-strengthening exercises in order to preserve muscle mass and prevent the risk of sarcopenia ;
• The risk of biliary calculi, which may require tailored prevention in the event of rapid weight loss ;
• Particular vigilance when prescribing in cases of severe eating disorders (history of anorexia or bulimic hyperphagia).

Anticipating the challenges of a therapeutic paradigm shift

"This joint position of the GCC-CSO and the FORCE network is in line with our main mission: to promote multidisciplinary management of obesity, based on scientific data and respectful of the people concerned, while anticipating the clinical, ethical and societal issues linked to the rise of drug treatments for obesity", declare Prof. Judith Aron-Wisnewsky, president of the GCC-CSO, and Prof. Emmanuel Disse, co-coordinator of the FORCE network.

Scientific reference: " GCC-CSO position paper on drug treatments for obesity (TMO) in adults and their support in practice", Judith Aron-Wisnewsky, et al. Médecine des Maladies Métaboliques 2025, https://doi.org/10.1016/j.mmm.2025.10.003. (https://www.sciencedirect.com/science/article/pii/S1957255725002871)

Documents available (position paper, argumentation, care pathway, patient information) on the GCC-CSO website: obesitefrance.fr