Aim: To describe the design and methodological aspects of the upcoming European Association for the Study of Obesity (EASO) Framework for the Pharmacological Treatment of Obesity utilizing currently available evidence.Methods: An expert panel of 13 members, selected by EASO, developed the framework using the GRADE methodology to ensure transparent, evidence-based guideline development. Clinical questions were formulated using the Population, Intervention, Comparator, Outcomes (PICO) framework, focusing on the effectiveness and safety of European Medicines Agency-approved obesity management medications (OMM), including orlistat, naltrexone/bupropion, liraglutide, semaglutide, and tirzepatide. A comprehensive literature search will be conducted using Medline and Embase, including randomized controlled trials with a minimum duration of 48 weeks. Meta-analyses and network meta-analyses will be conducted to compare treatment effectiveness and safety profiles across various patient subgroups.Results: The guidelines will target adults with a body mass index (BMI) ≥27 kg/m² and at least one weight-related comorbidity or a BMI ≥30 kg/m². The primary endpoint will be total body weight loss (TBWL%). Secondary outcomes will be changes in body composition (i.e., fat mass, fat-free mass), metabolic improvements (i.e., glucose levels, HbA1c, lipid profile), remission of obesity-related comorbidities (i.e., type 2 diabetes, obstructive sleep apnoea syndrome, metabolic dysfunction-associated steatotic liver disease, cardiovascular disease, and knee osteoarthritis), and improvements in mental health and quality of life. Preliminary analyses suggest that this framework will provide structured, individualized treatment recommendations based on the latest evidence.Conclusions: The EASO framework aims to optimize pharmacological treatment for obesity through an individualized, evidence-based approach. By integrating clinical efficacy, safety outcomes, and patient-specific factors, these guidelines will support healthcare professionals in improving obesity management and its related comorbidities.

Aim: To describe the design and methodological aspects of the upcoming European Association for the Study of Obesity (EASO) Framework for the Pharmacological Treatment of Obesity utilizing currently available evidence.Methods: An expert panel of 13 members, selected by EASO, developed the framework using the GRADE methodology to ensure transparent, evidence-based guideline development. Clinical questions were formulated using the Population, Intervention, Comparator, Outcomes (PICO) framework, focusing on the effectiveness and safety of European Medicines Agency-approved obesity management medications (OMM), including orlistat, naltrexone/bupropion, liraglutide, semaglutide, and tirzepatide. A comprehensive literature search will be conducted using Medline and Embase, including randomized controlled trials with a minimum duration of 48 weeks. Meta-analyses and network meta-analyses will be conducted to compare treatment effectiveness and safety profiles across various patient subgroups.Results: The guidelines will target adults with a body mass index (BMI) ≥27 kg/m² and at least one weight-related comorbidity or a BMI ≥30 kg/m². The primary endpoint will be total body weight loss (TBWL%). Secondary outcomes will be changes in body composition (i.e., fat mass, fat-free mass), metabolic improvements (i.e., glucose levels, HbA1c, lipid profile), remission of obesity-related comorbidities (i.e., type 2 diabetes, obstructive sleep apnoea syndrome, metabolic dysfunction-associated steatotic liver disease, cardiovascular disease, and knee osteoarthritis), and improvements in mental health and quality of life. Preliminary analyses suggest that this framework will provide structured, individualized treatment recommendations based on the latest evidence.Conclusions: The EASO framework aims to optimize pharmacological treatment for obesity through an individualized, evidence-based approach. By integrating clinical efficacy, safety outcomes, and patient-specific factors, these guidelines will support healthcare professionals in improving obesity management and its related comorbidities.

Introduction: Loss of skeletal muscle mass and function (sarcopenia) is common in individuals with obesity due to metabolic changes associated with a sedentary lifestyle, adipose tissue derangements, comorbidities (acute and chronic diseases) and during the ageing process. Co-existence of excess adiposity and low muscle mass/function is referred to as sarcopenic obesity (SO), a condition increasingly recognized for its clinical and functional features that negatively influence important patient-centred outcomes. Effective prevention and treatment strategies for SO are urgently needed, but efforts are hampered by the lack of a universally established SO definition and diagnostic criteria. Resulting inconsistencies in the literature also negatively affect the ability to define prevalence as well as clinical relevance of SO for negative health outcomes. Aims and Methods: The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) launched an initiative to reach expert consensus on a definition and diagnostic criteria for SO. The jointly appointed international expert panel proposes that SO is defined as the co-existence of excess adiposity and low muscle mass/function. The diagnosis of SO should be considered in at-risk individuals who screen positive for a co-occurring elevated body mass index or waist circumference, and markers of low skeletal muscle mass and function (risk factors, clinical symptoms, or validated questionnaires). Diagnostic procedures should initially include assessment of skeletal muscle function, followed by assessment of body composition where presence of excess adiposity and low skeletal muscle mass or related body compartments confirm the diagnosis of SO. Individuals with SO should be further stratified into stage I in the absence of clinical complications or stage II if cases are associated with complications linked to altered body composition or skeletal muscle dysfunction. Conclusions: ESPEN and EASO, as well as the expert international panel, advocate that the proposed SO definition and diagnostic criteria be implemented into routine clinical practice. The panel also encourages prospective studies in addition to secondary analysis of existing data sets, to study the predictive value, treatment efficacy and clinical impact of this SO definition.

Introduction: Loss of skeletal muscle mass and function (sarcopenia) is common in individuals with obesity due to metabolic changes associated with a sedentary lifestyle, adipose tissue derangements, comorbidities (acute and chronic diseases) and during the ageing process. Co-existence of excess adiposity and low muscle mass/function is referred to as sarcopenic obesity (SO), a condition increasingly recognized for its clinical and functional features that negatively influence important patient-centred outcomes. Effective prevention and treatment strategies for SO are urgently needed, but efforts are hampered by the lack of a universally established SO definition and diagnostic criteria. Resulting inconsistencies in the literature also negatively affect the ability to define prevalence as well as clinical relevance of SO for negative health outcomes. Aims and Methods: The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) launched an initiative to reach expert consensus on a definition and diagnostic criteria for SO. The jointly appointed international expert panel proposes that SO is defined as the co-existence of excess adiposity and low muscle mass/function. The diagnosis of SO should be considered in at-risk individuals who screen positive for a co-occurring elevated body mass index or waist circumference, and markers of low skeletal muscle mass and function (risk factors, clinical symptoms, or validated questionnaires). Diagnostic procedures should initially include assessment of skeletal muscle function, followed by assessment of body composition where presence of excess adiposity and low skeletal muscle mass or related body compartments confirm the diagnosis of SO. Individuals with SO should be further stratified into stage I in the absence of clinical complications or stage II if cases are associated with complications linked to altered body composition or skeletal muscle dysfunction. Conclusions: ESPEN and EASO, as well as the expert international panel, advocate that the proposed SO definition and diagnostic criteria be implemented into routine clinical practice. The panel also encourages prospective studies in addition to secondary analysis of existing data sets, to study the predictive value, treatment efficacy and clinical impact of this SO definition.