Beyond GLP-1s: Reimagining obesity care in gastroenterology

Clinical Takeaway: Use GLP-1s as part of a broader, multidisciplinary obesity-care plan—one that considers clinical obesity, comorbidities, patient selection, endoscopic options, surgery, and long-term maintenance.

Obesity management is moving beyond BMI and beyond medication alone, creating a larger role for gastroenterologists and hepatologists who routinely treat obesity-related GI and liver disease.

The rapid rise of GLP-1 receptor agonists has reshaped obesity treatment, but a new Gastroenterology commentary argues that medications are only one part of the next chapter. In “Revisiting POWER in the GLP-1 Age,” AGA experts update the 2017 POWER framework to reflect a treatment landscape now defined by anti-obesity medications, endoscopic bariatric and metabolic therapies, expanded bariatric surgery indications, and early steps toward precision obesity care.

The authors emphasize that obesity should be treated as a chronic, relapsing, systemic disease—not simply as a number on the scale. They highlight the emerging concept of “clinical obesity,” which looks beyond BMI and incorporates excess adiposity, organ dysfunction, cardiometabolic risk, and obesity-related complications.

For gastroenterologists and hepatologists, the message is direct: obesity care belongs in GI and liver clinics. These specialists frequently manage obesity-associated conditions including MASLD, GERD, gallbladder disease, colorectal cancer risk, and GI complications of obesity and its treatments.

The commentary also points to a growing therapeutic toolkit. GLP-1s can produce clinically meaningful weight loss, but access, cost, discontinuation, adverse GI effects, and weight regain remain major challenges. Endoscopic sleeve gastroplasty and other endoscopic therapies may help fill treatment gaps, while bariatric surgery remains the most durable option for many patients with obesity and weight-related comorbidities. Combining medications with endoscopic or surgical approaches may offer greater and more sustained benefit than any single therapy.

“We strongly recommend that gastroenterologists and hepatologists embrace the management of obesity,” the authors write, adding that POWER 2.0 is intended as a “live document” to help practices adopt state-of-the-art obesity care.

The bottom line: In the GLP-1 era, obesity care is not narrower—it is broader, more personalized, and more multidisciplinary.

Source: Acosta A, et al. (2026, June 17). Gastroenterology. Revisiting POWER in the GLP-1 Age