Obesity has long been recognized as a major driver of type 2 diabetes (T2D), yet until recently, treatment approaches in clinical practice often emphasized lifestyle change while giving limited attention to pharmacotherapy. The landscape shifted dramatically with the advent of GLP-1 receptor agonists and dual GIP/GLP-1 agents, which demonstrated not only substantial weight reduction but also significant improvements in cardiometabolic outcomes. By 2025, these therapies have moved from being viewed as optional adjuncts to becoming core components of evidence-based obesity and diabetes prevention strategies.
The American Diabetes Association (ADA) Standards of Care in Diabetes 2025 reflect this shift. Section 8, focused on obesity and weight management, expands the role of pharmacotherapy, highlighting when and how clinicians should integrate medications such as semaglutide, liraglutide, and tirzepatide into treatment plans. The document underscores obesity as a chronic disease that requires long-term management and links pharmacologic treatment directly to the prevention and management of T2D.
By 2025, these therapies have moved from being viewed as optional adjuncts to becoming core components of evidence-based obesity and diabetes prevention strategies.
This article reviews the ADA’s 2025 updates on obesity pharmacotherapy, explores how these recommendations can be applied in primary care and endocrinology, and considers the broader implications for patient care and healthcare systems.
2025 ADA Standards Obesity and Pharmacotherapy
The American Diabetes Association (ADA) Standards of Care in Diabetes 2025 place unprecedented emphasis on obesity treatment as a cornerstone of type 2 diabetes prevention and management. Section 8, dedicated to obesity and weight management, integrates new clinical trial evidence and formalizes a stronger role for pharmacotherapy alongside lifestyle interventions. For clinicians, this marks an important transition: obesity is no longer treated as an optional target but as a chronic disease requiring the same structured management as hypertension or dyslipidemia.
The 2025 ADA Standards reaffirm lifestyle modification, i.e., nutrition therapy, physical activity, and behavioral support, as the foundation of care. However, the ADA acknowledges that lifestyle strategies alone are often insufficient. Sustained weight loss of more than 5-10% through lifestyle change remains difficult for many patients, especially those at high risk of type 2 diabetes. For these individuals, pharmacologic therapy is recommended earlier and more consistently than in prior versions of the Standards.
Clinical trial data underpin these changes. The STEP program demonstrated that semaglutide 2.4 mg once weekly can achieve average weight reductions of 15% or more, with accompanying improvements in glycemic control and cardiometabolic risk factors. Similarly, the SURMOUNT trials of tirzepatide showed weight reductions of 20% or greater, with many participants moving out of prediabetes ranges. Beyond weight, these agents improve blood pressure, lipid levels, and markers of systemic inflammation i.e., outcomes that translate into reduced long-term diabetes and cardiovascular risk.
The ADA highlights that pharmacotherapy should be considered for adults with BMI ≥30 kg/m², or ≥27 kg/m² with comorbidities, particularly when lifestyle interventions have not yielded adequate results. In the context of diabetes prevention, individuals with prediabetes and obesity may benefit from early initiation of GLP-1 or GIP/GLP-1 therapy. Importantly, the Standards emphasize long-term treatment: medications should not be viewed as short-term aids but as ongoing therapy to sustain weight loss and reduce disease risk. An additional update is the reframing of obesity as a chronic, relapsing disease that requires maintenance therapy. Just as hypertension requires ongoing antihypertensives, obesity pharmacotherapy is expected to be long-term to preserve benefits. Discontinuation often leads to weight regain, as shown in clinical trials, reinforcing the ADA’s position that pharmacotherapy should be maintained unless contraindications or intolerable side effects arise.
The Standards also discuss pharmacotherapy within the context of cardiometabolic risk reduction. GLP-1 receptor agonists and dual agonists are now positioned not only as weight-loss medications but as agents that improve cardiovascular outcomes, reduce progression from prediabetes to diabetes, and support renal protection. The ADA aligns obesity management with the broader goal of comprehensive diabetes prevention, placing drug therapy at the intersection of weight, metabolic control, and cardiovascular health.
Equity and access remain significant challenges. The Standards acknowledge that cost and insurance coverage often limit pharmacotherapy use, especially for underserved populations. Nevertheless, the ADA stresses that clinicians should advocate for patient access, document clinical justification for therapy, and engage in shared decision-making to ensure treatment aligns with patient goals and resources.
The 2025 ADA Standards move pharmacotherapy from the margins to the mainstream of obesity care. The evidence supporting GLP-1 and GIP/GLP-1 therapies is now robust enough that they are recommended as integral to preventing type 2 diabetes and improving overall health outcomes. For clinicians, the Standards provide a clear directive: obesity should be addressed proactively, with medications considered early and sustained as part of comprehensive care.
Applying the Standards in Primary Care
Primary care physicians (PCPs) are on the front line of obesity and diabetes prevention. The 2025 ADA Standards emphasize that the majority of patients at risk for type 2 diabetes will first present in primary care settings, making these providers central to implementing pharmacotherapy recommendations. Translating evidence-based guidance into routine practice, however, requires practical strategies.
Screening remains the main foundation. The ADA recommends annual assessment of BMI and waist circumference in adults, along with evaluation of weight trajectory and comorbidities. For patients with overweight or obesity, clinicians are encouraged to assess readiness to engage in structured weight management. When lifestyle interventions alone fail to achieve clinically meaningful weight loss, generally defined as 5% or greater, primary care providers should discuss pharmacotherapy options.
The Standards make clear that initiating medications such as GLP-1 receptor agonists or GIP/GLP-1 dual agonists is not restricted to specialists. PCPs can and should prescribe these therapies when indicated, provided they are equipped to monitor safety, manage side effects, and coordinate follow-up. Common adverse effects like nausea, vomiting, and gastrointestinal discomfort can often be managed with dose titration and patient counseling. Importantly, PCPs are well positioned to reinforce adherence through regular contact.
Cost and insurance coverage remain persistent barriers. Many patients encounter prior authorization hurdles or high co-pays, discouraging sustained use. PCPs can play a role by documenting comorbidities, such as prediabetes, hypertension, or dyslipidemia, to strengthen coverage appeals. Shared decision-making is emphasized: clinicians should present realistic expectations about weight loss, discuss financial implications, and ensure treatment aligns with patient values.
A team-based approach enhances effectiveness. Nurses, dietitians, and behavioral health specialists can provide counseling, reinforce lifestyle modifications, and monitor progress between visits. The ADA notes that integrating pharmacotherapy into multidisciplinary care improves adherence and outcomes. For example, combining semaglutide with dietary support and behavioral therapy can yield greater long-term weight reduction than any single strategy alone. Primary care settings also face practical workflow challenges. Incorporating weight-management discussions into short visits requires planning. Some practices use dedicated obesity management visits or group sessions, while others integrate digital tools for monitoring weight and blood glucose. Electronic health record prompts can help identify eligible patients and streamline prescribing.
The Standards encourage PCPs to view obesity as a chronic condition that deserves continuous attention, rather than a secondary issue behind other diagnoses. By initiating pharmacotherapy when lifestyle efforts plateau, monitoring closely, and coordinating with specialists when needed, primary care clinicians can play a decisive role in preventing diabetes progression.
In essence, the ADA 2025 Standards empower primary care to move beyond advice and referrals. By prescribing and managing modern pharmacotherapies, PCPs can directly influence outcomes for millions of patients living with obesity and prediabetes.
Endocrinology Practice and Advanced Obesity Management
While primary care provides the entry point for most patients, endocrinologists play a critical role in managing obesity at the more advanced or complex stages. The 2025 ADA Standards highlight the importance of specialist involvement for individuals with severe obesity (BMI ≥40) or for those with multiple, poorly controlled comorbidities such as diabetes, hypertension, and dyslipidemia. Endocrinologists are well positioned to integrate pharmacotherapy into multidisciplinary management strategies that also include lifestyle modification and, when indicated, bariatric surgery.
In endocrine practice, pharmacotherapy is increasingly being used as a bridge between lifestyle interventions and surgical options. For some patients, medications like semaglutide or tirzepatide can reduce weight and improve glycemic control enough to delay or even avoid the need for bariatric procedures. For others, pharmacotherapy may serve as an adjunct before and after surgery to optimize outcomes and minimize weight regain. The Standards note that endocrinologists should tailor therapy not only to BMI thresholds but also to individual risk profiles, incorporating cardiovascular and renal considerations.
GLP-1 and GIP/GLP-1 agents in endocrine care
The ADA places special emphasis on the role of GLP-1 receptor agonists and dual GIP/GLP-1 agonists in endocrine practice. Trials such as SELECT and SURMOUNT have demonstrated substantial benefits: reductions in body weight of 15-20%, decreases in progression from prediabetes to diabetes, and improvements in cardiovascular outcomes. These findings are particularly relevant for endocrinologists, who often treat patients at high cardiometabolic risk.
The Standards recommend that endocrinologists consider these agents for patients with obesity and type 2 diabetes not adequately controlled by metformin or lifestyle measures. GLP-1 and GIP/GLP-1 therapies are prioritized over older pharmacologic options (e.g., orlistat, phentermine/topiramate) because of superior efficacy and stronger evidence for reducing long-term complications. Safety remains important: gastrointestinal side effects and rare risks such as pancreatitis must be discussed with patients. Endocrinologists are also responsible for monitoring kidney function, cardiovascular parameters, and glycemic response to ensure safe, sustained use.
In addition to prescribing, endocrinologists often lead specialized weight-management clinics, where they coordinate with dietitians, behavioral therapists, and exercise physiologists. These centers exemplify the ADA’s call for integrated, patient-centered care. For patients with severe obesity, endocrinologists may be the ones to determine whether pharmacotherapy alone is sufficient or whether a combined strategy that includes bariatric surgery offers the best long-term outcomes. The Standards also emphasize continuity of therapy. Endocrinologists should counsel patients that pharmacotherapy is typically long-term and discontinuation often results in weight regain. By framing obesity as a chronic, relapsing condition, specialists can help patients adjust expectations and commit to sustained treatment plans.
In summary, endocrinology practice is central to advancing the ADA’s 2025 vision of obesity care.
Looking Forward Pharmacotherapy in the Broader Care Landscape
The integration of pharmacotherapy into the ADA’s 2025 Standards reflects a larger shift in how the healthcare system views obesity treatment. Medications like semaglutide and tirzepatide are no longer framed as optional aids but as disease-modifying therapies with long-term implications for public health. The question is no longer whether to use pharmacotherapy, but how to scale it responsibly and equitably. The biggest obstacles are access and affordability.
Healthcare delivery systems also face challenges. Most primary care practices were not designed to provide intensive, chronic obesity management. Integrating pharmacotherapy requires infrastructure for monitoring, adherence support, and coordination with dietitians and behavioral health. Workforce training will be essential: clinicians across specialties need familiarity with prescribing, titrating, and managing GLP-1 and GIP/GLP-1 therapies.
From a public health perspective, the 2025 Standards align pharmacotherapy with prevention goals. If used strategically, these drugs could reduce the incidence of type 2 diabetes across high-risk populations, lowering long-term healthcare costs and improving quality of life. Yet disparities must be addressed: rural populations, minority communities, and low-income patients face the greatest barriers to accessing advanced therapies.
Looking ahead, pharmacotherapy will not replace lifestyle or surgical interventions but will increasingly function as a bridge among them. The ADA’s guidance sets the stage for a more integrated model of care, where obesity is treated as seriously as other chronic diseases. Whether healthcare systems can deliver on this vision will define the next decade of diabetes prevention.
Conclusion
The 2025 ADA Standards of Care represent a pivotal moment in the management of obesity and diabetes prevention. By positioning pharmacotherapy as a routine and evidence-based component of treatment, the ADA acknowledges both the limitations of lifestyle-only strategies and the transformative impact of modern agents like GLP-1 receptor agonists and GIP/GLP-1 dual agonists. These medications have proven efficacy not only in achieving substantial weight loss but also in reducing cardiometabolic risk and delaying the onset of type 2 diabetes. For primary care providers, the Standards clarify that prescribing obesity medications is within scope, provided patients are monitored and supported. For endocrinologists, the guidance reinforces their role in managing complex cases and leading multidisciplinary approaches. Across the spectrum, the message is consistent: obesity should be treated as a chronic, relapsing disease that requires sustained intervention.
Looking forward, challenges remain, particularly the affordability and equitable distribution of advanced pharmacotherapies. Yet, the 2025 Standards establish a roadmap for integrating these treatments into everyday practice. If clinicians, payers, and policymakers align around this vision, pharmacotherapy could become a cornerstone of prevention, changing the trajectory of obesity and diabetes in the United States.
References
- American Diabetes Association. (2025). 8. Obesity and weight management for the prevention and treatment of type 2 diabetes: Standards of Care in Diabetes 2025. Diabetes Care, 48(Suppl. 1), S167-S178. https://doi.org/10.2337/dc25-S008
- American Diabetes Association. (2025). Standards of Care in Diabetes 2025. Diabetes Care, 48(Suppl. 1), S1-S172. https://doi.org/10.2337/dc25-SINT
