Shifting the Paradigm: ACC Recommends GLP-1 Drugs as First-Line for Weight Loss

In a significant shift in medical guidance, the American College of Cardiology (ACC) has announced that popular obesity medications, specifically GLP-1 receptor agonists, can now be considered a first-line strategy for weight management, on par with diet and exercise. This new guidance, published in the Journal of the American College of Cardiology, emphasizes optimizing cardiovascular health.

Beyond Diet and Exercise: A New Era in Weight Management

For years, lifestyle interventions like diet and exercise have been the primary recommendation for weight loss. However, the ACC’s new concise clinical guidance promotes current-generation nutrient-stimulated hormone (NuSH) therapies – notably semaglutide (Ozempic, Wegovy) and tirzepatide (Zepbound, Mounjaro) – as upfront pharmacological tools.

“Patients should not be required to ‘try and fail’ lifestyle changes prior to initiating pharmacotherapy; nonetheless, lifestyle interventions should always be offered in conjunction with NuSH therapies,” stated Olivia Gilbert, MD, MSc, and her colleagues from Atrium Health Wake Forest Baptist Medical Center.

Why the Shift? Effectiveness and Cardiovascular Benefits

The ACC’s updated stance is rooted in compelling evidence:

• Greater Weight Loss: While lifestyle modifications typically lead to an average weight loss of around 10%, semaglutide can achieve closer to 15%, and tirzepatide up to 20%.
• Proven Cardiovascular Protection: Unlike lifestyle interventions alone, GLP-1 drugs have demonstrated significant reductions in adverse cardiovascular outcomes. Semaglutide, for instance, was FDA-approved last year for cardiovascular protection based on the large SELECT trial. Tirzepatide has also shown promise in reducing heart failure risk in specific patient populations.
• Lower Risk than Surgery: The ACC committee highlighted that these modern obesity medications are “more effective than lifestyle interventions and with less risk than procedure-based interventions” like bariatric surgery.

“Weight management by the cardiovascular community needs to be embraced, given both the prevalence of obesity and the impact it has on many forms of CVD [cardiovascular disease],” said Dr. Gilbert.

Important Considerations

While this is a promising development for many, the ACC acknowledges several factors that need addressing:

• Eligibility: Candidates for GLP-1 drugs should have their eligibility determined by Body Mass Index (BMI) or other relevant risk indicators.
• Access Challenges: Significant barriers remain regarding insurance coverage and the high cost of these medications (estimated yearly costs in the U.S. are $14,080 for semaglutide and $8,126 for tirzepatide). Obesity alone is currently not covered under Medicare Part D.
• Side Effects: While generally well-tolerated, gastrointestinal adverse effects are common. There are also emerging concerns about eye-related complications, such as nonarteritic anterior ischemic optic neuropathy and neovascular age-related macular degeneration.

This new guidance from the American College of Cardiology marks a pivotal moment in the approach to weight management, recognizing the potent role of these medications in improving cardiovascular health. It underscores the importance of a personalized treatment plan, combining medication with continued lifestyle interventions, to achieve the best outcomes for patients.

Gilbert, O, Gulati, M, Gluckman, T. et al. 2025 Concise Clinical Guidance: An ACC Expert Consensus Statement on Medical Weight Management for Optimization of Cardiovascular Health: A Report of the American College of Cardiology Solution Set Oversight Committee. JACC. null2025, 0 (0) .

https://doi.org/10.1016/j.jacc.2025.05.024