The explosion in use of GLP-1 drugs such as semaglutide and tirzepatide has transformed how obesity is treated, yet experts stress that medications alone are not the final answer. A new commentary in the journal Gastroenterology argues that the real revolution in obesity care will come from combining drugs with procedures, surgery, and precision medicine.
The paper revisits the influential POWER framework, a practice guide on obesity and weight management first released in 2017. Under the title “Revisiting POWER in the GLP-1 Age,” the authors update the model to reflect the rise of potent weight-loss injections, expanding endoscopic options, and more widespread bariatric surgery.
Beyond the GLP-1 boom
GLP-1 receptor agonists such as Ozempic, Wegovy, Mounjaro, and Zepbound have delivered weight loss of 15 % or more in many patients, far surpassing older drugs. This has helped reframe obesity as a treatable chronic disease rather than a matter of willpower, and has pushed primary care and specialty clinics to build new obesity programs.
Yet the authors warn that access, cost, side effects, and uncertain long-term adherence all limit what medications can achieve on their own. They argue that durable obesity care must integrate lifestyle support, psychological care, and interventional treatments tailored to each person’s biology and disease severity.
Rethinking how obesity is defined
The updated POWER framework embraces the concept of clinical obesity, which looks beyond body mass index alone. BMI does not fully capture risks such as fatty liver disease, cardiovascular strain, or sleep apnea, which may appear at lower weights in some groups while others remain metabolically healthier at higher BMIs.
By focusing on obesity as a multi-system disease, the new approach encourages earlier intervention for patients showing organ damage or metabolic dysfunction. It also supports using imaging, blood tests, and genetics to refine risk assessment rather than relying solely on weight cutoffs.
Endoscopic and surgical options grow
Alongside medications, evidence has mounted for endoscopic bariatric and metabolic therapies such as endoscopic sleeve gastroplasty. These procedures reduce stomach volume without full surgery, offering meaningful weight loss and metabolic gains with shorter recovery times than traditional bariatric operations.
At the same time, bariatric surgery itself has become safer and more standardized, with laparoscopic sleeve gastrectomy and gastric bypass delivering long-term weight loss and improvements in diabetes and heart risk. The commentary notes that these tools are increasingly viewed as complementary to GLP-1 drugs rather than as last-resort choices.
Toward combination and precision care
Researchers are now studying how best to combine GLP-1 therapies with endoscopic or surgical approaches to maximize results. Early data suggest that pairing medications with procedures can deepen weight loss and help maintain it, potentially allowing lower drug doses or shorter treatment courses.
Advances in genetics, microbiome research, and metabolism are also moving obesity care toward precision medicine. In the future, clinicians may select specific drugs, procedures, or sequences of therapies based on an individual’s biological profile, response patterns, and risk of complications.
Gastroenterologists’ expanding role
The authors emphasize that gastroenterologists and hepatologists are central to this shift because they frequently treat complications closely tied to obesity. These include metabolic dysfunction-associated steatotic liver disease, gastroesophageal reflux disease, gallstones, and other gastrointestinal problems that worsen as body weight and visceral fat increase.
Given this front-line experience, the commentary urges these specialists to take a more active role in screening for obesity, counseling patients, and coordinating multidisciplinary care. That may involve working with endocrinologists, surgeons, dietitians, and mental health professionals to deliver comprehensive, long-term management.
As GLP-1 demand continues to surge and supply remains tight in some markets, the updated POWER framework is designed to help clinicians balance enthusiasm for new drugs with realistic, holistic strategies. The authors argue that the coming decade of obesity care will be defined not by a single blockbuster medication, but by the intelligent integration of multiple tools around each patient’s needs.
