A new Gastroenterology commentary revisits the American Gastroenterological Association’s 2017 POWER framework, arguing that GLP-1 medicines should be integrated with endoscopic therapies, bariatric surgery and precision medicine to improve long-term obesity outcomes.
Specialists have revisited the American Gastroenterological Association’s 2017 POWER (Practice Guide on Obesity and Weight Management, Education, and Resources) framework in light of the rise of GLP-1–based weight-loss medicines such as semaglutide and tirzepatide. The authors say the popularity of drugs including semaglutide (sold as Ozempic, Wegovy and Rybelsus) and tirzepatide (sold as Mounjaro and Zepbound) has reshaped obesity treatment, but they argue medication alone is not a complete solution.
Published as a commentary in the AGA journal Gastroenterology and titled “Revisiting POWER in the GLP-1 Age,” the update calls for a broader, multidisciplinary model that combines medications with minimally invasive endoscopic procedures and bariatric surgery when appropriate, while incorporating advances in precision medicine.
The authors point to growing evidence supporting endoscopic bariatric and metabolic therapies, including endoscopic sleeve gastroplasty, and they caution against relying on body mass index (BMI) alone to assess obesity-related health risk. The framework also incorporates the emerging concept of “clinical obesity,” describing obesity as a chronic disease that can affect multiple body systems.
The commentary underscores the role of gastroenterologists and hepatologists in obesity care, noting that they frequently treat conditions linked to obesity, including metabolic dysfunction-associated steatotic liver disease (MASLD), gastroesophageal reflux disease (GERD), gallbladder disease and other gastrointestinal complications.
Finally, the authors cite evidence suggesting that pairing GLP-1 medications with endoscopic procedures or bariatric surgery could produce greater weight loss and longer-lasting results than using any single approach alone.
