Supplementary Material for: Development of the European Association for the Study of Obesity (EASO) Grade-Based Framework on the Pharmacological Treatment of Obesity: Design and Methodological Aspects.

Aim: To describe the design and methodological aspects of the upcoming European Association for the Study of Obesity (EASO) Framework for the Pharmacological Treatment of Obesity utilizing currently available evidence.
Methods: An expert panel of 13 members, selected by EASO, developed the framework using the GRADE methodology to ensure transparent, evidence-based guideline development. Clinical questions were formulated using the Population, Intervention, Comparator, Outcomes (PICO) framework, focusing on the effectiveness and safety of European Medicines Agency-approved obesity management medications (OMM), including orlistat, naltrexone/bupropion, liraglutide, semaglutide, and tirzepatide. A comprehensive literature search will be conducted using Medline and Embase, including randomized controlled trials with a minimum duration of 48 weeks. Meta-analyses and network meta-analyses will be conducted to compare treatment effectiveness and safety profiles across various patient subgroups.
Results: The guidelines will target adults with a body mass index (BMI) ≥27 kg/m² and at least one weight-related comorbidity or a BMI ≥30 kg/m². The primary endpoint will be total body weight loss (TBWL%). Secondary outcomes will be changes in body composition (i.e., fat mass, fat-free mass), metabolic improvements (i.e., glucose levels, HbA1c, lipid profile), remission of obesity-related comorbidities (i.e., type 2 diabetes, obstructive sleep apnoea syndrome, metabolic dysfunction-associated steatotic liver disease, cardiovascular disease, and knee osteoarthritis), and improvements in mental health and quality of life. Preliminary analyses suggest that this framework will provide structured, individualized treatment recommendations based on the latest evidence.
Conclusions: The EASO framework aims to optimize pharmacological treatment for obesity through an individualized, evidence-based approach. By integrating clinical efficacy, safety outcomes, and patient-specific factors, these guidelines will support healthcare professionals in improving obesity management and its related comorbidities.