Adult Overweight and Obesity Management: Updates From the 2025 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guidelines

DESCRIPTION: Obesity is a chronic, relapsing neurohormonal disease associated with substantial morbidity, mortality, and health care burden among U.S. veterans and active-duty service members. Advances in obesity assessment and treatments since publication of the 2020 clinical practice guideline (CPG) on management of adult overweight and obesity from the U.S. Department of Veterans Affairs (VA) and the U.S. Department of Defense (DoD) prompted an update of the guideline. This synopsis highlights key 2025 recommendations that are relevant to primary care practice. METHODS: The VA/DoD Evidence-Based Practice Work Group (WG) convened a multidisciplinary panel of clinical stakeholders to update the guideline. A systematic review of evidence published from 1 April 2019 through 6 January 2025 was conducted to address 12 key questions developed using the PICOTS (population, intervention, comparator, outcomes, timing of outcomes measurement, and setting) framework. An independent third party reviewed the evidence. Recommendations were formulated using GRADE (Grading of Recommendations Assessment, Development and Evaluation) methods, incorporating evidence quality; benefits and harms; patient values informed by focus groups; and consideration of resources, equity, acceptability, and feasibility. RECOMMENDATIONS: for Asian adults) along with waist circumference and clinical context to refine risk. The WG strongly recommends comprehensive lifestyle intervention (CLI) as the foundation of care. There was insufficient evidence to recommend for or against delaying pharmacotherapy relative to CLI and no requirement to complete CLI before initiating additional treatments. The guideline supports flexible, individualized integration of pharmacotherapy and CLI and discourages discontinuation of effective medications to prevent weight regain. New and updated recommendations address medications containing glucagon-like peptide-1 receptor agonists, endoscopic therapies, and metabolic and bariatric surgery, promoting patient-centered, stigma-informed, longitudinal care tailored to veterans and service members.