Obesity pharmacotherapy: 2026 update recommendations for the care of persons with obesity in Romania

Cornelia Bala; Catalina Poiana; Gabriela Roman; Nicolae Hancu

Cornelia Bala Department of Diabetes and Nutrition, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
Catalina Poiana Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Gabriela Roman Department of Diabetes and Nutrition, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
Nicolae Hancu Department of Diabetes and Nutrition, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania

Keywords: obesity, anti-obesity agents, incretin-mimetics, guideline

Abstract

This article presents the 2026 update of the FORO (Romanian Obesity Forum) recommendations for the pharmacological management of persons with obesity. The update focuses on the three incretin-mimetic anti-obesity medications (AOMs) currently approved by the European Medicines Agency and available in Romania: liraglutide, semaglutide (including the newly approved 7.2 mg weekly dose), and tirzepatide, a dual GLP-1/GIP receptor agonist. In addition, agents with limited use — orlistat, naltrexone/bupropion, and setmelanotide — are briefly reviewed. A novel risk stratification tool, the RO score (Obesity Risk), is proposed to guide prioritization of pharmacotherapy. The score integrates anthropometric criteria (body mass index [BMI], waist circumference, waist-to-height ratio), Edmonton Obesity Staging System disease stage, and cardiovascular risk category. AOM selection is primarily guided by the presence or absence of obesity-associated complications, with therapeutic decisions supported by evidence from landmark phase 3 trials addressing cardiovascular outcomes, heart failure with preserved ejection fraction, metabolic steatohepatitis, prediabetes, obstructive sleep apnea, and knee osteoarthritis. Practical guidance is provided on contraindications, adverse effects, nutritional monitoring, perioperative management, and use in special circumstances including pregnancy planning. An updated treatment algorithm is included to aid clinicians’ decisions, aligned with current international obesity pharmacotherapy guidelines.