FORO Algorithm

Selection of Anti-Obesity Medications — Pharmacotherapy of Obesity: Update 2025
Liraglutide 3 mg Semaglutide 2.4 mg Tirzepatide
PwO (BMI ≥30 or ≥27 + comorbidities) → EVALUATION → DECISION FOR PHARMACOTHERAPY
💡 Click any evidence cell for study details and source links
Without Complications
Goals: ↓ fat mass, BMI, WC • Prevention of complications • ↓ CV risk • ↑ QoL
ParameterLiraglutideSemaglutideTirzepatide
Order reflects EMA approval sequence for obesity treatment
With Complications of Obesity
Goal: Reversibility / improvement • Select by evidence per complication
ComplicationLiraglutideSemaglutideTirzepatide
In PwO with multiple complications, prioritise the complication with the most severe prognosis
Evidence colour coding:
Phase III RCT (strong)
Phase II RCT (emerging)
Under evaluation (ongoing)
No dedicated studies
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Semaglutide vs Tirzepatide — FORO Pharmacotherapy of Obesity: Update 2025
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Abbreviations
ASCVD, atherosclerotic CV disease; BMI, body mass index; CV, cardiovascular; HFpEF, heart failure with preserved EF; MACE, major adverse CV events; MASH, metabolic dysfunction-associated steatohepatitis; OSA, obstructive sleep apnoea; PwO, person with obesity; QoL, quality of life; RCT, randomised controlled trial; T2DM, type 2 diabetes mellitus; WC, waist circumference
FORO = Romanian Federation of Diabetes, Nutrition, and Metabolic Diseases + Romanian Society of Endocrinology. Only incretin-mimetic molecules included; other AOM classes are of restricted use. Molecules listed by EMA approval order for obesity treatment.