Gender differences in the relationship between dynapenic abdominal obesity and non-neoplastic digestive system diseases among middle-aged and older adults.

PRIMARY, AGA 2022 (pharmacotherapy, the GI-society spine): Manage obesity as a chronic disease with lifestyle intervention as the foundation. In adults with BMI ≥30 kg/m², OR BMI ≥27 kg/m² with a weight-related complication, who have an inadequate response to lifestyle intervention alone, the AGA STRONGLY recommends ADDING long-term pharmacotherapy to (not replacing) continued lifestyle intervention. Among agents the AGA suggests semaglutide 2.4 mg, liraglutide 3.0 mg, phentermine-topiramate ER, and naltrexone-bupropion ER (all moderate-certainty evidence), and, as lower-certainty options, e.g., where cost is a barrier, phentermine and diethylpropion (low-certainty evidence); when prioritizing for greatest weight loss the panel favored semaglutide 2.4 mg. The AGA suggests AGAINST orlistat and made no recommendation on Gelesis100 (identified as a knowledge gap). Agent choice should be individualized to comorbidities, contraindications, patient preference, and cost/access. COMORBIDITY BRANCHES (attributed separately, NOT part of the AGA document): For obesity-associated MASH, AASLD Practice Guidance supports selecting patients with stage F2-F3 fibrosis by non-invasive tests (VCTE ~8-15 kPa, MRE 3.1-4.4 kPa, or ELF 9.2-10.5) rather than mandatory biopsy, and endorses resmetirom (thyroid hormone receptor-β agonist; FDA-approved March 2024) as the only currently approved pharmacotherapy for MASH (not indicated for MASH cirrhosis). For metabolic/bariatric surgery, the 2022 ASMBS/IFSO indications recommend surgery at BMI ≥35 kg/m² regardless of comorbidity and consideration at BMI 30-34.9 kg/m² with metabolic disease (lower Asian-population thresholds: offer surgery at BMI >27.5, clinical obesity from >25), with multidisciplinary pre-operative evaluation. Concurrently screen for and manage the GI/hepatology comorbidities of obesity (MASLD/MASH, GERD, cholelithiasis).