WORLD OBESITY DAY – Most people living with obesity are now in low and middle-income countries (LMICs), according to the World Obesity Federation (WOF) – yet people living in these countries are least likely to have access to the Glucagon-Like Peptide-1 (GLP-1) medicine that is transforming treatment outcomes in wealthier countries.

Around one billion people are currently living with obesity, and four billion people – almost half the world’s population – are projected to be overweight or obese by 2035. Obesity in children has risen from 4% in 1975 to 20% by 2025.

People with obesity are at greater risk of non-communicable diseases (NCDs), particularly heart disease, stroke, high blood pressure and diabetes.

The GLP-1 drugs are transforming obesity treatment after years of behaviour-based policy interventions have failed to stop the rise of obesity.

In clinical trials of newer GLP-1 drugs such as semaglutide (Wegovy), obese patients without diabetes lose 15%–25% of their body weight over 12 to 18 months.

The World Health Organization (WHO) issued its first guidelines for their use to address obesity last December. (Several have already been approved as essential drugs to treat type 2 diabetes).

Around 10 million people in the US were estimated to be on GLP-1 drugs in 2025, and this is projected to rise to 25 million by 2030. Australians, New Zealanders and Europeans are also embracing the drugs.

Scarce and expensive

But these medicines are scarce in LMICs despite the growing need. Between 2010 and 2022, obesity more than doubled across all LMICs and tripled in low-income countries, according to the WOF.

In South Africa, for example, the prevalence of obesity in adults rose by 38% between 1998 and 2017, affecting 28% of the adult population, with women having double the rate of men.

But GLP-1 drugs are “currently prohibitively expensive, prone to massive repeated supply shortages, and unavailable from state clinics and most medical aids”, according to South African clinicians Dr Francois Venter and Dr Nomathemba Chandiwana.

The monthly cost of the medication varies from around $100 to $300, way out of the reach of the vast majority of South Africans.

Only four of the 20 countries most impacted or projected to be most impacted by rising obesity rates cover obesity medicine in their public health systems, according to the Economist Impact’s Global Obesity Response Index.

Only the UK covers all four forms of evidence-based obesity care – nutrition counselling, intensive behavioural therapy, medications, and metabolic and bariatric surgery –through public insurance.

Canada, China, Mexico, Nigeria, Rwanda and South Africa offer no national-level coverage of any of these interventions.

“Without deep price reductions and scalable care systems, obesity treatment will remain out of reach, and health systems will continue to absorb the far higher costs of untreated disease,” according to the Medicines Patent Pool this week.

However, access to GLP-1 medicine should improve as the key compound patents for semaglutide (Wegovy) expire within the next few months, with generic medicine poised to enter the market.

Curbing ultra-processed food

While medicine is key to reducing obesity, so too are policy measures to rein in the industries that promote ultra-processed food that drives the condition.

Key interventions are high taxes on ultra-processed food and sugary drinks; front-of-package warning labels on food high in sugar, salt and fat; and restrictions on marketing these products to children.

However, of the 20 most affected countries, only one – Mexico – taxes both unhealthy foods and drinks, according to the Global Obesity Response Index.

Only three – Brazil, Canada, and Mexico – require front-of-package nutrition labelling.

Image Credits: Flip.