A first-ever guidance recommending the use of glucagon-like peptide-1 (GLP-1) therapies for the treatment of obesity in adults has been issued by the World Health Organization – in what the global health agency said is a “conditional” sign of approval for the cutting edge medications that have become widely popular. 

The new WHO recommendations go well beyond those of its Essential Medicines List (EML) issued in September, which recommended the drugs only for diabetes. 

And they should have widespread ramifications for policy decisions in countries where the drugs have not yet been approved. Worldwide, more than one billion people are obese, leaving individuals susceptible to a host of health conditions like diabetes, heart disease, and some cancers. 

The highly-sought after drugs, sold under brand names like Wegovy®, Ozempic®, and Zepbound® in the United States, were initially only recommended by WHO for the treatment of Type II diabetes – when it added the active ingredients of these drugs to its Essential Medicines List – which guides procurement decisions for many national governments. 

Recognizes obesity is a chronic disease

 “The new guidance recognizes that obesity is a chronic disease that can be treated with comprehensive and lifelong care,” said WHO Director General Dr Tedros Adhanom Ghebreyesus, in a statement. “While medication alone won’t solve this global health crisis, GLP-1 therapies can help millions overcome obesity and reduce its associated harms.”

The WHO did qualify its recommendations, saying endorsement “is conditional due to limited data on their long-term efficacy and safety, maintenance and discontinuation, their current costs, inadequate health-system preparedness, and potential equity implications.”

The drugs should not be used by pregnant women, and should be paired with evidence-based interventions like healthy diets and physical activity, the guidelines also stress. 

Need to assure equitable access

With US consumers comprising nearly 75% of current GLP-1 demand worldwide, the “greatest concern is equitable access” to the new treatments, said Tedros, speaking with journalists earlier this week. 

“Without concerted action, these medicines could contribute to widening the gap between the rich and poor, both between and within countries,” he added. 

And even with ramped up production, these drugs would likely only reach 10% of adults who could benefit from GLP medications in the next five years, the WHO said in a press release. Their guidelines recommended that countries and pharma companies implement several strategies to try to expand access, such as pooled procurement, tiered pricing, and voluntary licensing of what are now patented formulations to local manufacturers. 

Writing in the Journal of the American Medical Association (JAMA), this week, a team of WHO directors and advisors argued that “the availability of GLP-1 therapies should galvanize the global community to build a fair, integrated, and sustainable obesity ecosystem.”

Nearly one in five Americans have used a GLP-1 therapy at least once. And nearly one in eight are currently on the medication. Thirteen states already cover the drugs under Medicaid programmes, despite the enormous up-front cost – with others considering coverage.

While the US currently dominates GLP-1 sales, EU countries, China, and India are expected to make up more of the demand for these drugs in the coming years.

So the question remains whether lower-and-middle income countries, which are facing their own accelerating obesity rates, will have the same level of access. These countries still face barriers to basic diabetes care, the initial intent of use of GLP-1 drugs. 

‘Medication alone won’t solve the obesity crisis’

Despite the excitement and potential of these drugs, the WHO cautioned that obesity treatment still must be paired with healthy diets and physical activity. 

“Medication alone will not solve the obesity crisis,” said Tedros. “Obesity is a complex disease that requires comprehensive, lifelong care. And it has many social, commercial and environmental determinants, requiring action in many sectors – not only in the clinic.”

These other determinants of obesity, such as a food environment rich in high sugar, fat, and salt foods, mean that the global overweight or obese population is expected to reach 60% by 2050.

Countries in Sub-Saharan Africa, the Middle East, and Latin America will be particularly affected by this surge. 

“Obesity is largely preventable,” said the WHO’s assistant director-general for health promotion and disease prevention, Jeremy Farr. “Yet millions of people around the world face environments that make it easier to gain weight and harder to stay healthy.”

Image Credits: David Trinks, KFF.