The World Health Organization (WHO) has for the first time published official guidelines on the clinical use of glucagon-like peptide-1 (GLP-1) agonists in the treatment of obesity. Supporting information on the guideline is also published in the Journal of the American Medical Association (JAMA). Experts have recognized the high effectiveness of the pharmacological approach but accompanied the recommendations with a number of important caveats.
Scale of the Threat and Cost of Inaction
The publication of the document is dictated by a critical situation in global healthcare. Obesity, classified as a chronic relapsing disease, has already been diagnosed in more than 1 billion people.
According to WHO, the situation requires immediate intervention:
- In 2024, obesity caused the death of 3.7 million people.
- Without decisive measures, the number of people with this diagnosis will double by 2030.
- The economic damage from the obesity epidemic by 2030 could reach $3 trillion USD annually.
A New Stage in Obesity Treatment
The document contains recommendations on the use of three key drugs for patients with a body mass index (BMI) of 30 and above: liraglutide, semaglutide, and tirzepatide.
The new WHO guideline provides two main recommendations with “conditional” status:
- GLP-1 agonists may be used for the long-term treatment of obesity in adults, excluding pregnant women. Despite the evident effectiveness of these drugs for treating obesity and improving metabolic and other indicators, the recommendation is conditional due to a lack of data on their long-term effectiveness and safety, maintenance and discontinuation of treatment regimens, as well as taking into account their current high cost, insufficient readiness of health systems for their introduction, and the possible exacerbation of inequality in care provision.
- Adults with obesity prescribed GLP-1 agonists may be recommended intensive behavioral therapy, including dietary improvement and physical activity. This recommendation is based on low-certainty evidence that such therapy can improve treatment outcomes.
“To reverse this global crisis trend, medications alone are not the solution, but GLP-1 therapies can help millions of people reduce their obesity and related health harms”.
— Dr. Tedros Adhanom Ghebreyesus, WHO Director-General
Availability Crisis and the Shadow Side
Inequality of access causes serious concern. Even under an optimistic scenario, by 2030, fewer than 10% of patients in need worldwide will be able to receive the drugs. To avoid a situation where life-saving medicines are available only to wealthy segments of the population, WHO calls on governments to implement joint procurement mechanisms and consider voluntary licensing for the production of affordable generics.
In addition, high demand has provoked the growth of the black market. WHO warns of the spread of falsified products that threaten patients’ lives. Combating counterfeits requires strict control of supply chains and the prescription of therapy exclusively by qualified doctors.
