The World Health Organisation has endorsed the use of GLP-1RA therapies for the long-term treatment of obesity but emphasised the “profound equity dilemma” of ensuring universal access.
The agency published its first guidelines on the use of the agents on December 1, supporting their use for adults living with obesity and recommending those prescribed the therapies take part in intensive behavioural therapies alongside medications for the best results.
But while the WHO’s guideline development group said GLP-1RAs represented a global tipping point in obesity management, they were cautious about the knowns of the treatment category.
Both the recommendation for use of GLP-1RA and intensive adjunctive behavioural therapies were rated as conditional, with the panel pointing to uncertainties about their long-term benefits.
“Limited data on long-term efficacy and safety, titration, maintenance and discontinuation with trials still ongoing, together with the high current cost of GLP-1 therapies, inadequate health system preparedness, and potential equity implications, reduced the GDG’s confidence that the benefits of this intervention clearly outweigh its undesirable attributes,” they said.
Inclusive implementation key
The guidelines authors agreed GLP-1RAs were more than a scientific breakthrough, saying their efficacy across diabetes and weight management would guide a “conceptual shift” from considering obesity as a lifestyle condition to a preventable chronic disease.
Yet the global impact of the treatment class would depend on more widespread and fair access to the therapies, something that would be challenging to achieve, according to the panel.
“Even under the current highest projected scenario, the production of GLP-1 therapies could only cover around 100 million people,” the guideline authors said.
“While significant, this number represents less than 10% of people currently living with obesity.”
The first WHO guideline on the use of GLP-1s for obesity were revealed on December 1.
High costs, limited production capacity and supply chain constraints remained major barriers to access, the guidelines committee said.
While conversations about the PBS listing of GLP-1RAs for obesity have ramped up in Australia in 2025, patients do not yet have subsidised access for weight management.
At its November meeting, the Pharmaceutical Benefits Advisory Committee (PBAC) considered an application for the listing of semaglutide for patients with established cardiovascular disease and obesity [link here].
The guidelines also emphasised that GLP-1RAs could solve the global obesity epidemic alone.
“What is needed is a comprehensive, system-wide response addressing prevention, care, and the underlying determinants of obesity,” the authors argued.
“In parallel, large-scale medicine distribution mechanisms must be leveraged to ensure that interventions reach all those in need fairly and a robust platform is built to integrate innovations as they enter the market.”