The World Health Organization has issued its first-ever guidance recommending the use of medications originally designed for type 2 diabetes to treat obesity, a condition impacting an estimated one billion people worldwide and increasingly straining global healthcare systems. While acknowledging the potential of glucagon-like peptide-1 (GLP-1) therapies like semaglutide, the WHO stresses a extensive approach alongside these drugs, including lifestyle changes and increased access. The recommendations arrive as the economic burden of obesity is projected to reach $3 trillion annually by 2030, and as Portugal and other nations grapple with rising medication costs and potential shortages due to off-label use for weight loss.
The World Health Organization (WHO) has, for the first time, recommended expanding the use of a class of medications originally developed for type 2 diabetes to treat obesity, a condition affecting an estimated one billion people globally. This marks a significant shift in how the international health community approaches a growing public health crisis.
The WHO’s first guidance document on therapies using glucagon-like peptide-1 (GLP-1) – which includes medications like semaglutide – suggests these drugs be used in the treatment of obesity in adults as part of a “comprehensive approach” that includes a healthy diet, regular physical activity, and support from healthcare professionals.
The recommendations emphasize that obesity is a “chronic and relapsing disease” impacting individuals across all countries. In 2024 alone, it was associated with 3.7 million deaths worldwide, and without decisive action, the number of people living with obesity is projected to double by 2030.
Currently, the WHO’s Model List of Essential Medicines includes 532 therapies considered indispensable for a basic and universal health system. The WHO’s position, announced on December 2, will help national health systems guide their public policies and improve access to these medications.
The WHO advocates for these treatments – used for both diabetes and obesity – to be universally and financially accessible. Making these medications more widely available could significantly reduce the burden of obesity-related health complications.
“Our new guidelines recognize that obesity is a chronic disease that can be treated with comprehensive care and over the life course,” said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General, during a press conference announcing the new guidance.
Dr. Ghebreyesus stressed that while medications alone won’t solve the global health challenge posed by obesity, “GLP-1 therapies can help millions of people overcome obesity and reduce its adverse effects.”
“These therapies are part of a holistic strategy based on three pillars. First, creating healthier environments through robust policies; second, protecting individuals at high risk by promoting early detection and intervention; and third, ensuring access to person-centered and lifelong care for those living with obesity,” he explained.
“A Powerful Clinical Tool”
GLP-1 therapies, including semaglutide, liraglutide, and dulaglutide, are used to treat type 2 diabetes and obesity by improving blood sugar control, suppressing appetite, and promoting weight loss. These medications work by mimicking a natural hormone that regulates appetite and glucose metabolism.
“Obesity is one of the most serious challenges of our time,” said the WHO Director-General, adding: “These new medicines are a powerful clinical tool that offers hope to millions of people.”
The new WHO guidelines include a recommendation, based on “moderate certainty evidence,” for the use of GLP-1 therapies for the long-term (more than six months) treatment of obesity in adults, with the exception of pregnant women.
Despite the proven effectiveness of these treatments, the recommendation is conditional due to a lack of long-term data on their use, maintenance, and discontinuation, as well as their current costs, inadequate preparation of health systems, and potential equity implications. Further research is needed to fully understand the long-term effects and optimal use of these medications.
The WHO highlights that obesity is a major risk factor for cardiovascular disease, type 2 diabetes, and certain types of cancer, and also contributes to poorer outcomes in patients with infectious diseases. Beyond the health impacts, the WHO projects the global economic cost of obesity will reach $3 trillion (approximately €2.59 trillion) annually by 2030.
In Portugal, these therapies are currently covered by the National Health Service only when used for patients with diabetes. According to data from Infarmed – the National Authority for Medicines and Health Products – the therapeutic class of antidiabetics registered the largest expense for the SNS between January and September of this year, totaling €354.6 million.
Some medications covered in the case of diabetes are often used by individuals seeking weight loss, which has already led to shortages in the market for diabetic patients. As a result, Infarmed announced in January a “broadened” process of audits and inspections throughout the supply chain of certain diabetes medications.
