In a landmark decision addressing a growing global health crisis, the World Health Institution this week issued its first-ever guidelines for the use of pharmaceutical interventions-specifically, GLP-1 receptor agonists like semaglutide-in long-term obesity treatment. Affecting an estimated one billion people worldwide,obesity is increasingly recognized as a chronic disease requiring sustained medical attention. The WHOS recommendation, added to its List of Essential Medicines, signals a notable policy shift and aims to improve access to these therapies, though challenges related to cost and equitable distribution remain.
The World Health Organization (WHO) has, for the first time, issued guidelines recommending therapies with GLP-1, such as semaglutide, for the treatment of obesity in adults. This decision addresses a growing global health crisis, as obesity now affects an estimated one billion people worldwide.
The WHO formally recommended the use of a specific class of drugs to combat obesity on Monday, June 5, 2023, a move long anticipated and signaling a shift in how this chronic disease is approached. The recommendation, the first of its kind from the United Nations agency, covers medications known as glucagon-like peptide-1 (GLP-1) receptor agonists, which include substances like semaglutide and liraglutide.
This decision includes these therapies on the WHO’s List of Essential Medicines, a reference document listing drugs considered indispensable for any robust public health system. The model list currently includes 532 items. The stated goal is to guide national policies and, crucially, to push for more universal and financially accessible access to these treatments, the high cost of which has been a significant barrier in many regions. Increased access to effective obesity treatments is a critical step in addressing a condition linked to numerous other health problems.
“We recognize, finally in a clear way, that obesity is a chronic disease. And as such, it requires comprehensive and persistent care throughout life,” said Tedros Adhanom Ghebreyesus, WHO Director-General, during a public announcement in Geneva. However, he cautioned against viewing these medications as a quick fix, emphasizing that they alone will not resolve the global crisis. Instead, he described them as a powerful clinical tool within a broader strategy that also includes public policies creating healthier food environments and early risk detection.
The effectiveness of these drugs, initially developed for type 2 diabetes, in controlling weight is well-documented. They work by suppressing appetite and delaying gastric emptying. The WHO’s recommendation is classified as “conditional” and is directed toward long-term treatments – those lasting more than six months – for adults with obesity, excluding pregnant women. The “conditional” label reflects remaining uncertainties, including limited data on very long-term effects, logistical challenges for health systems, and the potential for prohibitive costs and exacerbated inequalities in access.
This tension between potential benefits and accessibility is particularly evident in Portugal. Currently, these medications are only covered by the state when prescribed for diabetes. Data from Infarmed, the Portuguese health authority, reveals that the class of antidiabetic drugs – which includes these medications – accounted for 354.6 million euros in the National Health Service’s accounts between January and September of the current year. This substantial cost partially explains the authorities’ restrictive stance.
The off-label popularity of these medications for weight loss has, at times, led to intermittent supply problems for patients with diabetes. In response, Infarmed launched a comprehensive audit program in January of all distribution chains for some of these medications, aiming to curb diversions and ensure stock for the approved indication. This local response reflects a global dilemma that the WHO’s new recommendation, while lacking legal force, now brings to the forefront for policymakers.
NR/HN/Lusa
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