WHO backs use of GLP-1 drugs for weight loss, along with diet, exercise

In a much-anticipated development, the World Health Organization has finally issued global guidelines on the use of popular weight loss drugs. These glucagon-like peptide-1 (GLP-1) therapies are being used for the treatment of obesity in adults.  

The WHO guidelines released on December 1 posit equitable access as the key element of using such therapies, and read them as one element of a full complement of actions against obesity. “While medication alone won’t solve this global health crisis, GLP-1 therapies can help millions overcome obesity and reduce its associated harms,” WHO director general Tedros Adhonom Ghebreysus said, while launching these guidelines.  

With the guidelines, the WHO recognises that the GLP-1 class of drugs are indeed effective, and that they are likely to have an impact on the global costs of obesity. Beyond its health impacts, the global economic cost of obesity is predicted to reach $3 trillion annually by 2030. The guidelines can help efforts to reduce the skyrocketing health costs associated with managing the condition and associated health complications, the WHO said.  

Conditional recommendation

There are two primary components to the WHO’s recommendations: That GLP-1 therapies may be used by adults, excluding pregnant women, conditionally, for the long-term treatment of obesity; and that intensive behavioural interventions in diet and physical activity must be continued alongside the drugs. The WHO also specified that while the efficacy of these therapies in treating obesity and improving metabolic and other outcomes was evident, it was making a conditional recommendation partly because of the limited data available on long-term efficacy, safety and probable outcomes when the drugs are discontinued, but also because of their costs which put them out of the reach of many people. 

Obesity is a complex chronic disease and a major driver of noncommunicable diseases, such as cardiovascular diseases, type 2 diabetes, and some types of cancer. It also contributes to poorer outcomes for patients who have infectious diseases. It is only in recent years that the treatment for obesity has been revolutionised by the emergence of a class of drugs that not only effect significant weight loss, but also confer a whole range of metabolic benefits to individuals. 

Equitable access needed

A special communication in the recent issue of JAMA notes that “medication alone cannot solve the global obesity burden. The availability of GLP1 therapies should galvanise the global community to build a fair, integrated, and sustainable obesity ecosystem. Countries must ensure equitable access not only to comprehensive disease management, but also to health promotion and prevention policies and interventions targeting the general population and those at high risk.” 

Anoop Mishra, director of the National Diabetes, Obesity, and Cholesterol Foundation, said: “I believe this statement by the WHO is a progressive step towards obesity management worldwide. For India, the costs of these drugs is a roadblock that needs more efforts, insurance coverage and development of generics. The real impact will be there only if a large segment of the population is able to afford these drugs.”  

V. Mohan, chairman of the Madras Diabetes Research Foundation, added: “It is good that the WHO’s guidelines specify that the drugs alone will not suffice. People will think, ‘all I need to do is take this weekly injection, and then I’m done. I don’t need to follow a diet, or exercise.’ Here, the WHO clearly says no. Your diet and exercise are paramount, and only when those fail, and when you really need the help of a drug or if morbidly obese, then you go for these drugs.”