Why the World Health Organization endorses weight-loss drugs as treatments for obesity | DW News

Key Concepts

• GLP-1 Therapies: Glucagon-like peptide-1 receptor agonists, a class of drugs originally developed for diabetes, now approved for obesity treatment.
• Obesity as a Chronic Relapsing Disease: The WHO's classification of obesity, emphasizing the need for ongoing, comprehensive care.
• Comprehensive Lifelong Care: The multi-faceted approach to managing obesity, involving medication, behavioral therapy, diet, physical activity, and potentially bariatric surgery.
• BMI (Body Mass Index): The WHO's standard metric for classifying obesity (BMI > 30).
• Intensive Behavioral Therapy: Structured interventions focusing on healthy diet and physical activity, recommended in conjunction with GLP-1 therapy.
• Global Assess Ecosystem: The system for ensuring access to medicines, including factors like cost, production, availability, and affordability.
• Essential Medicine List: A WHO list of medicines considered most important for public health.
• Pre-qualification: A WHO process to assess the quality, safety, and efficacy of medicines.

WHO Endorsement of GLP-1 Therapies for Obesity

The World Health Organization (WHO) has endorsed GLP-1 therapies as effective treatments for obesity, recognizing the condition as a chronic relapsing disease. This decision stems from listening to the requests of individuals living with obesity, civil society, and member states burdened by the high prevalence, morbidity, and mortality associated with obesity. After analyzing current evidence and consulting experts, the WHO concluded that GLP-1 therapies are a powerful clinical tool offering hope to millions.

How GLP-1 Therapies Work

GLP-1 therapies, also known as glucagon-like peptide-1 receptor agonists, have been used for diabetes treatment since 2005. They function by:

• Lowering Blood Glucose: A primary effect for diabetes management.
• Reducing Appetite: This leads to decreased food intake and subsequent weight loss.
• Other Metabolic Effects: These are still being investigated but contribute to the overall impact on the body.

Beyond weight loss, these drugs have demonstrated positive impacts on other health outcomes, including reductions in cardiovascular diseases, kidney diseases, liver diseases, and diabetes.

GLP-1 Therapies as Part of a Comprehensive Approach

The WHO emphasizes that GLP-1 therapies are not a standalone solution to the obesity crisis. Instead, they are one tool within a broader, multi-intervention strategy. Obesity is a complex, chronic, and relapsing disease requiring comprehensive lifelong care. This care involves:

• Pharmaceutical Intervention: The use of GLP-1 therapies.
• Behavioral Therapy: Including healthy diet and structured physical activity interventions.
• Bariatric Surgery: As another potential intervention.

The WHO's current guidelines include two recommendations:

1. The use of GLP-1 therapy for adults with obesity (excluding pregnant women).
2. The association of GLP-1 therapy with intensive behavioral therapy, which amplifies the effectiveness of the medication.

The organization stresses that it is not an "either/or" situation but rather a complex interplay of different interventions.

Global Prevalence and Contributing Factors

Contrary to older narratives associating obesity solely with high-income countries, the WHO highlights that obesity is a universal global public health crisis. It is prevalent and poses a significant burden in all countries worldwide. The causes of obesity are complex and multifaceted, encompassing:

• Metabolic Conditions: Biological factors influencing metabolism.
• Socioeconomic Conditions: Factors related to social and economic status.
• Environmental Factors: Including the food environment (availability of healthy foods) and the active environment (safety and accessibility for physical activity).

Profound changes in these environments across the globe contribute to the rising rates of obesity.

Addressing Affordability and Access

The high cost of GLP-1 medicines is a significant concern. The WHO is actively working to shape the global access ecosystem, which is currently immature. Strategies include:

• Inclusion in the Essential Medicine List: To prioritize these drugs for public health.
• Release of Guidelines: To inform and guide healthcare systems.
• Proposing GLP-1 Therapy for Pre-qualification: To ensure quality and potentially facilitate broader access.

However, these efforts are not sufficient. The global community needs to work towards decreasing costs, increasing production, improving availability, ensuring affordability, and promoting sustainability of these medicines.

Cultural Perceptions vs. Medical Definition

The WHO maintains a global definition of obesity based on BMI, with a BMI greater than 30 indicating obesity in adults. While cultural perceptions of body size may vary, the medical classification and the health risks associated with obesity remain consistent. The WHO's guidelines apply this definition universally, irrespective of cultural norms.

Long-Term Management and Discontinuation

Obesity requires lifelong chronic care, which does not necessarily mean lifelong medication. The current WHO recommendation for GLP-1 therapy is conditional due to a lack of long-term data on discontinuation and maintenance of the medication's effects. Therefore, it is not yet definitively known whether these medicines need to be used long-term or lifelong. The recommendation currently suggests long-term use for now. The focus remains on ensuring individuals with obesity receive the best possible ongoing care through the health system.