WHO Endorses Treating Obesity in Adults With GLP-1s

The World Health Organization (WHO) now recommends the use of glucagon-like peptide-1 (GLP-1) receptor agonists as part of a comprehensive approach for treating obesity in adults.

The recommendation, based on “moderate-certainty evidence,” comes in a guideline issued today, the first such document the WHO has released on pharmacological treatment of obesity in adults (age > 19 years). A separate guideline addressing the treatment of obesity in children and adolescents is forthcoming.

A second recommendation in the current guideline states that intensive behavioral therapy targeting dietary habits, physical activity, and other factors may be offered to adults living with obesity who are prescribed these medications. Here, the advice is based on “low-certainty evidence” that these types of interventions can boost efficacy.

“These new medicines are a powerful clinical tool offering hope to millions, but let me be clear: medication alone will not solve the obesity crisis,” WHO Director-General Tedros Adhanom Ghebreyesus, PhD, said at a media briefing. “Obesity is a complex disease that requires comprehensive lifelong care, and it has many social, commercial, and environmental determinants requiring action in many sectors, not only in the clinic.”

The guideline document is based on evidence of the safety and efficacy for three specific agents—liraglutide, semaglutide (Wegovy; Novo Nordisk), and tirzepatide (Zepbound; Eli Lilly)—when used to treat obesity. Tirzepatide is a dual agonist of the GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) receptors.

Tedros noted that, in September, the WHO added these three agents, along with dulaglutide, to its list of essential medicines for high-risk adults with type 2 diabetes, including those with obesity.

“Obesity is one of the most serious public challenges of our time. Globally, more than 1 billion people are living with obesity, and that number is expected to double by 2030,” he said, adding that about 3.7 million worldwide deaths last year were tied to the “chronic relapsing disease,” which is known to impart higher risks of various cardiometabolic conditions and some cancers.

This new guideline, Tedros said, focuses on GLP-1 and GLP-1/GIP receptor agonists as part of a more comprehensive strategy with three pillars: “First, creating healthier environments through robust policies. Second, protecting individuals at high risk through screening and early intervention. And third, ensuring access to lifelong person-centered care for those living with obesity.”

Let me be clear: medication alone will not solve the obesity crisis. Tedros Adhanom Ghebreyesus

In a special communication simultaneously published in JAMA, Francesca Celletti, MD, PhD (Department of Nutrition and Food Safety, WHO, Geneva, Switzerland), and others involved in the creation of the guideline, note that the new recommendations are conditional, “reflecting that GLP-1 therapies—with or without behavioral therapy—are effective, but limited long-term data, cost, system readiness, equity, variability in patient priorities, and context-specific feasibility remain considerations.

“Implementation of these guidelines depends on equitable access to affordable therapies, health system preparedness, and most importantly assurance that care is person-centered, nondiscriminatory, and universally accessible,” they continue. “Given the time required to implement these measures, a priority is a transparent, equitable, evidence-based framework to identify those at highest need while allowing incremental expansion of eligibility as access, capacity, and readiness evolve; this will be the next focus of the WHO guideline.”

Tedros highlighted concerns around equitable access to the GLP-1 and GLP-1/GIP receptor agonists. “Without concerted action, these medicines could contribute to widening the gap between the rich and poor, both between and within countries,” he said. “We must work together on strategies like pool procurement and tiered pricing to make these medicines affordable for all.”

The new document, a key part of the WHO’s acceleration plan to stop obesity, “is built on evidence and shaped by the principle of health for all, ensuring that scientific progress benefits everyone everywhere,” Tedros said.