WHO Issues First Guidelines on GLP-1 Receptor Agonists for Obesity Treatment

The World Health Organization (WHO) released its inaugural guideline on using glucagon-like peptide-1 (GLP-1) receptor agonists to treat obesity this week, providing conditional recommendations for the medications within a broader strategy that focused on dietary modifications, exercise, and health care professional support.

Obesity, defined by WHO as a body mass index of 30 kg/m² or greater, now affects mroe than 1 billion individuals worldwide and contributed to 3.7 million fatalities in 2024. Without stragetic intervention, WHO estimates that the affected population could double within the next 5 years.

"Obesity is a major global health challenge that WHO is committed to addressing by supporting countries and people worldwide to control it, effectively and equitably. Our new guidance recognizes that obesity is a chronic disease that can be treated with comprehensive and lifelong care," Tedros Adhanom Ghebreyesus, director general of WHO, said in a statement. "While medication alone won't solve this global health crisis, GLP-1 therapies can help millions overcome obesity and reduce its associated harms."

The first-of-its-kind guideline makes 2 conditional recommendations for adult patients with obesity, with pregnancy as an exclusion:

First, clinicians may prescribe GLP-1 therapies for long-term obesity management, though the conditional provision reflects insufficient data regarding "their long-term efficacy and safety, maintenance and discontinuation, their current costs, inadequate health-system preparedness, and potential equity implications," the statement reads. Those reservations notwithstanding, the WHO acknowledges the efficacy of the novel therapies in treating obesity as well as salutory effects on metabolic and related outcomes.

Second, clinicians may provide intensive behavioral programs, including organized interventions focused on nutrition and exercise, to adults with obesity who are prescribed GLP-1 drugs, with the caveat that the evidence for improved outcomes is of low certainty.

WHO stressed that pharmaceutical interventions alone cannot resolve the challenge obesity presents on a personal level but in the aggregate on a societal level. The global agency recommended a broad approach "built with 3 pillars:"

1. Building healthier environments through broad population-based policies for health promotion and obesity prevention
2. Using targeted screening efforts and early intervention to help protect individuals at elevated risk for obesity and its complications.
3. Establising policy that ensures availability of lifelong, individualized medical care.

WHO incorporated GLP-1 therapies into its Essential Medicines List for type 2 diabetes management in high-risk populations last September.² The present guideline offers recommendations specifically for 3 medications approved for sustained management of obesity in adults: liraglutide, semaglutide, and tirzepatide.

Obstacles to Implementation

The guideline tackles implementation obstacles, particularly concerning "fair access" to GLP-1 therapies and healthcare system readiness. WHO estimates that despite accelerated manufacturing, GLP-1 therapies will be accessible to less than 10% of potential beneficiaries by 2030. Without intentional policy measures, availability of these therapies risks widening current health inequities, WHO cautioned. The organization advocates for approaches to broaden access, such as collective purchasing agreements, graduated pricing models, and voluntary patent licensing.

The WHO guideline authors caution that accelearted worldwide demand for GLP-1 therapies has driven proliferation of counterfeit and inferior products, "threatening patient safety and trust." Maintaining product quality, the guideline emphasizes, requires regulated distribution channels and prescribing by credentialed healthcare professionals, robust regulatory oversight, patient education, and international collaboration for public health protection.

Guideline is a Living Document

The organization formulated these guidelines after Member States requested assistance in confronting obesity-related challenges. The development process required a thorough examination of existing research and discussions with diverse parties, including individuals personally affected by obesity. These guidelines represent a central component of WHO's accelerated obesity prevention initiative and will receive periodic revisions as fresh data becomes available.

In the coming year, WHO plans to partner with relevant parties to promote creation of a clear and fair system for determining treatment priority, directing interventions toward the most severely affected individuals first.

The worldwide economic burden of obesity is forecast to total $3 trillion yearly by 2030, according to WHO. Beyond financial implications, obesity accelerates noncommunicable conditions including heart disease, T2D, and certain cancers, while worsening clinical outcomes for patients with infectious diseases. The guideline may support initiatives to decrease healthcare expenditures linked to managing obesity and its related complications.