WHO'S GUIDANCE ON GLP-1 THERAPY FOR OBESITY

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Picture Courtesy: Times of India

Context:

The World Health Organization (WHO) has classified obesity as a chronic disease and released its first guidelines on the use of Glucagon-Like Peptide-1 (GLP-1) for weight-loss therapies.

What is obesity?

Obesity is a chronic medical condition in which excess body fat accumulates to the extent that it impairs health, increases disease risk, and reduces quality of life. Clinically, obesity is most commonly identified when Body Mass Index (BMI) is 30 or higher

Current Status of obesity:

• According WHO, globally, obesity has reached epidemic proportions, with around 1 in 8 people now living with obesity, reflecting a dramatic rise over the past three decades.
• More than 5 billion adults are overweight, and nearly 900 million of them are obese, indicating that excess weight is now a mainstream health condition rather than an exception.
• In India too, obesity is rising sharply, with around one-fourth of women and nearly one-quarter of men now overweight or obese, marking a shift from a once-urban and elite issue to a nationwide challenge.
• India may face hundreds of millions of obese adults by 2050 unless aggressive prevention, awareness, and treatment measures are scaled up. (Source: The Lancet)

 What is Glucagon Like Peptide -1(GLP-1) therapy?

Glucagon-Like Peptide-1 (GLP-1) therapy refers to the use of medicines that mimic the natural hormone GLP-1, which is produced in the gut and helps control appetite, blood sugar, and metabolism.

 How GLP-1 therapy helps in controlling obesity?

Rewiring Appetite Control: GLP-1 therapy reduces hunger by acting on brain centres that regulate appetite, making individuals feel full with smaller quantities of food. This biological support helps curb overeating without the constant struggle of dietary restraint.

Prolonging Satiety Through Slower Digestion: By slowing the emptying of the stomach, GLP-1 medicines extend the feeling of fullness after meals. This smoother digestive pace reduces snacking impulses and helps maintain a lower overall calorie intake.

Improving Glucose and Hormone Balance: The therapy enhances insulin response and suppresses excess glucagon, stabilising blood sugar and reducing fat storage signals. In this way, it corrects metabolic imbalances that often fuel weight gain and cravings.

Enabling Sustained Weight Reduction: Through coordinated effects on appetite, digestion, and metabolism, GLP-1 therapy supports gradual yet meaningful weight loss—often ranging from 10% to 20% of body weight depending on duration and drug type. This loss is accompanied by wider health benefits, including reduced cardiovascular risk and improved metabolic health.

 Key highlights of World Health Organisation:

Conditional recommendation, not blanket approval: Drugs like semaglutide, tirzepatide, and liraglutide are advised only for adults with BMI ≥ 30, and only under clinical supervision.

Therapy must be part of a comprehensive care package: WHO stresses that GLP-1 drugs work best when combined with healthy diet, regular physical activity, and behavioural counselling, and should not be used in isolation.

Equity and access challenges highlighted: Due to high cost and supply constraints, WHO warns that fewer than 10% of eligible people may access these drugs by 2030, unless pricing reforms and pooled procurement are adopted.

Safety and monitoring remain critical: WHO notes uncertainties over long-term use, discontinuation effects, potential muscle loss, and side-effects like nausea—calling for close medical follow-up.

Significant clinical benefits acknowledged: Evidence shows 15–25% body-weight reduction, along with improvements in blood sugar, cardiovascular risk, kidney health, and quality of life, when continued long-term.

 What are the challenges in using GLP-1 therapy for Obesity?

• High-cost limits accessibility, making these medicines available mainly to urban or affluent populations while excluding those who need them most.
• Supply shortages and manufacturing constraints mean that even eligible patients may struggle to access treatment, especially in low- and middle-income countries.
• Long-term safety data are still limited, leading to uncertainty about effects after discontinuation, potential muscle loss, or metabolic rebound.
• Side effects such as nausea, vomiting, or digestive discomfort require careful dose adjustments and medical supervision, which many health systems cannot consistently provide.
• Weak health system preparedness, including lack of trained obesity specialists, behaviour counsellors, and follow-up mechanisms, makes correct implementation difficult.
• Ethical concerns emerge when drugs are used for cosmetic weight loss rather than for medically indicated obesity, potentially diverting supplies from high-risk patients.

 Conclusion:

GLP-1 therapy represents a major advance in treating obesity as a chronic disease rather than a personal failure, offering meaningful biological support for sustained weight loss and metabolic improvement. Yet its promise will only translate into public health gains when issues of affordability, access, long-term care, and lifestyle integration are addressed, making it not just a medical breakthrough but a test of health system equity and policy readiness.

 Source: Times of India