Obesity Treatment: WHO's Global Guidelines on GLP-1 Drugs

Context

The World Health Organization (WHO) has issued global guidelines for the first time supporting the use of GLP-1 receptor agonist drugs for the long-term treatment of obesity. This guideline emphasizes viewing obesity as a chronic disease, not a problem that can be cured solely through lifestyle changes.

What is Obesity ?

• Obesity is a condition characterized by excessive body fat accumulation that poses a health risk.
• According to the WHO, individuals with a BMI of 30 or more are considered obese.
• Obesity is a major cause of diseases such as heart disease, diabetes, high blood pressure, stroke, and some cancers. It is now considered a chronic, progressive, and relapsing disease.
• More than one billion people worldwide are obese, and 3.7 million deaths are expected to be associated with obesity in 2024.

What are GLP-1 medications ?

• GLP-1 receptor agonist medications are a group of drugs originally developed to treat type 2 diabetes.
• They mimic the GLP-1 hormone found in the body, which regulates appetite and increases insulin production.

Functions:

• They reduce appetite and slow stomach emptying, leading to fewer calories consumed.
• They regulate blood sugar.
• They improve metabolic health and reduce burden on the heart and kidneys.
• They have been shown to induce weight loss of up to 10–20% when taken long-term.

About the WHO GLP-1 Guidelines

• Conditional recommendations have been issued on the use of GLP-1 drugs for the long-term treatment of obesity in adults.
• In 2024, WHO included GLP-1 drugs for diabetes on the Essential Medicines List.
• Their long-term use is now also supported for the treatment of obesity.
• Obesity is no longer an individual problem but a public health priority.

Key Guidelines

WHO recommends a model for obesity management based on three pillars:

1. Creating a healthy environment
2. Identifying individuals at risk and early intervention
3. Lifelong, person-centered care
   • These drugs are not approved for use in pregnant women.
   • The drugs cannot be used alone. They must be used in conjunction with a diet plan, exercise, and counseling.
   • The WHO has warned that without proper price controls and health system preparedness, access to these drugs could be unequal.
   • There are concerns that by 2030, less than 10% of those who could benefit from them will have access to these drugs.

Indian Government Efforts

• India has intensified efforts to combat obesity through programs such as the National Health Policy, the Fit India Movement, the Nutrition Campaign, and the School Health Program.
• Given the rising incidence of obesity and diabetes, the government is also working on healthy food labeling, trans-fat restrictions, and sugar reduction strategies.
• India is studying WHO guidelines to align the availability, affordability, and safety of these drugs with India's health system.

Challenges

• GLP-1 drugs are very expensive and not widely available.
• There is limited data on their long-term effects, safety, and weight regain after discontinuation.
• Awareness about obesity and related diseases is low in rural areas.
• Health systems lack expert counseling and structured programs.
• Social stigma associated with obesity prevents many people from seeking treatment.

Way Forward

• Making GLP-1 drugs affordable and gradually incorporating them into India's health system.
• Running extensive awareness programs on healthy eating and physical activity in schools and communities.
• Viewing obesity as a 'chronic disease' rather than a 'lifestyle problem' and adopting new treatment models.
• Developing better infrastructure for both obesity prevention and treatment through public-private partnerships.
• Increasing long-term research to provide clear scientific evidence on the safety and long-term effects of GLP-1s.