The World Health Organisation (WHO) on Monday issued global guidelines recommending GLP-1 drugs for the long-term treatment of obesity. According to the WHO, this disease affects more than 1 billion people worldwide. The decision comes at a time when demand for drugs like semaglutide and tirzepatide has surged, and countries are working on how to include these therapies in public health systems. This announcement now formalises a shift that could influence medical policy, insurance coverage, and the global effort to combat obesity.
What exactly are GLP-1 drugs?
GLP-1 (Glucagon-Like Peptide-1) drugs mimic a hormone produced in the gut that regulates appetite, digestion, and blood sugar. They help slow gastric emptying so that individuals feel full for longer, reduce hunger signals, and improve insulin regulation, which stabilises blood sugar levels. Although initially developed for type 2 diabetes, clinical trials later demonstrated that at higher doses, these drugs induce significant weight loss, often between 10% and 20% of body weight. Popular GLP-1 medicines include semaglutide (sold as Ozempic/Wegovy), tirzepatide (Mounjaro/Zepbound), and an older molecule, liraglutide (Saxenda).
Why has the WHO issued these guidelines now?
WHO explains that the recommendations reflect the growing understanding of obesity as a chronic, long-term disease rather than a lifestyle issue. According to Director-General Dr Tedros Adhanom Ghebreyesus, obesity requires comprehensive and lifelong care, and global health systems must move away from short-term or stigma-based approaches. The timing also corresponds to a surge in worldwide demand for GLP-1 drugs, accompanied by confusion among countries about coverage, regulation, supply chains, and appropriate use. A unified guideline was needed to help governments make consistent, evidence-based decisions. Additionally, long-duration clinical trials, such as the STEP and SURMOUNT series, have produced strong evidence showing that these drugs improve weight outcomes, reduce cardiovascular risks, and delay the progression of diabetes.
What has the WHO actually recommended?
The new guideline includes two conditional recommendations. First, the WHO advises that GLP-1 drugs may be used for long-term treatment of obesity in adults with a BMI of 30 or higher, except in pregnant women. Second, the organisation stresses that these drugs must be paired with lifestyle-based interventions, including balanced diets, physical activity, and behavioural changes. WHO emphasises that medication alone cannot resolve a complex global health problem such as obesity; it must complement broader, sustained interventions.
Why are the recommendations “conditional”?
Experts note that the conditional rating stems from uncertainties that still surround long-term use of these medicines. Dr Marie Spreckley of the University of Cambridge points out unresolved questions about safety when the drugs are taken at high doses over several years, potential gastrointestinal or pancreatic risks, and how patients respond after discontinuation. Cost remains a critical concern, as GLP-1 therapies can be prohibitively expensive, limiting access, especially in low- and middle-income countries. Health systems also need capacity to monitor patients, adjust dosages, manage side effects, and provide counselling, requirements that many countries are not yet fully equipped for.
What about equitable access?
WHO identifies equitable access as the most urgent challenge. Even with expanded manufacturing, current projections suggest that fewer than 10% of eligible individuals will receive GLP-1 drugs by 2030 due to cost barriers and global shortages. Tedros warned that without a coordinated approach, these medicines could deepen inequalities, particularly between richer and poorer nations and even within societies themselves. To address this, WHO recommends scaling up production, negotiating lower prices, and creating procurement mechanisms such as pooled purchasing, strategies that have succeeded in large-scale health programs for diseases like HIV.
How does this connect to earlier WHO decisions?
In September, the WHO added semaglutide and tirzepatide to its Essential Medicines List, but only for managing type 2 diabetes in high-risk groups. The organisation had stopped short of including them for obesity at that time. The new guideline, therefore, marks a significant evolution in WHO’s position, even though it does not yet declare these medications “essential” for weight management on a global scale.
Who will benefit from the new guideline?
The recommendations apply to adults with a BMI of 30 or above, as well as individuals with obesity-related health risks based on clinical assessment. The guideline does not apply to pregnant women or those with certain medical conditions where the drugs could pose complications. WHO stresses that access pathways must prioritise individuals with the highest medical need.
What happens next and why it matters for governments?
The new guideline places significant responsibility on governments, which must now decide whether GLP-1 drugs should be included in public insurance schemes, how to regulate and monitor their use, and how to prevent misuse for cosmetic or non-medical weight loss. Countries will also need to negotiate prices, plan supply chains, and ensure adequate availability at a time when the global economic burden of obesity is projected to reach $3 trillion annually by 2030.
To support these transitions, the WHO plans to work with governments, manufacturers, and global health organisations in 2026 to develop strategies for procurement, affordability, and prioritisation. This collaborative effort will focus on building health-system capacity, expanding equitable access, and creating mechanisms that ensure GLP-1 therapies reach populations with the highest medical need. The broader aim is to prevent obesity treatment from becoming a privilege limited to wealthy countries or higher-income groups within them.