With the new class of GLP-1 medicines leading to effective weight loss, the World Health Organisation (WHO) on Monday released its first guidelines on their use to combat the obesity crisis. The agency recommended long-term use of these medicines for obesity but added that those prescribed these medicines should also undergo intensive behavioural therapy as part of a multi-pronged approach to treating obesity.
The guidelines refer to obesity as “a chronic disease requiring lifetime care.” It goes on to say that comprehensive treatment for obesity should include screening, early diagnosis and management of obesity-related complications and co-morbidities with pharmaceuticals, surgeries and other treatment options. “Our new guidance recognises that obesity is a chronic disease that can be treated with comprehensive and lifelong care. While medication alone won’t solve this global health crisis, GLP-1 therapies can help millions overcome obesity and reduce its associated harms,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.
There are currently one billion people living with obesity across the world, including 188 million school-aged children and adolescents. If nothing is done to address the crisis, it is estimated that the numbers will double by 2030. And, obesity itself is a risk factor for other chronic conditions such as diabetes and heart diseases.
At present, there are 12 GLP-1 therapies approved for the treatment of obesity or Type-2 diabetes. Another 40 agents, including those that target more than just the GLP-1 receptor, are in active development for various indications and in different formulations, according to the WHO.
While the WHO has supported long-term use of these medicines in adults, except pregnant women, the recommendation is not strong owing to the lack of data on long-term use of the medicines. Dr Nicola Magrini, who was part of the team that developed the guidelines, said there was limited evidence on the long-term use of the drug. More data was needed on issues such as titrating (process of gradual, measured adjustment) the dose down in different settings and continuing on a maintenance dose after a year, he said.
Importantly, the guidelines call for equitable access to these critical medicines. The guidelines say: “Even under the current highest projected scenario, the production of GLP-1 therapies could only cover around 100 million people. While significant, this number represents less than 10% of people currently living with obesity.”
High costs, limited production capacity, and supply-chain were regarded as major barriers to universal access to these therapies. These medicines were included in the WHO list of essential medicines, which would ensure wider access to these drugs in healthcare settings. WHO also proposed manufacturing of generic versions of the drugs, pre-qualification to allow international organisations to purchase these medicines for various countries.
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The guidelines, in addition, propose changes to make the healthcare system more conducive to providing chronic obesity care. This would include “training health care providers, establishing patient registries and referral pathways, strengthening procurement and cold-chain systems, and implementing robust monitoring frameworks,” the guidelines said.
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