WHO's New Obesity Guidelines: Why Access and Affordability Matter More Than the Drug Itself

The World Health Organization released its first comprehensive guidelines on glucagon-like peptide-1 (GLP-1) medications for obesity in December 2025, conditionally endorsing their long-term use while emphasizing that medication alone cannot solve the global obesity crisis without addressing affordability, health system readiness, and equitable access across diverse populations. The guidelines recognize obesity as a chronic disease affecting more than 1 billion people worldwide—roughly 1 in 8 individuals—with global healthcare costs projected to exceed $3 trillion annually by 2030.

What Does the WHO Actually Recommend About GLP-1 Drugs?

The WHO's conditional endorsement comes with two main recommendations. First, GLP-1 therapies like semaglutide and tirzepatide may be used as long-term treatment for obesity, defined as continuous use for at least 6 months, based on moderate-certainty evidence from clinical trials lasting 26 to 240 weeks. However, this recommendation applies only to adults with obesity and does not extend to people with a body mass index (BMI) between 27 and 30 kg/m² who have obesity-related conditions. The second recommendation suggests that adults taking GLP-1 medications should receive intensive behavioral therapy as part of comprehensive care.

"Our new guidance recognizes that obesity is a chronic disease that can be treated with comprehensive and lifelong care," said Tedros Adhanom Ghebreyesus, director-general of the WHO. "While medication alone won't solve this global health crisis, GLP-1 therapies can help millions overcome obesity and reduce its associated harms".

What Does Intensive Behavioral Therapy Actually Include?

The WHO emphasizes that GLP-1 medications work best when combined with structured lifestyle support. Intensive behavioral therapy in the clinical trials included specific, actionable components designed to reinforce medication benefits:

• Structured Goal-Setting: Participants worked with counselors to establish concrete targets for physical activity and dietary changes.
• Energy-Intake Restriction: Counseling focused on reducing calorie consumption through dietary modifications and portion control.
• Regular Counseling Sessions: Patients received weekly 30- to 45-minute sessions to discuss progress, troubleshoot barriers, and maintain motivation.
• Periodic Progress Assessment: Counselors monitored treatment response and adjusted strategies based on individual results.

The WHO notes that while evidence directly showing intensive behavioral therapy enhances GLP-1 effectiveness was limited, "Counselling on behavioural and lifestyle changes should be provided as a first step to intensive behavioural therapy to amplify and support optimal health outcomes".

Why Is Access the Real Problem?

Here's where the WHO's guidelines reveal a sobering reality: even if GLP-1 drugs work, most people with obesity won't be able to get them. The organization identified three foundational challenges that threaten to undermine the entire effort:

• Production Capacity and Affordability: Global manufacturing cannot currently meet demand, and the high cost of GLP-1 therapies limits access in most countries.
• Health System Readiness: Many healthcare systems lack the trained workforce, chronic care infrastructure, supply-chain capacity, and monitoring systems needed to deliver these medications safely and effectively.
• Person-Centered Universal Access: Ensuring equitable, nondiscriminatory care across different countries and populations remains a profound challenge.

The numbers are stark: even under the most optimistic projections, only an estimated 100 million people could have access to GLP-1 therapies—less than 10% of the global population living with obesity. This means that roughly 900 million people with obesity would remain without access to these medications, even if production and distribution were optimized.

What Does Health System Readiness Actually Require?

The WHO emphasizes that delivering GLP-1 therapies at scale requires far more than simply prescribing pills. Healthcare systems must establish robust infrastructure including supporting governance structures, training programs for health workers, monitoring and evaluation systems, referral pathways, procurement and supply-chain management, and financial coverage mechanisms. Additionally, personalized periodic monitoring of treatment response and side effects is essential to ensure sustained adherence and achieve optimal health outcomes.

To address these challenges, the WHO plans to develop an evidence-based prioritization framework in early 2026 to identify which adults with obesity should be prioritized for GLP-1 treatment as supply and system capacity gradually expand. This framework will evaluate cost-effectiveness across diverse health systems, long-term outcomes including cognitive effects and kidney disease, and strategies for initiating, adjusting doses, and discontinuing treatment.

What Strategies Could Improve Global Access?

The WHO recommends several approaches to expand access while managing costs and ensuring equitable distribution:

• Pooled Procurement: Countries working together to purchase medications in bulk, reducing per-unit costs through collective bargaining power.
• Market Competition: Encouraging multiple manufacturers to produce GLP-1 drugs, which typically drives prices down over time.
• Tiered Pricing: Implementing different price points for different regions based on local economic capacity and ability to pay.
• Local Manufacturing: Supporting production facilities in lower-income countries to reduce transportation costs and increase supply.
• Voluntary or Compulsory Licensing: Allowing other manufacturers to produce patented drugs under license, particularly in countries with limited access.
• Telehealth-Enabled Multidisciplinary Care: Using digital tools to extend specialist expertise to remote areas and reduce in-person visit requirements.
• Task-Shifting and Task-Sharing: Training nurses, community health workers, and other non-physician providers to deliver behavioral therapy and monitoring, optimizing limited specialist resources.

The WHO also recommends that GLP-1 therapies be incorporated into universal health coverage and primary care benefit packages, though current global access and affordability remain far below population needs.

Ultimately, the WHO's guidelines represent a cautious endorsement of GLP-1 medications as a legitimate treatment tool for obesity—but with a clear warning that the drug itself is only part of the solution. Without addressing the triple challenge of affordability, health system capacity, and equitable access, these medications will remain out of reach for the vast majority of people living with obesity worldwide.