WHO Publishes GLP-1 Guidelines for Obesity Treatment

Amid soaring global demand for glucagon-like peptide-1 (GLP-1) medications and widespread concerns about affordability and access, the World Health Organization (WHO) released its global comprehensive guidelines on GLP-1 therapies for adults with obesity.¹

Obesity currently affects more than 1 billion people—about 1 in 8 individuals—around the world.² Since the WHO first declared it a global epidemic in 1997, the global prevalence of obesity has doubled and is expected to double again by 2030 without intervention.^2,3 Associated health care costs are also going up—the global cost of obesity is projected to exceed $3 trillion per year by 2030.³

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

Conditional Endorsement of Long-Term GLP-1 Therapy

The WHO added GLP-1 therapies to its Essential Medicines List in September 2025 for managing high-risk patients with type 2 diabetes.⁴ The new guidelines added conditional recommendations for using these therapies to treat obesity in conjunction with lifestyle habits like healthy diets and physical activity.¹ It’s important to note these recommendations are based on moderate to low certainty of evidence.

Recommendation 1 is that GLP-1 therapies may be used as a long-term treatment for obesity, defined as continuous use for at least 6 months. This recommendation is based on moderate-certainty evidence from trials of liraglutide, semaglutide, and tirzepatide, with treatment durations ranging from 26 to 240 weeks and a median follow-up of 52 weeks; key outcomes included weight change, quality of life, adverse events, major adverse cardiovascular events, and mortality. Although these randomized trials used varying definitions of overweight and obesity, the recommendation applies only to adults with obesity and does not extend to those with a BMI between 27 and 30 kg/m² who have obesity-related conditions. The WHO noted there is still uncertainty around GLP-1 discontinuation, maintenance dosing, long-term safety, and health equity implications. The high global price of GLP-1s and limited production capacity were major contributors to the conditional rating.

“Chronic care requires a capacitated health system to ensure essential functions are in place, including supporting governance, training of health workers, monitoring and evaluation, referral systems, procurement and supply chain, and financial coverage,” the guidelines read. “In the context of obesity chronic care programmes, personalized periodic monitoring of treatment response and side effects/adverse events is essential to ensure sustained adherence and achieve optimal health outcomes.”

Recommendation 2 is that adults prescribed GLP-1 therapies may receive intensive behavioral therapy (IBT) as part of multimodal care. In the trials informing this recommendation, IBT included structured goal-setting for physical activity and diet, energy-intake restriction, weekly 30- to 45-minute counseling sessions, and periodic assessment of progress. The decision was based on low-certainty evidence, with limited data on major adverse cardiovascular events and no data on mortality. Follow-up durations in the evidence base ranged from 6 to 24 months, with no direct evidence for outcomes beyond 2 years. Although evidence that IBT enhances GLP-1 effectiveness was limited, the guidelines said, “Counselling on behavioural and lifestyle changes should be provided as a first step to intensive behavioural therapy to amplify and support optimal health outcomes.”

Global Access, Equity, and Infrastructure Barriers

The guidelines also highlighted real-world issues with delivering GLP-1 therapies at scale, focusing on 3 foundational challenges:

1. Achieving affordable, widespread access
2. Ensuring health system readiness, including workforce training, chronic care models, and supply-chain capacity
3. Delivering person-centered, nondiscriminatory care across countries and populations⁴

“This triple challenge—production capacity and availability and affordability, health system preparedness, and person-centered universal access—confronts the global health community not only as a technical problem but as a profound equity dilemma that lies at the very heart of global public health and the pursuit of health for all,” JAMA researchers said. Even under the most optimistic projections, they added, only an estimated 100 million people could have access to GLP-1 therapies—less than 10% of the global population living with obesity.

Under the December 2025 guidelines, GLP-1 receptor agonists and GIP/GLP-1 dual agonists should be delivered within a chronic care model supported by a fully capacitated health system.¹ Countries expanding access to these therapies must consider local cost-effectiveness data, budget impact, and social and ethical implications to determine how best to integrate GLP-1 treatment into existing services.

The guidelines also emphasized GLP-1 therapies should be incorporated into universal health coverage and primary care benefit packages; however, current global access and affordability remain far below population needs. Strategies such as pooled procurement, market competition, tiered pricing, local manufacturing, and voluntary or compulsory licensing may help improve access, alongside telehealth-enabled multidisciplinary care, according to the WHO. Integration of intensive behavioral therapy with GLP-1 treatment may also rely on task-shifting and task-sharing to optimize resources and support comprehensive, patient-centered care.

“Implementation of these guidelines depends on equitable access to affordable therapies, health system preparedness, and, most importantly, assurance that care is person-centered, nondiscriminatory, and universally accessible,” the guideline authors said. “Given the time required to implement these measures, a priority is a transparent, equitable, evidence-based framework to identify those at highest need while allowing incremental expansion of eligibility as access, capacity, and readiness evolve; this will be the next focus of the WHO guideline.”

In early 2026, the WHO said it will develop an evidence-based prioritization framework to identify which adults with obesity should be prioritized for GLP-1 treatment as supply and system capacity expand. The guideline development group will also evaluate cost-effectiveness across diverse health systems, long-term outcomes (including cognition, kidney disease, and addiction), and strategies for initiation, titration, and discontinuation.

References

1. WHO guideline on the use of glucagon-like peptide-1 (GLP-1) therapies for the treatment of obesity in adults. World Health Organization. December 1, 2025. Accessed December 1, 2025. https://app.magicapp.org/#/guideline/LrRxrL
2. Klein HE. 5 ways the US obesity landscape strays from the global picture. AJMC^®. May 16, 2025. Accessed December 1, 2025. https://www.ajmc.com/view/5-ways-the-us-obesity-landscape-strays-from-the-global-picture
3. WHO issues global guideline on the use of GLP-1 medicines in treating obesity. News release. World Health Organization. December 1, 2025. Accessed December 1, 2025. https://www.who.int/news/item/01-12-2025-who-issues-global-guideline-on-the-use-of-glp-1-medicines-in-treating-obesity
4. Celletti F, Farrar J, De Regil L. World Health Organization guideline on the use and indications of glucagon-like peptide-1 therapies for the treatment of obesity in adults. JAMA. Published online December 1, 2025. doi:10.1001/jama.2025.24288