Pills to reduce obesity not enough, say WHO experts

In an article in the Journal of the American Medical Association, three of World Heath Organisations’s experts, Francesca Celetti, Francesco Branta and Jeremy Farrar, ask the question about the new anti-besity drugs put out by Novo Nordisk and Eli Lilly: “Should the world embrace this novel pharmacological solution as the answer to the obesity pandemic? Or should the world be concerned that the medicalisaton of obesity will dull incentives for healthier lifestyles and allow market forces to perpetuate a profitable cycle of cause and cure?”

The WHO experts cite overwhelming statistics to say that obesity is a public health hazard with tremendous mortality and economic costs. They say, “The global burden of obesity constitutes a major public health challenge that also undermines social and economic development throughout the world, and has the effect of increasing inequalities between countries and within populations.

“Global costs associated with obesity are predicted to be $3 trillion per year by 2030, and these costs for obesity could absorb up to 18 per cent of national health expenditure in countries with prevalence rates of 30 per cent for obesity. There are 5 million obesity-related deaths from incommunicable diseases worldwide.”

Those are grave statistics. They also accept that healthy diets are not making much difference in dealing with the problem.

Most of the time the problem of obesity is traced back to sedentary lifestyle associated with modern urban living, with physical activity reduced to a minimal role. Obesity is not always related to over-eating or to eating unhealthy food. In some people, it is a question of metabolism. Metabolism rates differ and this affects the absorption of food.

So the medical research seem to be scratching the surface of the problem. The new drugs are perhaps calibrated to check the metabolism rates. But the medical intervention would be an external stimulus. In other cases, and perhaps in a majority of them, the cause could be due to lack of physical activity. The WHO authors say, “It is time to recognise that multisectoral efforts to influence behaviours around healthy diet and exercise have so far failed to treat obesity or turn the tide on obesity pandemic.”

What the WHO seems to fear is the commercialisation of the obesity problem. People would readily embrace the solution provided by the new pills, now known by their brand names, Wegovy and Mounjaro or Zepbound. The apprehension expressed by the WHO experts is two-fold. First, the medication is not sufficiently backed up by the medical system which would require broader strategy of monitoring obesity. Secondly, the pills would not be easily available in poor countries where obesity poses a problem as much as it does in rich countries.

An integrated medical approach which has programmes addressing obesity should be evolved to support and back the medication. It is also recognised that extreme obesity leads to other problems of the heart and kidney. Therefore the need for a holistic obesity care policy.

The authors say that a separate WHO committee will formulate the necessary guidelines for the administering of these anti-obesity drugs referred to by the WHO by its chemical formulation, glucagon peptide-1 receptor agonists (GLP-1 RAs) will have to follow guidelines that the WHO will formulate through an expert committee.

They say, “...the WHO is currently working to develop guidelines on the use of GLP-1 RAs in adults with obesity to provide clarity on the clinical conditions, application, and programmatic considerations globally, including their use in low- and middle-income countries.”

There is then a glimmer of hope that obesity can be reduced through medications but protocols remain to be worked out. There is sure to be further research on the problem and other developments in the drugs used to treat obesity as well.