The World Health Organization (WHO) has released a guideline on the use of GLP-1 medications in a JAMA Special Communication article, which is getting lots of attention worldwide. Here are some of their key messages, some of which I have mixed feelings about.

The first key point is that WHO has finally declared that obesity IS (indeed!) a ‘chronic, relapsing disease requiring lifelong care’. Let’s pause here for a moment – this is a really big deal! Many health organizations around the world still view obesity as a risk factor and not a health condition in and of itself – I’m so happy to see WHO taking a firm stance on obesity as a chronic disease in this guideline.

The WHO guideline emphasizes ‘early diagnosis and integrated person-centered approaches’ to treatment, using whichever treatment strategies that are most appropriate to the individual, to help manage weight AND weight-related health issues. However, the WHO also advises that there should be a framework to prioritize treatment to those at highest need within current medication supply and health care system constraints. While I appreciate it is not possible to treat everyone who deserves access to obesity treatments, it’s also not fair to deny access to a person because they are not (yet) ‘sick enough’ with obesity-related health issues. In our Obesity Canada 2025 Pharmacotherapy Clinical Practice Guidelines (disclosure, I am the lead author), we advise treating early in the natural history of obesity, and not waiting until health complications develop.

As regards use of GLP1 therapies, the WHO recommends that these may be used as a long-term treatment for obesity; however, they state their definition of ‘long term’ to be 6 months or more. In our Obesity Canada guidelines, we have a specific recommendation (#4) that obesity medication should be used long term, when effective, in conjunction with health behaviour changes to avoid weight regain and loss of health benefits achieved with treatment (and actually, the non-GLP1 medication orlistat also has data for this). In our guidelines we do not recommend ANY stop date for medication, as studies of all durations (many well beyond 1 or 2 years) show that when you stop treatment, weight is regained and health benefits regress.

The WHO also recommends that intensive behavioral therapy (including weekly counseling sessions!) may be provided as part of a comprehensive treatment strategy. As discussed in our guidelines, all three of the GLP-1 based medications [liraglutide (Saxenda), semaglutide (Wegovy), and tirzepatide (Zepbound/Mounjaro – name varies by country)], and the non-GLP1 obesity medication naltrexone/bupropion (Contrave), have shown benefit in addition to intensive behavioural therapy – however, this intensive lifestyle approach may be difficult to find in regular health care, and may be challenging to stick to for the long term.

While the WHO guideline focuses specifically on GLP1-based medications, it’s important to remember that there are non-GLP1-based weight management medications available, and coming down the pipeline in the next couple of years, which can help improve health and weight as well.

BOTTOM LINE: The World Health Organization is now clear that obesity is a chronic disease requiring lifelong care, and they are in favor of expanding access to GLP1 based medications. Given how common obesity is worldwide, just how to do that remains a topic of debate and uncertainty.

Disclaimer:  . I am/have been an investigator in clinical trials of liraglutide, semaglutide and tirzepatide. I receive honoraria as a continuing medical education speaker and consultant from the maker of liraglutide and semaglutide (Novo Nordisk), naltrexone/bupropion (Bausch), and tirzepatide (Eli Lilly).

Share this blog post using your favorite social media link below!

Follow me on twitter! @drsuepedersen 

www.drsue.ca © 2025