The worldwide prevalence of obesity has more than doubled in the last three decades, bringing with it an increase in weight-related diseases like diabetes, cardiovascular disease, and cancers. This public health crisis strains global healthcare systems and economies, but a new study co-led by investigators from Mass General Brigham could inform strategic programs to make GLP-1 medications part of the solution.
Mass General Brigham researchers and collaborators from Washington University School of Medicine in St. Louis and Emory University's Rollins School of Public Health pooled data from 99 countries and 810,635 adults to determine how many people worldwide may benefit from GLP-1 use. They found more than one-in-four adults would be eligible for GLP-1s for weight management, with women, older individuals, and low- and middle-income countries among the most eligible. These critical metrics could be formative in policy development to deploy GLP-1s around the world to tackle obesity and its comorbidities. Their results are published in a research letter in The Lancet Diabetes & Endocrinology.
"There has never been such a potentially transformational and scalable tool for obesity, type 2 diabetes, and other health-related complications of obesity," said co-senior author Jennifer Manne-Goehler, MD, ScD, a physician in the Division of Infectious Diseases at Brigham and Women's Hospital and the Department of Medicine at Mass General Brigham . "For so many decades, we told everyone the problem was you—you need to move more and eat less, then you won't struggle with this problem. GLP-1 receptor agonists have allowed us to really understand that biology is much more powerful than that, and 'eat less, move more' is just an oversimplified way to think about things."
The power and promise of GLP-1s has been recognized by the World Health Organization (WHO), as they actively are working to make them standard, accessible mediations . But scaling up production and rolling out application of GLP-1s globally starts with one big question: Exactly how many people need them?
"Given the steadily increasing prevalence of obesity, it's not surprising that our analysis found that more than one quarter of adults around the world may be eligible for this medication," said corresponding author Sang Gune K. Yoo, MD, who conducted this work as a research fellow in cardiology at WashU Medicine. "This medication has the potential to help many individuals, although further research is needed to better understand its long-term safety and sustainability. Access remains a major challenge as these medications are difficult to obtain in many settings. Most importantly, we must continue to invest in and develop effective non-pharmacological strategies for the prevention and treatment of obesity, an area where substantial gaps remain."
The researchers started with household health survey data collected from 99 countries between 2008 and 2021. A total of 810,635 adults between 25 and 64 years old were pooled based on availability of diabetes biomarkers, blood pressure and BMI measurements, and hypertension and diabetes diagnostic history. Those that had a BMI of more than 30 or a BMI of more than 27 with additional hypertension, diabetes, or both, were deemed eligible for GLP-1 use.
Globally, 27% of the adults were eligible for GLP-1s for weight management—four-fifths of whom came from low- and middle-income countries. Eligibility rates were highest in Europe and North America (42.8%) and the Pacific Islands (41.0%). Women were also more likely (28.5%) than men to be eligible, as were older individuals more likely (38.3%) than their younger counterparts (17.9%).
"These socioeconomic and gender eligibility percentiles are especially staggering," added Manne-Goehler. "As of last year, type 2 diabetes was the top cause of death for women in South Africa. There are parts of the world where women can really benefit from these medicines, and it's our job to see through their implementation."
"Global access to GLP-1s is a question of health equity," said co-lead author Felix Teufel, MD, from Emory University's Rollins School of Public Health. "The goal is to ensure large-scale access for people who would benefit most – not just those easiest to reach."
About Lancet Diabetes & Endocrinology Research Letters: Research letters published in the Correspondence section include research findings and are externally peer-reviewed. Unlike Articles containing original data, research letters are shorter and the research they contain is usually preliminary, exploratory, or reporting on early findings.
Authorship: In addition to Jennifer Manne-Goehler, Sang Gune K Yoo, and Felix Teufel, authors include Michaela Theilmann, Yajuan Si, Elhadji A Toure, Krishna Aryal, Till Bärnighausen, Abdul Bait, Marta Barreto, Pascal Bovet, Luisa C C Brant, Sarah Cuschieri, Albertino Damasceno, Farshad Farzadfar, Asher Fawwad, Pascal Geldsetzer, Ian R Hambleton, Corine Houehanou, Christina Howitt, Jutta Jørgensen, Juan P González-Rivas, Demetre Labadarios, Maja Marcus, Joao Martins, Omar Mwalim, Ramfis Nieto-Martínez, Augustine N Odili, Binur Orazumbekova, Gastón Perman, Sarah Quesnel-Crooks, Sahar Saeedi Moghaddam, Ronel Sewpal, Mafalda Sousa-Uva, Mubarak A Sulola, Kavita Venkataraman, Sebastian Vollmer, Sim Xueling, Rifat Atun, José R Banegas, Juan V A Franco, Clare Arnott, Nomathemba Chandiwana, Mark Huffman, Justine Davies, Mohammed K Ali, and David Flood.
Funding/Disclosures: Atun has grants and contracts with Novo Nordisk, Novartis Foundation, Virchow Foundation, and the Gates Foundation unrelated to the study. Atun received Honoria for lectures and presentations for Merck, unrelated to the study. Huffman has received travel support from the World Heart Federation and consulting fees from PwC Switzerland. Huffman has pending patents for heart failure polypills. Huffman has an appointment at The George Institute for Global Health, which has a patent, license, and has received investment funding with intent to commercialise fixed-dose combination therapy through its social enterprise business, George Medicines. Arnott has received honoraria and sat on the advisory boards and steering committees for AstraZeneca and Novo Nordisk. Yoo was supported by the National Institutes of Health, grant number T32 HL007081. Flood was supported by the US National Heart, Lung, and Blood Institute (award K23HL161271), the Michigan Center for Diabetes Translational Research (award P30DK092926), the University of Michigan Claude D Pepper Older Americans Independence Center (award 5P30AG024824), and the University of Michigan Caswell Diabetes Institute Clinical Translational Research Scholars Program. Manne-Goehler was supported by the US National Heart, Lung, and Blood Institute (award 1R01HL172907–01A1).
Paper cited: Yoo SGK et al. "GLP-1 receptor agonist for obesity: eligibility across 99 countries" Lancet: Diabetes and Endocrinology DOI: 10.1016/S2213-8587(25)00356-0
