WHO guideline on the use of glucagon-like peptide-1 (GLP-1) therapies for the treatment of obesity in adults

Introduction

Obesity is one of the defining health challenges of our time, affecting more than 1 billion people globally and contributing to millions of preventable deaths each year. Yet despite its scale and impact, the global response remains fragmented, underfunded and is often shaped by outdated views that frame obesity as a lifestyle issue rather than what it truly is: a chronic, progressive and relapsing disease.

This guideline offers evidence-informed recommendations on the use of glucagon-like peptide-1 (GLP-1) receptor agonists and glucose-dependent insulinotropic polypeptides (GIP)/GLP-1 dual agonists – a new generation of pharmacotherapies for treatment of people living with obesity. This is WHO’s first clinical guidance on the pharmacological treatment of obesity in adults. It represents a critical step toward establishing a global standard of care – an evolving foundation upon which countries can build evidence-based, equitable and sustainable obesity treatment programmes. The guideline will be continuously updated and expanded in response to the evolving evidence base and emerging real-world data on safety, feasibility, effectiveness and system-level requirements.

Scope and purpose

This guideline is global in scope and intended for use across a wide range of settings, income levels and health system capacities. It focuses on the treatment of adults (>19 years) with obesity, which is defined as body mass index (BMI) ≥30 kg/m2. A separate WHO guideline is under development on the management of obesity in children and adolescents. This guideline aims to support the safe, equitable and appropriate inclusion of pharmacological therapy for adults as part of comprehensive obesity chronic care programmes. These programmes must move beyond a narrow focus on weight loss to address the full spectrum of associated health risks, obesity-related diseases and disorders and the broader social and structural determinants of health.

While not a standalone solution, this guideline represents one of many tools to support countries in designing comprehensive chronic care systems that incorporate pharmacological treatment as one option, while also building health systems that recognize obesity as the complex, lifelong condition it is. A successful transition to chronic care models requires more than clinical guidance – it also demands careful attention to health system capacity and a strong commitment to equity. Without deliberate investment and inclusive implementation strategies, the introduction of new therapies may exacerbate existing disparities in access, affordability and quality of care. Equity considerations must, therefore, be integrated throughout programmes – from procurement and service delivery to financing, information systems and workforce capacity development.

The key stakeholders that comprise the target audience of this guideline are national policy-makers, public health authorities, national clinical guideline developers and regulatory bodies. Further stakeholders the recommendation may benefit are healthcare providers, system managers, researchers, professional societies and people living with obesity organizations.

Methods

This guideline development process followed the methods and standards in the WHO handbook for guideline development, second edition and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) for formulating evidence-informed recommendations and good practice statements.

The process involved synthesis and GRADE assessments of efficacy, effectiveness and safety evidence around GLP-1 receptor agonists and GIP/GLP-1 dual agonists for obesity and possible co-interventions alongside GLP-1 receptor agonists and GIP/GLP-1 dual agonists. It also involved synthesis and GRADE-Confidence in the Evidence from Reviews of Qualitative Research (CERQual) assessments of qualitative findings related to values and preferences, acceptability and potential equity impacts around the use of GLP-1 receptor agonists and GIP/GLP-1 dual agonists for obesity.

A Guideline Development Group (GDG) of researchers, clinicians, ethicists and people living with obesity was involved in the decision-making for the guideline and the development of recommendations and good practice statements.