Obesity drugs pose a big challenge for health care equity

Weight loss treatments have the potential to revolutionize health care in rich countries. They are driving a race among drugmakers for a slice of a market that could exceed $100 billion by 2030. But little thought has apparently been given to helping people in low- and middle-income countries, where obesity rates are soaring despite poor nutrition.

Without decisive action to develop fair access plans to these drugs for people living in poorer countries, there is a real danger that a significant medical advance will end up increasing inequality in health care. This is especially true if the rush to fund obesity research and development diverts research and development resources from other important unmet medical needs.

There is little doubt that anti-obesity medicines like Novo Nordisk’s semaglutide (Wegovy) and Eli Lilly’s tirzepatide (Zepbound), which work by mimicking the gut hormone GLP-1 to suppress appetite, offer important health benefits. This is underscored by data from clinical trials involving overweight people with diabetes and cardiovascular disease. But demand for these products is also being fueled by celebrity endorsements and the marketing efforts of the pharmaceutical industry.

What does this mean for the 80% of the world’s people who live in low- and middle-income countries, where infectious diseases remain big killers but obesity-related problems such as heart disease, diabetes, and cancer are rising rapidly? In an ideal world, effective new drugs to help people shed excess weight would be used to help the poor just as much as the rich. In practice, however, the high cost and limited availability of these medicines put them out of reach of most global citizens, further increasing global inequality.

Obesity is a complicated health condition that takes a heavy physical, psychological, and economic toll on both individuals and wider society. In the past, it was viewed as simply a problem for richer countries. That is no longer true. Today, around 70% of all people with overweight or obesity live in low- and middle-income countries, where obesity rates are increasing faster than in rich nations due to lack of access to nutritious foods and increasingly sedentary lifestyles.

Overall, more than a billion people globally are now considered to have obesity, according to a major study published this year in The Lancet spanning data from 200 countries. An international team of researchers found that obesity rates for adults had, on average, more than doubled between 1990 and 2022, and more than quadrupled among children and adolescents. The analysis also showed levels of obesity are now higher in some poor countries than rich ones, including parts of the Caribbean, the Pacific islands, and the Middle East.

The fact that resource-poor countries now face an obesity crisis does not mean the age-old problem of undernourishment has been solved. The sad fact is that hundreds of millions of people still do not have enough to eat, even as others struggle with excess weight. The result is that many poor countries are facing double epidemics of hunger and obesity, both of which have serious long-term consequences for health.

Access to Medicine Foundation, the organization I lead, has spent nearly two decades monitoring the pharmaceutical industry’s role in global health and studying the barriers that make medicines unaffordable and unavailable. My colleagues and I have seen a raft of problems where the world’s poor have been left behind, from cancer treatments to Covid-19 vaccines. Today, the warning lights are flashing on weight-loss treatments.

Companies reaping huge commercial benefits from the new GLP-1 so-called wonder drugs need to take responsibility for the impact of their innovations. Drug manufacturers must include better and earlier access planning to ensure that people in resource-poor countries are not left at the back of the queue.

Ensuring equitable access will not be easy, especially as obesity demands a holistic approach to prevention and treatment that also prioritizes interventions like a healthful diet and exercise. But that is all the more reason for pharmaceutical companies, governments, and the global health care community to start work now to meet the challenge.

To serve global markets effectively and equitably, the pharmaceutical industry also needs to maintain a balanced R&D portfolio that meets the broad needs of society. The prospect of mammoth profits from selling obesity drugs in high-income markets has sparked a global research rush into the field in the past two years, with more than 200 new weight loss drug candidates now in clinical development. This should not drive investment and attention away from other essential — but less lucrative — areas of medicine, such as the development of much-needed antibiotics to address rising drug resistance globally, and should come at the detriment of other treatments needed by low-income populations.

To be sure, pharmaceutical companies are businesses that must pay attention to their bottom lines. But society also expects them to address the needs of people around the world, and not simply focus on those who live in North America and Europe. There are some signs that some companies are ready to target other markets — notably where they can achieve reimbursement and substantial sales. Novo Nordisk, for example, expects China to approve semaglutide this year and Eli Lilly is exploring an obesity drug launch in India in 2025. But affordability and inadequate health care infrastructure remain major hurdles in many places outside such major markets.

Obesity is a growing global issue, and the health threats it poses need to be prioritized. The new generation of GLP-1 drugs alone will not solve the problem, but they can contribute to the solution if they are made affordable and are combined with investments in proven obesity management and good nutrition. Pharmaceutical companies have a moral and societal responsibility to help make this a reality.

Jayasree K. Iyer, Ph.D., is the CEO of the Access to Medicine Foundation.