Nearly 800 Million Adults May Be Eligible for GLP-1 Weight Management Therapy

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Medications known as GLP-1 receptor agonists, including drugs commonly prescribed for weight management, have gained global attention, but until now, it has been unclear how many adults worldwide might actually qualify for them based on clinical trial standards.

In this large international study, published in The Lancet Diabetes & Endocrinology, investigators analyzed health data from more than 810,000 adults across 99 countries to estimate how many people could be eligible for these medications and where they live. They found that nearly 800 million adults globally may meet clinical trial criteria for GLP-1 therapy.

“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 investigator Jennifer Manne-Goehler, M.D., Sc.D., 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.”

Using criteria from major clinical trials, adults were considered eligible if they had obesity (a body mass index (BMI) of 30 or higher) or overweight (BMI of 27 or higher) with high blood pressure, diabetes or both. For parts of Asia, lower BMI cutoffs were used to reflect regional health risks. The team focused on nonpregnant adults ages 25 to 64 and relied on measured weight, blood pressure and lab markers for diabetes rather than self-report alone.

Among respondents, the median age was 38 years and 48.9% were women.

The findings suggest that about 27% of adults worldwide (roughly 799 million people) would meet eligibility criteria for GLP-1 medications for weight management. Eligibility varied widely by region and income level. Rates were highest in Europe, North America and the Pacific Islands, where more than four in 10 adults qualified, and lowest in low-income countries, though millions of people in those regions were still eligible. Notably, Asia accounted for the largest absolute number of eligible individuals, even though the percentage was lower than in Western countries (23.1%).

“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 Sang Gune K. Yoo, M.D., investigator and research fellow in cardiology at Washington University School of Medicine.

Eligibility was more common among women than men and increased steadily with age. Socioeconomic patterns differed by country income level: In high-income countries, people in lower-income households were more likely to be eligible, while in lower-income countries, eligibility rose with household income.

Investigators mentioned some important limitations to keep in mind. The team did not include all medical conditions or exclusions that can affect whether someone should take a GLP-1 medication, which means the total number of people estimated to be eligible may be slightly higher or lower than in real-world practice. Differences in survey timing, diagnostic definitions and how BMI was adjusted for Asian populations could also affect the accuracy of the estimates. Finally, while the data came from 99 countries and represent the most comprehensive global analysis available, the findings do not capture every country or every individual who might qualify for these medications.

These findings highlight the enormous global demand for weight management treatments and raise important questions about access, affordability and health equity as GLP-1 medications become more widely used.

“This medication has the potential to help many individuals, although further research is needed to better understand its long-term safety and sustainability,” Yoo said. “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 nonpharmacological strategies for the prevention and treatment of obesity, an area where substantial gaps remain.”