No Obesity Drugs in WHO Essential Medicines List

The World Health Organization’s (WHO) latest model list of essential medicines does not include weight loss drugs, despite the growing global burden of obesity.

Of more than 100 therapeutics considered, the WHO recommended adding 24 medicines to the Model List of Essential Medicines (EML) and 12 to the Model List of Essential Medicines for Children (EMLc). Among them are medications to treat multiple sclerosis, Ebola, and multiple cancers.

According to the WHO, essential medicines "satisfy the priority health care needs of a population." They are selected taking into account disease prevalence and public health relevance, evidence of efficacy and safety, and comparative cost-effectiveness.

"They are intended to be available in functioning health systems at all times, in appropriate dosage forms, of assured quality and at prices individuals and health systems can afford," the WHO states.

For the first time, the list includes medications to treat multiple sclerosis (MS), a potentially disabling central nervous system disease affecting about 2.8 million people globally. The newly added drugs are: cladribine, glatiramer, and rituximab. Although the latter is typically used as a treatment for certain types of lymphoma, leukemia, and autoimmune diseases, increasing evidence shows its benefits for MS patients.

"Given the evidence base and the increased affordability of rituximab, including the availability of prequalified biosimilars, it has been prioritized over on-label alternatives as an essential medicine to treat relapsing-remitting and progressive MS," Benedikt Huttner, Secretariat of the WHO EML, says in a statement.

Fixed-dose combinations of multiple medicines, also known as "polypills," that are intended to prevent heart and blood vessel diseases, have been added to the EML list for the first time. The "polypills" include aspirin, a statin to lower cholesterol levels, a medication lowering blood pressure, and a drug that makes the heart beat with less force.

Studies suggest that the polypill approach is safe and may be effective at reducing the risk of stroke and other severe cardiovascular events and levels of bad cholesterol while adherence is high.

The WHO also recommended expanding the list with medications for infectious diseases, such as hepatitis C and Ebola viruses, and two cancer treatments.

Obesity drugs, however, did not make it to the updated EML. Earlier this year, a group of researchers from the United States requested the WHO to add a class of drugs called GLP-1 receptor agonists "under a novel section of obesity with the indication of weight loss."

They noted that the global burden of obesity was 38% in 2020, while obesity is a risk factor for multiple chronic conditions, such as type 2 diabetes or cardiovascular disease.

GLP-1 receptor agonists, sold under the brand names Ozempic, Wegovy, and others, work by mimicking the GLP-1 hormone that is naturally produced in the gut after a meal and is involved in stimulating insulin release. While Wegovy is approved for people with obesity, Ozempic is a type 2 diabetes drug with off-label use for weight loss.

Over 150 countries use the WHO model lists to decide which medicines represent the best value for money based on evidence and health impact.