GLP-1 receptor agonists and the path to sustainable obesity care

Abstract

As of 2024, more than 1 billion people are estimated to be living with obesity worldwide. The glucagon-like peptide-1 receptor agonist (GLP-1RA) and closely related glucose-dependent insulinotropic polypeptide (GIP/GLP-1) dual agonist medication classes offer a promising strategy to treat obesity and prevent its downstream health complications. However, the optimal use of these medications is currently hindered by many unanswered questions, ranging from how best to select the optimal patients for treatment to their long-term effects to how to manage their costs. Among these is an increasingly urgent concern about the coverage and optimal treatment duration of GLP-1RAs at obesity dosing and evidence-based approaches to off-ramping, defined as the tapering or withdrawal of a GLP-1RA after this treatment period and its replacement by an alternative approach to weight maintenance.