Are GLP-1s the answer to our obesity epidemic?

A game changer for severe childhood obesity

New Zealand is facing a major crisis: obesity in our children and young people. Anyone with obesity is at significant risk of serious health problems: diabetes, high blood pressure, sleep apnea, osteoarthritis, heart, liver and kidney disease.
But it’s worse in children.

My colleagues and I are seeing a frightening rise in the numbers of children and teenagers in our type 2 diabetes clinics; virtually all are significantly overweight.

These young people are staring down the barrel of a life of serious, chronic disease. Type 2 diabetes is particularly aggressive in children and teenagers. They develop complications (from eye damage and kidney failure to heart attacks and stroke) much earlier and much faster, medications have less effect, and they die younger than their peers.

The human cost is enormous, as is the cost (and future cost) to our health system.

Moreover, the young people with type 2 diabetes are just the tip of a much larger iceberg. One in eight Kiwi children aged two to 14 years is now classified as obese. In paediatrics, we see children as young as ten who weigh more than 100kg, often gaining weight at an alarming rate. Dietary and lifestyle advice almost never makes a difference for these young people.

Wegovy is approved by New Zealand regulatory body Medsafe for children aged 12 and over. But it isn’t funded by Pharmac and can cost $400 a month or more.
Most of the young patients we see at Starship Hospital don’t have the money to afford Wegovy.

But in the few who do, these medications can have dramatic effects. They are less hungry, less driven by food, they lose weight and feel better. Their risk of obesity-related health problems decreases.

There are unknowns – not least the long-term effects of such medications on young people, and whether they can ever successfully stop them. We worry about loss of muscle mass and the best ways to avoid it, but these concerns pale in comparison to the risk of uncontrolled obesity.

We urge Pharmac to look at funding Wegovy for children and teenagers with severe or complicated obesity.

Dr Ben Albert is a specialist paediatric endocrinologist and a senior research fellow at the Liggins Institute.
 

Where will the funding come from?

Around 1.5 million adults and 175,000 children in New Zealand are obese, which increases the likelihood of them developing health problems. People living with obesity face discrimination within the health system, while obesity-related conditions have a disproportionate impact on Māori and Pacific peoples. Social, commercial and structural determinants drive these issues, with obesity and overweight costing the New Zealand health system about $2 billion a year.

Against this background comes the development of GLP-1 receptor agonists that help some people lose weight. Pharmac has placed one such weight-loss medicine, Wegovy, on its Options for Investment list without any guarantee of funding now or in the future. If funded, Wegovy is likely to require significant investment.

Pharmac allocates New Zealand’s pharmaceutical budget and spent $1.8 billion in 2025/26. How much extra money will be required? Under conservative assumptions, including restrictive qualifying conditions (a BMI greater than 40 and two-plus obesity-related conditions), Wegovy is likely to cost above $300 million every year for adults alone, even after Pharmac negotiates price reductions. Wegovy might not be the first candidate funded with an increased pharmaceutical budget, so obtaining Wegovy may require a bigger budget still.

Where might funding come from? In the short term, Wegovy won’t substantially reduce the current costs of obesity, as obtaining access depends on people already having developed obesity-related conditions and few people with obesity would qualify for treatment. Wegovy is likely to instead require trade-offs, with cuts elsewhere in the health system to accommodate access to weight-loss drugs.

Swiss physician and alchemist Paracelsus observed that ‘the dose makes the poison’. International evidence, especially from the UK, suggests that higher spending on newer medicines (especially in oncology and immunology) reduces population health overall. Here, increased pharmaceutical spending displaces more efficient activities elsewhere in the system.

New Zealand seems to be in a similar situation overall. Calls to increase the pharmaceutical budget tend to ignore the potential for toxicity. Rather than spending on pharmaceuticals, a better approach may be to address the broader reasons underlying health problems, and invest where medicine tends to be most cost effective, especially in primary care.

Health economist Richard Edlin is an associate professor of health systems in the Faculty of Medical and Health Sciences.

Health gain, not just weight loss

New-generation weight-loss treatments are a genuine breakthrough in obesity care. But these medicines are intended as adjuncts to physical activity, dietary modification and behavioural support, not stand-alone treatments.

That distinction matters, because the aim of obesity care is not simply to make a body lighter. It is to help a person become healthier, stronger and more able to live well. During rapid pharmacological weight loss, current evidence indicates that 20–40 percent of total weight lost may come from non-fat tissue, including skeletal muscle.

Muscle is not just ‘weight’; it is central to controlling glucose, powering movement and protecting independence as we age. Losing too much of it, particularly for older adults or people already living with chronic disease, risks reducing physical function at a time when treatment should be improving health.

University-trained clinical exercise physiologists have a crucial role to play and should be embedded in obesity care. Their expertise is assessing risk, measuring function, prescribing and progressing exercise, and adapting to the other complex chronic conditions that many seeking obesity medicines live with.

For people using obesity pharmacotherapy, exercise should be understood as a core component of care, especially progressive resistance training, to preserve muscle, strength and physical capacity while weight is falling. Exercise training alongside therapy can protect muscle, improve physical function and produce more healthy body-composition changes than the medicine alone.

These drugs may be part of the answer to the obesity epidemic. But a medication-only model is too narrow. The future should be multidisciplinary care, including behavioural support, clinical exercise physiology, physiotherapy and dietetics working together. If we get that right, the promise is not just weight loss. It is health gain

Professor Nicholas Gant is head of the School Exercise, Sport and Rehabilitation Sciences.

An eating-disorder perspective

The so-called ‘obesity epidemic’ receives significant attention, and with good intentions: improving the health and quality of life of the population.

However, a simplistic focus on modifying body size, shape or weight in the name of health risks overlooking the many determinants of health that exist independent of body size, while reinforcing society’s often-subconscious weight stigma.

In my clinical work supporting people with eating disorders, we increasingly see clients who have been offered or prescribed GLP-1 drugs as a ‘solution’, with little consideration of the broader psychosocial factors driving body-related distress.

While emerging evidence supports the use of GLP-1s for medical conditions such as diabetes, there is currently little empirical evidence to guide their use in those with eating-disorder symptoms. Safety data specific to eating disorders remains limited.

The allure of a drug-based solution is completely understandable. A legitimate and safe role for GLP-1s in some people with disordered eating who live in larger bodies may be emerging, particularly in the context of binge-eating symptoms.

However, there is a risk that blanket prescribing practices in the absence of contextual screening or assessment could contribute to the onset, maintenance, escalation or relapse of eating-disorder symptoms.

These drugs also present clinical challenges. Eating-disorder treatment for some presentations often involves rebuilding interoceptive awareness of hunger or fullness cues, while GLP-1s pharmacologically alter these same signals.

What is our goal when considering GLP-1 drugs for weight loss alone? Are we using thinness as a proxy for health? Do we expect biologically quieting ‘food noise’ to sustainably improve psychological well-being? Or do these medications risk becoming a surface approach where broader, more considered intervention is required for long-term well-being?

As health professionals we must remain aware that weight alone is a poor indicator of health, and it is unrealistic to expect all bodies to conform to a size or shape society labels as ‘healthy’.

From an eating-disorder perspective, meaningful intervention requires compassionately understanding and addressing an individual’s broader biopsychosocial context and relationship with food.

Eating disorders are rarely just about food and body size. My hope is that we will strive to see the whole person in the room, not just the size of their body.

Dr Marion Roberts is a senior lecturer specialising in eating disorders in the Faculty of Medical and Health Sciences, and principal clinical psychologist at Nurture Psychology.

Aim for a ‘triple whammy’ effect

I have been doing obesity research at the metabolic, clinical and public-health levels for nearly 40 years. In that time, obesity has continued to increase in almost every country in world. It is only in the past ten years that we have seen some hope.

On the public health side, many Latin American countries have now implemented strong food policies, such as sugary drinks taxes, front-of-pack warning labels and bans on marketing junk food to children, and these are starting to reduce child obesity.

On the clinical side, the emergence of GLP-1 drugs is proving to be a gamechanger for people living with obesity (and a goldmine for pharmaceutical companies). I recently attended the International Congress on Obesity in Mexico, where there was a lot of new research on the pipeline of variants of GLP-1 drugs. There was also much discussion about how the drugs could influence the course of the epidemic.

I think that influence will be similar to that of blood pressure (BP) drugs, but even more powerful because weight reduction is much more visible and rewarding for people than BP reductions. Cardiovascular disease in New Zealand and other high-income countries has plummeted by over 90 percent in the past 50 years, in part due to the wide use of BP medications. Individuals reduce their risk of a stroke or heart attack, and the average BP of the population drops as well.

In time, the price of GLP-1 drugs will drop far enough for Pharmac to buy enough for all those who would benefit. That is probably about a third of adults, so the price will need to be in terms of cents rather than hundreds of dollars. This will have potentially important impacts beyond individual benefits and could turn the slow rise in obesity prevalence into an early decline.

If Pharmac can expand from its usual role of just funding drugs and combine with Health New Zealand to fund community nutrition support services and with the Ministry of Health to develop complementary policies (as per Latin America), then we will get a triple-whammy of effect – drugs, programmes, policies.

Boyd Swinburn is a professor of medical epidemiology and biostatistics in the Faculty of Medical and Health Sciences.