WHO may add Saxenda obesity drug to essential medicines

Not every medicine is the same. Some can ease symptoms but have severe side effects. Others are safe, cure serious medical conditions and improve lives. The World Health Organization (WHO) gathers the most important drugs on its Model List of Essential Medicines.

The list is a recommendation for health systems worldwide and contains nearly 600 different medicines such as anesthesia, antiviral drugs or treatments for pain and fever.

"The medicines on the list are defined as the priority health needs of a population. They need to be safe, effective, available and affordable at all times," said Benedikt Huttner, Team Lead for Essential Medicines at the WHO.

The goal is to ensure that medicines are used as wisely as possible and to improve medical care worldwide.

"Our essential medicines list is a template for countries to base their own national list on," said Huttner. 

More than 150 countries worldwide have already done that — low and middle income countries rely on the WHO recommendations.

Obesity drug could be added to essential medicines list

Every two years, advisers to the WHO discuss which medicines should be added to the list.

"Anyone can submit suggestions: academic institutions, pharmaceutical companies and individuals — it's completely open," Huttner told DW.

For the 2023 update, researchers in the US have suggested adding an obesity drug called Saxenda to the list. It's a daily injection that affects hunger signals to the brain and slows the rate at which a person's stomach empties, making them feel fuller for longer.

Saxenda is a prescription medication which contains the active ingredient liraglutide. The substance will soon be free patent restrictions, allowing for cheaper generic versions to be developed.

It would be the first obesity medicine on the WHO's list of essential medicines.

Obesity is a global issue

People who live with overweight or obesity accumulate excessive fat, presenting a risk to their long-term health.

A body mass index (BMI) over 30 is considered obese.

"Obesity is a global problem that is basically increasing everywhere," said Francesco Branca, Director of the WHO Department of Nutrition for Health and Development.

The WHO says that more than 650 million adults worldwide are obese. More than 4 million people die every year from the consequences of obesity, such as heart disease, diabetes and cancer. Most affected regions are North America, Europe and the Middle East.

Once considered a problem only in high income countries, obesity is now dramatically on the rise in low and middle income countries as well, particularly in urban settings.

"This is creating an incredible pressure on health systems that already have to deal with other kind of emergencies," Branca told DW. "Now they have this additional burden of obesity they are not equipped for." 

Potential side effects of obesity drugs

Including an obesity medicine on the WHO's list of essential medicines could help reduce the burden of obesity.

But some health experts are skeptical about considering obesity drugs as essential.

Some obesity medicines have potential side effects, such as inflammation of the pancreas, gallbladder problems or increased heart rate. Also, there is a lack of long-term safety and effectiveness data.

"These drugs have actually been developed for the treatment of diabetes. The use for obesity is a relatively new application," explained WHO Director Branca. "It will be important to see what the long-term consequences are because these drugs need to be used for life. Otherwise there will be a reversal of the weight loss."

Obesity is also a complex condition which cannot be cured with medicines only.

Health experts say that medicines are only one aspect of treatment options among non-medicinal approaches, such as improved nutritional habits, exercise and psychological support.

"Lifestyle interventions are absolutely a key for the management of obesity," said Branca.

"Preventive strategies and sustained efforts at education, gender-focused interventions, must take precedence over the use of obesity drugs," said Zulfiqar Bhutta, an obesity expert at the University of Toronto in a Reuters report.

Another important aspect is that the management of obesity is not only about loosing weight but about improving the person's body functions, such as their blood pressure, mental health and capacity to move.

"That's why a drug may be a part of a therapeutic strategy, but it's not a silver bullet that will resolve the problem of obesity," said Branca.

WHO to analyze benefits and risks of obesity drug

The researchers who suggested the drug Saxenda, including Sanjana Garimella from Yale School of Medicine and Sandeep Kishore from the University of California, did not respond to DW's requests for comment before publication.

The advisers to the WHO will review the request at the end of April 2023. They are an international group of experts in health, pharmaceuticals and evidence-based medicine, who will analyze the benefits, risks and costs of the obesity drug and other suggested medicines. They will make a recommendation, which will then either be approved or denied by the WHO Director General. The updated list of essential medicines is expected to be published in July 2023.