Por Dra. Anne Therese Bernadette Laudato, MD

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Published on agosto 8, 2025

Puntos clave

La OMS excluyó todos los medicamentos para la obesidad, incluida la semaglutida (Wegovy), de su Lista de Medicamentos Esenciales (LME) de 2023.
La decisión ha reavivado el debate mundial sobre si la obesidad debe tratarse como un problema médico o con estrategias más amplias de salud pública.
Los partidarios de la inclusión citan resultados convincentes de pérdida de peso y cardiovasculares; los críticos señalan lagunas en los datos sobre costos, equidad y a largo plazo.
La OMS dio prioridad a las soluciones escalables y preventivas en lugar de las costosas intervenciones basadas en los medicamentos.

En 2023, la Organización Mundial de la Salud tomó una decisión que llamó la atención: se negó a incluir cualquier medicamento contra la obesidad-más notablemente, semaglutide (comercializado como Wegovy)-en su última actualización de la Lista de Medicamentos Esenciales (EML)¹. This list, revised every two years, serves as a benchmark for which therapies governments and global health systems should prioritize.

For many, this felt like a step backward. Obesity is linked to higher risks of blood sugar regulation problems, heart problems, joint pain, and certain cancers. Why would the WHO sideline a category of therapies that, by several accounts, could improve quality of life and reduce mortality?

The answer lies in a layered mix of cost-effectiveness, public health strategy, and ethical questions about what it truly means to “treat” obesity.

Why the Decision Matters

Obesity is now one of the most urgent public health challenges worldwide. More than 1 billion people live with obesity, including nearly 160 million children and adolescents². Beyond visible weight gain, the symptom is associated with elevated risk for noncommunicable diseases (NCDs) such as type 2 blood sugar regulation problems, heart problems, and some cancers.

The WHO Essential Medicines List was created to help countries, especially those with limited healthcare infrastructure, prioritize therapies that offer the greatest impact per dollar. Inclusion on the list boosts global access, funding, and regulatory support.But in its 2023 decision, the WHO expert committee concluded that obesity medications—including GLP-1 receptor agonists like semaglutide and liraglutide—“did not meet the criteria for inclusion”³.

What the WHO Cited

According to the WHO’s official report, the reasons for rejection included:

High cost and low affordability, especially in low- and middle-income countries
Limited long-term data on outcomes, safety, and user adherence
Concerns about widespread off-label or cosmetic use
Inadequate evidence of population-level impact in real-world settings

The committee noted that while GLP-1 drugs had shown weight loss benefits in studies, they were not yet proven to offer long-term reductions in mortality or complications when used for obesity alone. Until those data are clearer—and until costs come down—the drugs remain outside WHO’s global priorities.

What the Science Actually Shows

Semaglutide is part of a class of injectable therapies that mimic GLP-1, a hormone involved in appetite regulation and insulin release. A landmark 2021 trial published in The New England Journal of Medicine found that users of semaglutide lost, on average, 14.9% of their body weight over 68 weeks, compared to 2.4% with placebo⁴. Other studies have shown potential cardiovascular benefits, such as reduced risk of heart problems in those with obesity and no prior diagnosis of blood sugar regulation issues⁵.

Yet these benefits come at a price—literally. Monthly retail costs for semaglutide exceed $1,000 in the U.S., and access in lower-income regions is virtually nonexistent. Additionally, users often experience gastrointestinal symptoms, and many regain weight after discontinuing the therapy⁶.

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Pharma Pressure and Ethical Tensions

Many critics see the push for inclusion on the EML as not only scientific but also commercial. Novo Nordisk, the manufacturer of Wegovy and Ozempic, has aggressively lobbied for global recognition and reimbursement of semaglutide.

A BMJ investigation noted that some of the experts involved in recommending GLP-1 inclusion had industry ties, raising questions about impartiality⁷. At the heart of the concern is the possibility that the EML could be influenced more by pharma marketing than by equitable health priorities.

As WHO officials put it, the EML is “not a recognition of scientific promise alone—it’s a guide for what works, what’s needed, and what’s possible at scale”³.

Framing Obesity: Disease or Social Symptom?

The WHO’s decision underscores a long-running debate: Should obesity be treated primarily through medical interventions—or through social, environmental, and behavioral reforms?

High-income countries like the U.S. and UK tend to frame obesity as a chronic, biological symptom. Accordingly, their regulatory agencies—the FDA and EMA—have approved semaglutide for chronic weight management⁸.

The WHO takes a broader view, emphasizing population-level prevention. Its 2022 report on obesity called for sugar taxes, urban design reforms, food advertising restrictions, and nutrition education as first-line strategies⁹.

These measures are often more scalable and cost-effective than individual therapy, especially in nations where people still struggle to access basic health services.

Equity and Access: The Crux of the Debate

Excluding obesity drugs from the EML may frustrate users in wealthy countries, but for many public health experts, it’s a pragmatic move. The cost of delivering injectable drugs globally is massive. Cold-chain storage, regular injections, and physician supervision make widespread rollout unlikely in rural or under-resourced communities.

Dr. Francesco Branca, WHO’s director of nutrition and food safety, summed it up clearly: “We must focus on solutions that are practical and equitable for every population—not just the ones that can afford it”³.

Where Do We Go from Here?

Although obesity drugs aren’t currently on the EML, this may not be the final word. The WHO left open the possibility of reconsidering the issue if future studies show long-term benefits, improved affordability, and population-level outcomes.

In the meantime, countries can—and some already do—include semaglutide in their national essential medicines lists. But the WHO’s stance sends a strong signal: addressing obesity requires more than a prescription.

It demands a system-wide reimagining of food environments, social norms, economic structures, and public policy. And for now, the world’s most influential health body has decided that’s where the real work begins.

Referencias

1. World Health Organization. WHO Model List of Essential Medicines – 2023 edition.Link
2. WHO Obesity and Overweight Fact Sheet, 2023.Link
3. WHO Expert Committee on the Selection and Use of Essential Medicines. 2023 Report.Link
4. Wilding JPH, et al. “Once-Weekly Semaglutide in Adults with Overweight or Obesity.” New England Journal of Medicine, 2021.DOI
5. Lincoff AM, et al. “Semaglutide and Cardiovascular Outcomes in Obesity.” NEJM, 2023.DOI
6. Rubino D, et al. “Weight Regain and Discontinuation of GLP-1 Therapy.” Lancet Diabetes Endocrinol, 2022.
7. Abbasi J. “WHO Rejects Obesity Drug Amid Industry Pressure Concerns.” The BMJ, 2023.Link
8. FDA Approval for Wegovy (Semaglutide) for Chronic Weight Management.FDA.gov
9. WHO Acceleration Plan to Stop Obesity, 2022.Link
10. World Health Organization. (2024, September 25). Essential medicines. WHO Fact Sheet. https://www.who.int/news-room/fact-sheets/detail/essential-medicines
11. World Health Organization. (2025, May 7). Obesity and overweight. WHO Fact Sheet. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
12. Wilding, J. P. H., et al. (2021). Once-weekly semaglutide in adults with overweight or obesity. New England Journal of Medicine, 384(11), 989–1002. https://doi.org/10.1056/NEJMoa203218
13. Lincoff, A. M., et al. (2023). Semaglutide and cardiovascular outcomes in obesity. New England Journal of Medicine, 389(24), 2221–2232. https://doi.org/10.1056/NEJMoa2307563
14. World Health Organization. (2022, March 4). World Obesity Day 2022 – Accelerating action to stop obesity [Press release]. https://www.who.int/news/item/04-03-2022-world-obesity-day-2022-accelerating-action-to-stop-obesity
15. International Diabetes Federation (Europe). (2025, September 6). WHO expands essential medicines list. https://idf.org/europe/news/who-expands-essential-medicines-list/

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