IIf there was a hot topic in healthcare in 2025, it would be this. were definitely GLP-1colloquially called “anti-obesity shots.” These drugs, taken as weekly injections into the abdomen, lead to significant weight loss and, although developed to treat type 2 diabetes in people with metabolic disorders, have become the mainstay treatment for obesity in many countries. Clinicians are delighted with the treatment results in patients taking the drug, and study after study has found health benefits from associated weight loss in those who are obese. Thanks to celebrity endorsements, online sales and off-label uses, they are widely used by people of all ages and sizes who want to lose weight.
This is a strange moment for the public health community. For many years we have advocated government action to combat obesity – not through new drugs, but through taking nutrition and food systems seriously. We emphasized the need for government action to ensure access to nutritious food, regulation ultra-processed foods, introducing sugar taxes and banning unhealthy food advertising among young people, and encouraging increased physical activity. The solutions are simple: get people to eat more nutritious foods and move. The problem was implementation, especially in poor areas.
So when GLP-1 drugs like semaglutide began to be used as a mainstream weight-loss treatment, leading to huge profits for pharmaceutical companies, the initial reaction in public health circles was something between horror and annoyance. Not because the drugs didn't work, but because they symbolized a kind of surrender. After decades of fighting to change the culture of diet and physical activity, a pharmaceutical company has emerged offering weekly shots as an answer to the problem created by the multinational food industry.
The irony is not lost on me. One group of companies profits by making the population obese; another is now profiting by promising to reverse this situation, at least as long as people can continue to pay and shoot up. We still don't know long term side effects these drugs, especially in people with a healthy weight and normal metabolic function.
But in the past year, more and more countries have moved to use GLP-1 drugs as the primary treatment for obesity. Actually, World Health Organization (WHO) recently recommended GLP-1 drugs for the treatment of obesity in all countries. For decades, the WHO has resisted pharmaceutical solutions to obesity, insisting that the crisis is environmental, structural and political. Now the agency is saying something different: All over the world, people are dying from obesity-related diseases, and we have a tool that works.
For some, this is surrender. Is 2025 the year that global health finally moves away from addressing the social and commercial causes of obesity and from talking about nutrition? Obesity rates are closely related to socio-economic status. In fact, it has been said that childhood obesity is a reflection of child poverty. GLP-1s were created for the medical treatment of people with metabolic disorders. Are we saying that the poorest 20% of people (who have higher rates of obesity) have a metabolic disorder that the richest 20% do not? Of course not.
We know that diet is related to income, time, education and resources. If obesity is “curable” with a shot, why take on the food industry? Why invest in affordable fruits and vegetables or healthy school lunches? GLP-1 has become a way for many politicians to appear to be doing something while avoiding dealing with systematic problems of food production and consumption that make us sick.
But I can understand the WHO's turnaround because obesity is not a theoretical problem that we have time to solve. It kills people and deprives them of opportunities in everyday life. Just ask any doctor about the effects of these drugs on people with heart disease, diabetes, fatty liver disease, joint failure… the list goes on. Talk about redesigning food systems is good, but right now we have a drug that reliably reduces weight, improves metabolic health, and reduces the risk of cardiovascular disease. In this context, one can understand doctors seeing health benefits for their patients and WHO advocating for these drugs to be accessible and affordable throughout the world, including in low-income countries.
We still need to be careful about the reality of these medications for individuals. They require a weekly injection, which can lead to lifelong addiction, given that studies have shown that the weight comes back when they are stopped. They have side effects and can cause serious complications, especially in people who have not been prescribed them by a doctor. They also do not replace the need for good nutrition. Just as you can be overweight and undernourished, you can also be thin and undernourished.
Additionally, weight loss alone does not provide the health benefits of physical activity. Exercise strengthens the heart, builds muscle, protects the brain from depression, anxiety and dementia, and helps reduce chronic pain. There may be a workout pill available in 2026, but we don't yet have a drug that can mimic its benefits. Despite all the promises of GLP-1, the body still needs what it has always needed: inexpensive and accessible nutritious food and daily exercise. It may be a pipe dream, but I hope the coming year brings social changes that will make this possible for all of us, without the need for weekly injections.
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Professor Devi Sridhar is Head of Global Public Health at the University of Edinburgh.
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Fit Forever: Health for Midlife and Beyond
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