在低收入和中等收入国家扩大肥胖预防和治疗的工具箱：需要什么才能实现？

Expanding the Toolbox for ObesityPrevention and Treatment in Low- andMiddle-Income Countries: What Does ItTake to Make It Happen? DANIEL MORA-BRITO, Engagement Manager, Global Health, EMEA Thought LeadershipOLIVIA MEADOWCROFT, Consultant, Obesity Program ManagerMOHIT AGARWAL, Consultant, EMEA Thought LeadershipCAROLINE NORBERT, Associate Consultant, EMEA Thought Leadership Table of contents Introduction1Obesity: Why should we care?2The state of obesity today2The growing double disease burden in low- and middle-income countries7The political profile of obesity in noncommunicable diseases-related policydiscussions8Are low- and middle-income countries ready for pharmacotherapeutic9approaches to obesity?The rise of anti-obesity agents as a feasible solution to treat and prevent9cardiometabolic diseasesMarket opportunities in low- and middle-income countries: Off-patent semaglutide,10oral anti-obesity medicines, and longer-acting injectablesScaling up the use of anti-obesity medicines in low- and middle-incomecountries12Recommendations for cross-sectoral action21Addressing access barriers to obesity prevention and treatment21The power of data in optimizing decision-making and facilitating access25Conclusions27References28About the authors37Acknowledgements38 Introduction The treatment and prevention of obesity from a public health perspective havetraditionally been managed through behavioral and policy approaches thatpromote, in the first dimension, nutrition, physical activity, and healthier lifestylechoices; and, in the second, taxation or disincentives to the production or widedistribution of unhealthy foods. In recent years, anti-obesity medicines (AOMs)were integrated into the current toolbox of solutions to address this condition,with the advantage of also treating and preventing other related comorbidities.However, while the use of these agents has provided positive results in differentdisease areas, their supply and circulation are mostly confined to high-incomecountries (HICs), where they are fundamentally accessed through out-of-pocket(OOP) payments or restricted reimbursement policies. Due to this characteristic,AOMs are often prescribed in private practices and are usually accessible tohigher-income population segments. With the loss of exclusivity of some AOMs and thegrowing recognition of their value as public healthtools, supported by an expanding body of clinicaland real-world evidence and their recent inclusion inessential medicines lists (EMLs), their launch or wideruse in low- and middle-income countries (LMICs) couldbe a game changer. As semaglutide, a componentcentral to many AOMs, goes off patent across manycountries in 2026, many opportunities will emergefor the manufacturing of generics with lower prices.On the other hand, the number of AOMs expectedto receive regulatory approval over the next decadecan rise dramatically, with over 180 novel substancescurrently under clinical development. Many of theseAOMs may not be necessarily relevant to LMICs, butthe magnitude and richness of the pipeline, as well asthe competition it will generate, hold the promise ofeven more effective and affordable agents for both on-and off-patent medicines. therapies could notably improve population healthand reduce financial pressures on patients and healthsystems. The 2025 World Obesity Atlas estimatesthat, should prevention and treatment not improve,the global economic impact of overweight andobesity could reach US$4.32 trillion annually by 2035.1Similarly, according to modeling presented by thesame source, most of the people living with overweightand obesity could reside in LMICs by the same year.2 With these facts in mind, this paper seeks tounderstand the implications of introducing AOMs inLMICs, examining (1) the current state of obesity asa public health threat in the world’s most vulnerablegeographies; (2) the opportunities and challenges thatthese therapies bring to the fore in terms of treatmentand prevention for many conditions; (3) the prospectsthat affordable AOMs at scale — led by but not limitedto off-patent semaglutide — could generate in LMICs;and (4) the potential routes that governments, lifescience companies, and multilateral organizationscould take to support better access and healthsystemreadiness. By tackling obesity and, as a result, reducing orstopping the progression of high-burden and costlynoncomunicable diseases (NCDs), the use of these importantly, literature on the subject highlights — andmost policymakers consider — the role of obesity notso much as an illness in itself but a major precursor ofNCDs, currently responsible for 74% of global deaths,with 73% taking place in LMICs. Out of 43 million adultsdying globally due to NCDs, some publications suggestthat 3.5 million of them have a body mass index (BMI)equal to or above 25 kg/m2,clearly signaling a strongand significant correlation between overweight andobesity and NCD-related mortality.4Figure 1 presentsa summarized