Australia at a crossroads in obesity management: Experts call for strategic use of GLP-1 receptor agonists

The advent of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) is reshaping clinical and policy discussions around obesity. With 32% of Australians now classified as obese and the economic burden projected to reach $87.7 billion by 2032, the urgency for effective, sustainable interventions is clear.

“We’re at a watershed moment in obesity management. Because of how these new medications work, they’re transforming the way we view obesity as a condition,” said Associate Professor Suong Le, a gastroenterologist at Monash University’s School of Clinical Sciences at Monash Health and CEO of Juno Healthcare who contributed to a new review.

“It’s clear that obesity is not just a lifestyle choice, but should be regarded as a chronic inflammatory disease with links to cancer, brain function and autoimmune conditions.”

The authors stress that as demand for Eli Lilly’s Mounjaro (tirzepatide) and Novo Nordisk’s Wegovy (semaglutide) surges, many critical questions remain unanswered: How long should treatment last? How can rebound weight gain be prevented after stopping the medication? What are the long-term funding implications?

“The weight loss clinical trials being conducted in the US are enormous in terms of sample size, partly because GLP-1RAs are priced higher there than in Australia, and partly due to the sheer size of the potential market,” said Associate Professor Le.

“In Australia, we need to focus on researching more niche, specific use cases where these medications can make a meaningful difference in our clinical practice whilst also developing a greater understanding on how exactly they lead to improved cardiovascular health, kidney function and neuroprotection.”

He further added, “For example, we’ve studied the use of Mounjaro as a short-term, targeted therapy to help dialysis patients with obesity lose enough to be safely waitlisted for kidney transplants.”

A key policy challenge lies in determining how long these drugs should be subsidised. This question is particularly relevant to the Pharmaceutical Benefits Scheme (PBS) as internationally many health insurers limit reimbursement of GLP-1 RAs for obesity treatment to a maximum of two years.

Yet, a new meta-analysis presented at the European Congress on Obesity has confirmed that patients who stop taking GLP-1 receptor agonists experience a rapid and near-total return of lost weight within 1 – 2 years.

Associate Professor Le argues that Australia should prioritise short-term, high-impact applications, where clinical and economic benefits are most concentrated.

“If we are to have equitable access, this may require smaller pilots in targeted populations for defined time periods, such as pre‐transplant, pre‐cancer treatment or pre‐surgery,” she said.

The question of who should prescribe these medications is also under scrutiny. According to the review, there are currently three models of care: a shared care approach initiated by specialist services with general practitioner follow-up; a sole prescriber model involving GPs or nurse practitioners; and a digital delivery model, typically backed by private equity or insurers.

Regardless of the model, the authors insist on the need for coordinated, wraparound allied health support to ensure safe and effective care.

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