Clinicians shift stance, join calls for PBS subsidy of obesity and weight-loss medicines

Over a third of Australian adults live with obesity, and the National Obesity Strategy estimates the direct and indirect costs of this are around $12 billion per year. The Royal Australian College of General Practitioners (RACGP) has shifted its stance on weight-loss medications, advocating for the inclusion of effective obesity treatments on the Pharmaceutical Benefits Scheme (PBS).

The move aligns with the RACGP’s newly released position statement on obesity prevention and management, which urges the healthcare sector to prioritise patient health over weight loss alone.

RACGP Specific Interest Obesity Management Chair Dr Terri-Lynne South stressed that while a PBS subsidy would be a crucial step in addressing obesity, broader systemic support is essential to help patients achieve and sustain better health.

“There is a growing body of evidence that semaglutide medicines are an effective way for patients to reduce their risk of developing complex and chronic conditions that are linked to overweight and obesity,” Dr South said.

A recent survey released on World Obesity Day found that 87% of respondents are actively attempting to lose weight. With an average weight of 109kg, participants indicated they aim to reduce, on average, 23% of their body weight.

Dr South emphasised, “Manufacturers have drawn exceptional profits from these medications. Now they must invest in reducing costs for patients. PBS spending is an investment in health, with competing calls for funding, so any spending must be efficient.

“If a medicine is effective and safe, and the cost of a condition to the health system outweighs the cost of treating it with a medicine, there’s a strong case to subsidise that medicine. The evidence for semaglutide and similar GLP-1 receptor agonists as effective weight loss medicines is, if not at, then approaching, that point.”

The push for better access to obesity treatments comes amid new findings in a head-to-head trial. Eli Lilly’s Mounjaro (tirzepatide) has proven superior to Novo Nordisk’s Wegovy (semaglutide) for weight loss, according to topline results from the SURMOUNT-5 trial, delivering 47% greater weight loss compared to Wegovy.

As the global approach to obesity treatment evolves, experts point to the importance of redefining obesity as a medical condition requiring personalised treatment. Professor Wendy Brown, Head of the Department of Surgery at Monash University and Director of The Alfred’s Oesophago-Gastric-Bariatric Unit, highlighted how updated diagnostic criteria are improving patient care.

“With the new criteria proposed by The Lancet Diabetes & Endocrinology Obesity Commission, we finally have a medically meaningful way of diagnosing obesity, meaning we can tailor the treatment plan according to the patient’s needs,” Professor Brown explained.

“Our recent research showing that bariatric surgery in Australia is relatively safe should also reassure patients, their loved ones, and payers such as government and insurers that bariatric surgery is safe, effective, and delivers great health improvement. It will also help to inform more accurate patient consent, so patients have an idea of what they can realistically expect to achieve after an operation and what the risks are,” she said.

Professor Brown emphasised the long-term benefits of surgery, particularly for those who have struggled with other weight-loss methods.

“The safety of bariatric surgery means we can safely offer people a way to lose and keep off a substantial amount of weight, offering an opportunity to reverse or improve many health problems. Usually, they will have tried other ways of losing weight prior to being offered surgery,” she said.

The RACGP President, Dr Michael Wright, urged policymakers to support a more comprehensive approach to obesity care, including increased Medicare rebates and investment in allied health professionals.

“Patients receive less funding from Medicare for longer consults, yet these are essential to effectively and efficiently manage chronic illnesses. Weight loss is challenging and personal, so patients and GPs must work on solutions that work for them. We need a health system that supports people to gain and maintain health,” he said.

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