More than one in four adults aged 25 to 64 years across the world may be eligible to receive glucagon-like peptide-1 (GLP-1) receptor agonists—a class of medicines increasingly used for weight management—according to a new international analysis published in the February issue of The Lancet Diabetes & Endocrinology.

The research, led by Dr Sang Gune K. Yoo of the Washington University School of Medicine in St. Louis, examined data from nationally representative household health surveys conducted in 99 countries between 2008 and 2021. The analysis included health information from over 810,000 non-pregnant adults aged 25 to 64 years, making it one of the most comprehensive global assessments of eligibility for GLP-1 receptor agonists to date.

Researchers found that an estimated 27 per cent of adults in the pooled global sample met the eligibility criteria for these medications. When applied to age-stratified United Nations population estimates for 2020, this translates to approximately 799 million people worldwide.

Eligibility varied sharply by income level and region. High-income countries showed the highest proportion of eligible adults at 41.8 per cent, followed by upper-middle-income countries at 26.2 per cent, lower-middle-income countries at 25.2 per cent, and low-income countries at 11.7 per cent.

Regional differences were also pronounced. Europe and North America recorded the highest eligibility rates at nearly 43 per cent, closely followed by the Pacific Islands at 41 per cent. In contrast, South, East, and Southeast Asia accounted for the largest absolute number of eligible individuals, with about 23 per cent of adults qualifying—reflecting the region’s large population base.

The study further noted important demographic patterns. Women were more likely to be eligible for GLP-1 receptor agonists than men, with eligibility rates of 28.5 per cent and 25.5 per cent respectively. Eligibility also increased steadily with age, rising from 17.9 per cent among adults aged 25 to 34 years to 38.3 per cent among those aged 54 to 64 years.

Commenting on the findings, Dr Yoo said the results reflect broader global trends in obesity. “Given the steadily increasing prevalence of obesity, it’s not surprising that our analysis found that more than one quarter of adults around the world may be eligible for this medication,” he said. However, he cautioned that access remains a major hurdle. “These medications are difficult to obtain in many settings,” he noted, highlighting issues related to cost, availability, and healthcare infrastructure.

GLP-1 receptor agonists, originally developed to treat type 2 diabetes, have gained global attention in recent years for their effectiveness in promoting weight loss. However, experts say the study underscores a widening gap between medical eligibility and real-world access, particularly in low- and middle-income countries.

The authors acknowledged that several contributors to the study have disclosed ties to the biopharmaceutical industry. They emphasized the need for broader policy discussions on affordability, equitable access, and long-term strategies to address obesity at a population level.

As obesity rates continue to rise worldwide, the findings raise important questions about how health systems can balance innovation with accessibility, ensuring that effective treatments reach those who need them most.