With the World Health Organization (WHO) defining obesity as a chronic disease requiring lifelong management and officially recommending glucagon-like peptide-1 (GLP-1) therapies as part of long-term treatment strategies, the global anti-obesity drug market is reaching a new turning point. The focus is shifting away from short-term weight loss competition toward securing treatment sustainability and access.
The WHO recommendation has brought back a question Korea has deferred: whether to treat obesity as a matter of personal responsibility or as a chronic disease requiring public management.
After the president mentioned reviewing insurance coverage for anti-obesity drugs, related agencies including the Ministry of Health and Welfare, the Drug Reimbursement Evaluation Committee, and the National Health Insurance Service entered a full-fledged review phase.
In Korea, despite the high price of treatment, substantial prescribing experience has already accumulated through out-of-pocket spending as obesity prevalence steadily increases. With both Wegovy and Mounjaro launched domestically, conditions are in place to secure clinical and real-world data (RWD). Observers say that if coverage opens, the foundation is set for competition to become visible in a short period.
The patient pool is also expanding rapidly. According to a community health survey conducted by the Korea Disease Control and Prevention Agency on more than 230,000 adults across 258 cities, counties, and districts nationwide, 34.4% of adults had a body mass index (BMI) of 25 or higher, corresponding to medical obesity. That is a sharp increase from 26.3% in 2015, meaning obesity prevalence has risen about 1.3 times in just 10 years.
◇ Signal from WHO: obesity treatment is "long-term management," the issue is expense
On the 1st, WHO said in the Journal of the American Medical Association (JAMA) that global economic losses from obesity are expected to reach $3 trillion (about 4,400 trillion won) by 2030, and conditionally recommended GLP-1-based anti-obesity drug use. It stressed, however, that pharmacotherapy must be combined with lifestyle modifications such as diet control and exercise, and that long-term safety and treatment access must be ensured.
The recommendation covers major GLP-1 therapies such as semaglutide (Wegovy, Ozempic), tirzepatide (Mounjaro), and liraglutide (Victoza, Saxenda).
At the same time, WHO pointed to high prices and supply constraints as limitations. It projected that even by 2030, only about 10% of the global population with obesity will be able to benefit from GLP-1 treatments.
This aligns with the domestic reality. Although Wegovy and Mounjaro have been introduced in Korea, most obesity care and pharmacotherapy—excluding some surgical treatments such as sleeve gastrectomy—remain non-reimbursable. As a result, the burden on patients is heavy, and last year controversy erupted over misprescribing and misuse via telehealth platforms.
According to data obtained by Seo Mihwa, a member of the Health and Welfare Committee from the Democratic Party of Korea, from the Health Insurance Review & Assessment Service (HIRA), Mounjaro was prescribed a total of 18,579 times under the Drug Utilization Review (DUR) standard during Aug. 20–31, roughly the first 10 days after its domestic launch. On some days, daily prescriptions exceeded 2,000.
◇ Insurance coverage debate in full swing: the key is "who, when, and how far"
In Korea, calls for insurance coverage of anti-obesity drugs have been steadily raised by academia and the medical community. In fact, Ozempic, which contains semaglutide, was recognized for reimbursement appropriateness by the Drug Reimbursement Evaluation Committee in Oct., and Mounjaro, which contains tirzepatide, also passed the first gate of reimbursement evaluation for its diabetes indication.
Some analysts say that insuring anti-obesity drugs could signal bringing obesity into the public management system beyond simply subsidizing drug costs. In the long term, it could reduce major complications such as diabetes and cardiovascular disease, lower medical expenses, and enhance the sustainability of health insurance finances.
According to research by the National Health Insurance Service, the socioeconomic expense of obesity increased an average of 7% annually over the past five years (2017–2021), reaching about 16 trillion won in 2021. The figure includes not only medical expenses but also productivity losses and future income declines due to premature death.
Experts say, however, that clear criteria are necessary. The United Kingdom, the United States, and Japan provide insurance support for obesity treatment expense under conditions such as BMI thresholds and the presence of comorbidities.
The United Kingdom began phased coverage centered on patient groups with high clinical need, while Japan limits coverage to patients with a BMI of 35 or higher, or those with a BMI of 27 or higher who have two or more comorbidities.
Jeong Hee-won, head of the Slow Aging Research Institute, said, "The goal of GLP-1 therapy is not simple weight loss but normalization of metabolic function," adding, "Applying Western clinical criteria as is to raise the dose quickly or stopping after short-term use can increase the risk of side effects."
Jeong continued, "Because Koreans have a lower average body weight, dosing should be adjusted much more slowly, and discontinuation also requires gradual tapering," noting, "In the current system where drugs are prescribed without nutrition and exercise education, overuse and misuse are bound to recur."
Jeong said, "Ultimately, the key is to clarify indications and establish principles for personalized prescribing," adding, "If oral and small-molecule therapies emerge in the future, drug prices are likely to drop rapidly. In the long term, depending on cost-effectiveness analyses, some GLP-1 therapies could be incorporated into insurance coverage."
Oh Ji-won, a professor in the Department of Anatomy at Yonsei University College of Medicine, also said, "GLP-1 is not a diet pill but a therapy," adding, "At this point, it is closest to principle to use it in patient groups with clearly defined benefits, such as those with high BMI or concurrent metabolic disease and cardiovascular risk."
Oh said, "For those with normal weight or for cosmetic purposes, it is hard to see the benefits outweighing the risks such as gastrointestinal side effects or muscle loss," adding, "Especially when long-term safety data are insufficient, indiscriminate use could be problematic."
Oh said, "Insurance coverage must be premised on a social consensus that the benefits are significant," adding, "Given current price levels, the financial burden on health insurance could be substantial in the short term, so phased application focused on very high-risk groups would be realistic."