GLP-1 Receptor Agonists: Shifting Obesity Management

The glucagon-like peptide-1 (GLP-1) receptor agonist market is experiencing rapid growth, with more than 150 drug candidates currently in development as reported by Research & Markets, 2025. These therapies were originally a treatment for type 2 diabetes mellitus (T2DM). However, GLP-1 treatments demonstrate substantial weight loss benefits and are now gaining traction in obesity management. Given their ability to address both obesity and its comorbidities, GLP-1 receptor antagonists are now considered a vital advancement in metabolic disease treatment.

Why are GLP-1s important in obesity management?

Diet, exercise and behavioural interventions – which are the conventional approaches to obesity – have limited long-term success. They tend to be hindered by factors like metabolic adaptation, psychological barriers, and environmental influences.

For many, maintaining weight loss is difficult. This is why obesity may require pharmacological intervention. Prior to the development of GLP-1 receptor antagonists, alternative options to weight loss drugs were limited. For example, Orlistat (marketed as Alli), one of the few available weight-loss drugs has modest efficacy and significant gastrointestinal side effects. The Oasis 1 trial reported by Novo Nordisk in 2023 provides evidence that GLP-1 therapies can offer a more effective alternative, with weight loss of up to 17.4%, and more tolerable side-effect profiles.

What are the Current Prescribing Guidelines for GLP-1s in the UK?

In the UK, as reported within a NICE published news article, GLP-1 receptor agonists are only prescribed when someone has a body mass index (BMI) over 35 kg/m² and has additional psychological or other medical conditions that are related to obesity. While NHS access remains restricted, as reported by Wharton et al. 2023, supply shortages have previously limited availability even for eligible patients. Black market access is rising, with unauthorised online sales raising safety concerns. As demand grows, policymakers face critical decisions on who should receive these treatments and how they should be funded.

Understanding Preferences in Obesity Treatment

Preferences: What Matters Most?

To optimise patient-centred obesity care, we must understand how individuals balance trade-offs between the effectiveness of treatment, its mode of delivery and potential side effects. This is especially important given the shift of GLP-1 receptor agonists from the diabetes space into the broader population with obesity.

For example, some people may prefer oral formulations over injectables due to comfort or convenience, even if the efficacy is slightly lower. Others may tolerate more severe side effects like nausea for faster weight loss. These trade-offs aren’t just clinical – they’re personal and behavioural, and they shape treatment adherence and real-world outcomes.

Importantly, treatment preferences among people with obesity (without diabetes) may differ from those managing T2DM. Because they’re not facing a chronic disease requiring lifelong medication, their risk tolerance for side effects may be lower, and they may be more motivated by improvements in daily quality of life, such as enjoyment of food, physical activity and mental wellbeing.

Patient preference studies can shed light on these questions and are particularly useful for understanding how preferences can vary within and across patient populations. For example, a recent study by OHE and the Acute Leukaemia Advocates Network examined preferences among people with acute leukaemia. It found that, on average, those with AML and those diagnosed longer ago cared more about quality of life and how treatment is given, compared to those with other types of acute leukaemia or more recent diagnoses.

Societal Preferences: Broader Considerations

At the population level, public preferences can influence policy decisions about who should have access to these therapies and how they should be funded. Should NHS funding be reserved for individuals with comorbidities, or extended more broadly? Would a co-pay model where patients contribute a portion of the cost be acceptable to the public?

Better understanding these societal values could inform cost-effectiveness evaluations, equity discussions and the design of benefit packages in both public and private health systems. Societal preference research can help achieve this. For example, a recent OHE study explored views in England and Wales on prioritising new medical treatments. It found that people believe treatments should be prioritised based on the severity of a health condition and place greater value on treatments for severe conditions than is currently reflected in NICE’s “severity modifier” policy.

What’s next?

As the GLP-1 therapy market expands, understanding patient and societal preferences is critical for market access, pricing and HTA decisions. A rigorous evidence base that incorporates preference research using qualitative (e.g., interviews, focus groups) and/or quantitative methods (e.g., discrete choice experiments, best-worst scaling) is an important next step for stakeholders to balance this important innovation with the needs and preferences of patients and society more broadly.