Global obesity rates for women are projected to reach 60·3% by 2050, according to a recent analysis by the Global Burden of Disease group cited in a new series of papers presented at the Annual Meeting of The European Association for the Study of Diabetes in Milan, Italy. Published in The Lancet Obstetrics, Gynaecology & Women’s Health, the research highlights significant disparities in GLP-1 receptor agonist drug use, efficacy, and access among women worldwide.
Obesity Prevalence and the Global Gender Gap
The prevalence of overweight or obesity stood at 46·7% in females and 43·4% in males in 2021, with estimates pointing to a widening gender gap over the coming decades. Professor Paul Franks of Lund University, Helsingborg Hospital, and Professor Claire Meek of the Leicester Diabetes Research Centre and Leicester NIHR Biomedical Research Centre authored the papers alongside colleagues, issuing a call to action to improve the evidence base for these treatments.
This gender gap remains especially pronounced in low- and middle-income countries, particularly across sub-Saharan Africa and south Asia. Broader social barriers and socioeconomic inequalities disproportionately affect women in these regions, contrasting with high-income countries where men can have higher prevalence rates.
Efficacy, Weight Loss, and Side-Effect Profiles
Clinical data show that weight loss with GLP-1 receptor agonists is greater in women than in men, while improvements in blood sugar control remain comparable. Researchers attribute this increased weight-loss efficacy to higher systemic drug exposure observed in women, even after adjustments for body mass. Pre-clinical findings also point to potential interactions between GLP-1 signalling and oestrogen, alongside enhanced suppression of food-motivated behaviours in female patients.
However, real-world studies comparing adverse events indicate a higher overall frequency of reported side-effects among women, including increased rates of dizziness, vomiting, and headache. Rapid weight gain following the cessation of GLP-1 RA medications—particularly gaining fat without extra muscle—raises concerns for long-term physical function and health in women, requiring targeted research.
Access Barriers and Affordability in Low- and Middle-Income Countries
Nearly 80% of adults who meet clinical eligibility criteria for GLP-1 receptor agonists live in low- and middle-income countries, where access remains minimal. Independent manufacturing estimates suggest that oral semaglutide could be produced for less than $1 per month supply, with injections costing under $5. Yet, retail prices in many of these settings frequently exceed $90 per month, leaving women who rely on publicly funded care or out-of-pocket payments without treatment.
The papers also emphasize conditions such as polyendocrine metabolic ovarian syndrome, which affects roughly 12% of women worldwide with the highest rates in south-east Asia and the eastern Mediterranean region. Despite weight loss improving health status for those with polyendocrine metabolic ovarian syndrome, GLP-1 receptor agonists are rarely centrally funded or generally available for this indication across most health-care systems.
Mandatory Reforms and Future Research Priorities
The authors conclude that extensive research is urgently required across multiple domains, including mental health, contraception, fertility, pregnancy safety, menopause, cardiovascular health, and healthy ageing. Their call to action outlines four core requirements:
- Women must have access to high-quality, equitable, and multidisciplinary obesity care worldwide.
- Clinical trials related to GLP-1 receptor agonists should enforce mandatory sex-stratified and ethnicity-stratified reporting.
- Care for women, as the main users of these therapies, must be guided by studies specifically assessing efficacy and safety during and around pregnancy.
- Companies, policymakers, insurers, and researchers must promote equitable access to genuine, high-quality treatments to maximise the treatment’s benefits and address existing access pathways that disadvantage women.
Frequently Asked Questions About GLP-1 Use in Women
Why is weight loss greater in women taking GLP-1 receptor agonists?
Studies indicate that women experience higher systemic drug exposure even after adjusting for body mass, along with enhanced suppression of food-motivated behaviours and potential interactions between oestrogen and GLP-1 signalling.
What are the primary access barriers for women in low- and middle-income countries?
While independent manufacturing estimates place production costs below $5 monthly for injections, retail prices exceed $90 in many regions, creating insurmountable hurdles for patients relying on out-of-pocket payments or public health systems.
Do GLP-1 receptor agonists present safety risks for psychiatric health?
Trial data support the overall psychiatric safety profile of these drugs, though researchers recommend routine screening for depression, anxiety, and eating disorders prior to treatment initiation and during follow-up.
Are GLP-1 medications currently available for polyendocrine metabolic ovarian syndrome?
Despite health improvements associated with weight loss in polyendocrine metabolic ovarian syndrome, these drugs are not generally available or centrally funded for the condition in most health-care systems.
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