Interpretation of the World Health Organization guideline on glucagon-like peptide-1 (GLP-1) therapies for the treatment of obesity in adults
Interpretation of the World Health Organization guideline on glucagon-like peptide-1 (GLP-1) therapies for the treatment of obesity in adults
Tianyi Ma 1Luping Ren2
作者信息
- 1. Clinical Medical College, Hebei Medical University, Shijiazhuang, Hebei 050000, China;Department of Endocrinology, Hebei General Hospital, Shijiazhuang, Hebei 050000, China
- 2. Department of Endocrinology, Hebei General Hospital, Shijiazhuang, Hebei 050000, China;Key Laboratory of Metabolic Diseases, Hebei General Hospital, Shijiazhuang, Hebei 050000, China
- 折叠
摘要
世界卫生组织（WHO）于2025年发布了《成人肥胖治疗中胰高血糖素样肽-1（GLP-1）疗法指南》，以应对日益增长的全球肥胖负担，这是一种慢性、进行性且极易复发的疾病，长期以来作为长期疾病管理不充分。该指南适用于年龄≥20岁的成人，肥胖定义为身体质量指数（BMI）≥30kg/m²，其证据基础仅限于利拉鲁肽、司美格鲁肽和替尔泊肽。通过系统评价、GRADE方法学、证据到决策框架以及GRADE-CERQual评估的快速定性证据综合，该指南制定了两项良好实践声明和两项条件性推荐。首先，应将肥胖纳入终身慢性病管理，以长期随访为基础的照护和情境特定的行为与生活方式咨询作为干预的基础。其次，对于成人肥胖患者，可考虑使用GLP-1受体激动剂或GIP/GLP-1双激动剂进行长期治疗，当资源和个体情况允许时，可将强化行为疗法与药物治疗结合。这些推荐的条件性反映了在长期疗效和安全性、治疗中断与维持策略、成本效益、可及性、实施能力及健康公平性方面仍存在不确定性。对于中国，该指南应谨慎解读，因为WHO对成年期和肥胖的定义与国内常用标准不同，且在药物可及性、支付能力、基层随访和多学科资源方面存在显著区域差异。因此，实施应适应本地诊断标准、医疗交付模式、分级管理路径和可持续随访系统，以支持公平和标准化的肥胖管理。
Abstract
The World Health Organization (WHO) issued the Guideline on glucagon-like peptide-1 (GLP-1) therapies for the treatment of obesity in adults in 2025 to address the growing global burden of obesity, a chronic, progressive, and highly recurrent disease that has long been inadequately managed as a long-term condition. This guideline applies to adults aged 20 years with obesity defined as a body mass index (BMI) 30 kg/m, and its evidence base is limited to liraglutide, semaglutide, and tirzepatide. Using systematic reviews, the GRADE methodology, an Evidence-to-Decision framework, and rapid qualitative evidence synthesis with GRADE-CERQual assessment, the guideline developed two good practice statements and two conditional recommendations. First, obesity should be incorporated into lifelong chronic disease management, with long-term, follow-up-based care and context-specific behavioral and lifestyle counseling as the foundation of intervention. Second, GLP-1 receptor agonists or GIP/GLP-1 dual agonists may be considered for long-term treatment in adults with obesity, while intensive behavioral therapy may be combined with pharmacological treatment when resources and individual circumstances permit. The conditional nature of these recommendations reflects remaining uncertainties regarding long-term efficacy and safety, treatment discontinuation and maintenance strategies, cost-effectiveness, access, implementation capacity, and health equity. For China, the guideline should be interpreted cautiously because the WHO definitions of adulthood and obesity differ from commonly used domestic criteria, and substantial regional disparities exist in drug accessibility, payment capacity, primary-care follow-up, and multi-disciplinary resources. Therefore, implementation should be adapted to local diagnostic standards, health care delivery models, tiered management pathways, and sustainable follow-up systems to support equitable and standardized obesity care.关键词
肥胖/GLP-1受体激动剂/GIP/GLP-1双激动剂/世界卫生组织临床指南解读Key words
Obesity/GLP-1 receptor agonist/GIP/GLP-1 dual agonist/World Health Organization clinical guideline interpretation引用本文复制引用
Tianyi Ma,Luping Ren.Interpretation of the World Health Organization guideline on glucagon-like peptide-1 (GLP-1) therapies for the treatment of obesity in adults[EB/OL].(2026-10-22)[2026-10-24].https://chinaxiv.org/abs/202610.00164.学科分类
临床医学
