The concerns about GLP-1RA in the real world

Simultaneously achieving weight loss and glycemic control can be achieved by overcoming human genetics. In other words, people must suppress their desires to control their blood sugar and weight. Many available drugs for these conditions help control impulses and maintain motivation but have shown unsatisfactory results in terms of weight loss and side effects. The recent interest in new GLP-1RAs and GLP-1/glucagon-like insulinotropic peptide-1 (GIP-1) dual receptor agonist combination preparations has resulted in unrealistic expectations that these drugs can eliminate obesity and diabetes permanently, and the problems of abuse and side effects have been ignored [2]. Initially developed and used as blood sugar-lowering aids, GLP-1RAs have been approved as weight loss and blood sugar control aids in Korea and the United States. Media articles about the weight loss effects and sensational titles such as ‘miracle anti-obesity drug’ have sparked explosive public interest in these drugs. In Korea, when it became available for use on October 15, 2024, Wegovy (Novo Nordisk, Bagsvaerd, Denmark) quickly became a topic of controversy due to their accessibility through non-face-to-face prescriptions without any kinds of restriction, raising concerns about misuse and safety [3].

Regulatory challenges and policy responses in Korea vs. Japan

When the issue of abuse and misuse due to non-face-to-face treatment was raised [3], the government simply restricted telemedicine prescriptions for most obesity drugs. But, this simplistic regulatory measure fails to address the root causes of the problem. In addition, the Korean Society for the Study of Obesity announced a statement that ‘incretin-based anti-obesity drugs such as GLP-1RAs require monitoring by medical staff while they are being used.’ However, it had already gone beyond the scope of the problem that the Korean Society for the Study of Obesity can solve. Efforts are needed to identify the reasons for and solutions to abuse and misuse.

In 2017, the U.S. Food and Drug Administration approved low-dose semaglutide ≤2.0 mg (Ozempic, Novo Nordisk) as an adjunct to glycemic control and higher-dose semaglutide ≤2.4 mg (Wegovy) as an adjunct to weight loss in adults 12 years of age and older. Similarly, tirzepatide ≤10 mg (Mounjaro, Eli Lilly, Indianapolis, IN, USA) and tirzepatide ≤15 mg (Zepbound, Eli Lilly) were approved for the same indications in 2022. In Korea, the regulatory timeline was as follows: Ozempic was approved for glycemic control in May 2022. Wegovy was approved for weight loss in April 2023. Mounjaro received approval for glycemic control in June 2023 and for weight management in July 2024.

The indications for use are that Wegovy and Mounjaro can be prescribed when the BMI ≥30 kg/m² or higher or when the BMI is 27 to 30 kg/m² and is accompanied by one or more comorbidities such as dysglycemia (pre-diabetes or type 2 diabetes mellitus), hypertension, dyslipidemia, obstructive sleep apnea, or cardiovascular disease. Wegovy has also been approved to reduce the risk of major cardiovascular events (cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke) in suitable overweight or obese patients with an initial BMI of 27≥kg/m². As of January 2025, only Wegovy can be prescribed as non-reimbursed weight loss aids in Korea. These non-coverage policies not only limit access to low-income populations, they also limit the rights of those who are eligible for obesity management.

By contrast, in Japan, both GLP-1RAs and GLP-1/GIP-1 combination drugs are covered by insurance for diabetes and obesity. Japan intends to strengthen insurance coverage criteria for use of Wegovy and Mounjaro and strictly manage the drugs to prevent use by the uninsured, limiting financial losses and maximizing the effectiveness of the use of these drugs (Supplementary Table 1). Japan has simultaneously prevented the problem of abuse and misuse by including strict guidelines in the national health insurance coverage criteria. In Japan, the price varies depending on the injection dosage, but in Korea, the price is the same for high doses regardless of dosage (Supplementary Table 1). Due to this difference, Korean patients with obesity or with combined obesity and diabetes pay up to five times more than Japanese patients, resulting in high individual medical expenses. As a result, some patients who need this drug are not able to use it, and only patients with financial means can use it.

Addressing the disparity in obesity management

Surgery for severely obese patients has been covered by insurance in Korea since 2019, and in Japan since 2014. The indications for such insurance coverage are shown in Supplementary Table 2. This coverage, determined by the Ministry of Health and Welfare, acknowledges that not all obesity is simply a personal lifestyle problem, and that some cases require medical intervention. So, it is reasonable to cover the obesity pharmacotherapy with insurance.

For effective obesity management, a comprehensive approach that combines various treatment methods with individual action is required. Among these, weight loss drugs and surgery are important methods. Although obesity metabolic surgery may be effective, it is not applicable to all patients. Therefore, excluding drug therapy from coverage for severely obese patients who cannot undergo surgery limits their access to medical benefits and further discriminates against the socially disadvantaged. In addition, because drug therapy is necessary as a method of follow-up management for patients who cannot be managed with surgical therapy [4], many countries, including the United States and Europe, provide insurance reimbursement for anti-obesity medications. Such support is intended to help resolve social and economic problems caused by obesity.

Conclusion and policy recommendations

Obesity and diabetes are interconnected chronic diseases that require integrated management strategies rather than being treated as separate conditions. Most available obesity drugs function only to help control blood sugar and were not highlighted in the present study. However, many obesity management drugs currently in the development stage are based on intestinal hormones and act to simultaneously weight and blood sugar control [5], for which the current individualized payment standards will undermine the fairness and universality of medical services. If these problems are not resolved immediately, there is a high possibility that they will persist into the future. For this reason, insurance coverage of GLP-1RAs and GLP-1/GIP-1 dual receptor agonist combinations should be implemented as soon as possible, as follows:

(1) Provide insurance coverage for GLP-1RAs based on strict eligibility criteria to prevent misuse.

(2) Implement tiered reimbursement models for medically vulnerable patients rather than indication-based universal reimbursement to maintain the financial sustainability.

(3) Strengthen monitoring and prescription guidelines to prevent off-label use and abuse, such as physician supervision and patient education programs to minimize misuse.

(4) Promote a multidisciplinary approach that combines pharmacotherapy, lifestyle interventions, behavioral therapy and psychological support.

SUPPLEMENTARY MATERIALS

NOTES

CONFLICTS OF INTEREST

No potential conflict of interest relevant to this article was reported.

REFERENCES

• 1. Park SE, Ko SH, Kim JY, Kim K, Moon JH, Kim NH, et al. Diabetes fact sheets in Korea 2024. Diabetes Metab J 2025;49:24-33.ArticlePubMedPMCPDF
• 2. GOV. UK. GLP-1 receptor agonists: reminder of the potential side effects and to be aware of the potential for misuse. Available from: https://www.gov.uk/drug-safety-update/glp-1-receptoragonists-reminder-of-the-potential-side-effects-and-to-beaware-of-the-potential-for-misuse (cited 2025 Feb 22).
• 3. Korea Biomedical Review. Concerns rise over misuse of obesity drug Wegovy via telemedicine platforms. Available from: https://www.koreabiomed.com/news/articleView.html?idxno=25454 (cited 2025 Feb 22).
• 4. Courcoulas AP, Patti ME, Hu B, Arterburn DE, Simonson DC, Gourash WF, et al. Long-term outcomes of medical management vs bariatric surgery in type 2 diabetes. JAMA 2024;331:654-64.ArticlePubMedPMC
• 5. Melson E, Ashraf U, Papamargaritis D, Davies MJ. What is the pipeline for future medications for obesity? Int J Obes (Lond) 2024 Feb 1 [Epub]. https://doi.org/10.1038/s41366-024-01473-y.Article

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Park TS. Glucagon-Like Peptide-1 Receptor Agonists: What’s the Optimizing Policies for Obesity-Related Metabolic Diseases?. Diabetes Metab J. 2025;49(2):169-171.

DOI: https://doi.org/10.4093/dmj.2025.0047.

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