At this time last year, people were still debating whether Novo-Nordisk A/S's Wegovy and Eli Lilly and Co's Zepbound were shortcuts to weight loss or medical breakthroughs. However, as substantial data indicates that these Pharmaceuticals provide health benefits beyond just reducing obesity—including alleviating heart disease, diabetes, chronic kidney disease, and sleep apnea—most people seem to have finally accepted their potential enormous social value.

Now, the most challenging phase has arrived. These effective Pharmaceuticals—GLP-1—are changing the way people perceive and treat obesity. These changes are happening so rapidly that they may benefit many, leading to new questions and ethical dilemmas for medical professionals, including who should receive drug treatment.

The market for Wegovy and Zepbound is theoretically huge: The FDA approves their use for individuals with a BMI of 30 or higher, and for those with a BMI of 27 or higher, treatment requires the presence of weight-related conditions such as hypertension or sleep apnea. Around 57 million working-age Americans with private Insurance meet these criteria, along with nearly 14 million retirees who also qualify. For patients using these Pharmaceuticals, the expectation is that once begun, they will need to be taken for life to maintain their effects.

But the question is, does everyone who fits this broad description need the drug? Medical opinions vary. Some strongly believe that everyone should receive treatment, while others differentiate between those at risk of weight-related health complications and those who are entirely healthy but meet the criteria for medication due to a BMI above the threshold.

In addition, within both camps, shortages of Pharmaceuticals and high prices have also forced doctors to devise methods to prioritize which patients should receive treatment.

These issues seem to indicate that the field requires an evidence-based approach to better identify the appropriate population for GLP-1 use. To this end, an international committee of obesity experts will release an interim report in early 2025, outlining the criteria for diagnosing 'clinical' obesity and how overweight can lead to or increase the risk of other health issues. The committee's head, Robert Kushner, an obesity medicine expert at Northwestern University's Feinberg School of Medicine, stated that ideally, this will help doctors more easily distinguish 'who is a true obesity patient that requires early treatment' from those who gain 10 or 20 pounds and exceed the BMI threshold but remain very healthy.

This will definitely raise other issues. In a situation where demand is high and supply is tight, no one wants overly strict conditions for medication. However, this approach may also be a significant step towards a stricter assessment of the relationship between weight and health, which could make it easier and fairer for those who need medications to access them, and provide guidelines for Insurance companies to promote their coverage.

This may also help alleviate the tension between doctors and Insurance companies. Generally, once a patient's BMI falls below a certain level, they will lose coverage for GLP-1 medications. But the reality is that without continuous treatment, weight will return, increasing the risk of patients developing diseases such as diabetes and hypertension. Proposing a disease risk-centered approach to define obesity may clarify the necessity for long-term treatment.

The standard will also help doctors answer another important question: When can a person's weight loss be considered complete?

Not long ago, doctors treating obesity mostly urged their patients to stick with it—claiming that if they could maintain lifestyle changes, their health would improve. However, it is concerning that these drugs not only lead to a reduction in fat and muscle but also affect nutritional intake. All of this must be considered in the patient's weight loss process.

Doctors still lack consensus on how to properly use medications to control patients' obesity. Additionally, the difference with weight-loss drugs is that patients often have strong opinions about treatment goals, which may not align with the best plans indicated by data (or their doctors).

Thus, data will ultimately become the best guide. But until then, doctors will continue to navigate this new era.