Presentation (CTI)

OBJECTIVES: To evaluate global access to evidence-based anti-obesity pharmacotherapies and assess how reliance on out-of-pocket (OOP) payments contributes to socioeconomic inequities. The study further examines the misalignment between the high disease burden and limited public investment, assessing implications for patients, payers, and long-term health-system sustainability.
METHODS: A targeted literature review (2015-2024) was performed across PubMed, EMBASE, OECD health statistics, CDC, CIHI, and NHS Digital data. Extracted variables included: regulatory approval, reimbursement status, OOP expenditure patterns, socioeconomic gradients in obesity prevalence, and economic evaluations of obesity treatment. Policy documents from major public payer systems (Medicare, Canadian provincial formularies, NHS England) were examined to assess structural barriers to coverage.
RESULTS: Availability of high-efficacy anti-obesity agents has increased globally, yet reimbursement remains limited across most health systems.• Access Model: The predominant financing mechanism is OOP payment, restricting use primarily to higher-income and privately insured individuals.• Equity Gradient: Obesity prevalence is significantly higher among populations with lower education and lower income in Canada, USA, and England. These groups experience earlier onset of cardiometabolic disease and higher mortality but are least able to afford pharmacotherapy.• Investment Gap: Although economic models consistently demonstrate that obesity treatment reduces long-term costs associated with diabetes, cardiovascular disease, disability, and healthcare utilization, public systems have not integrated obesity therapy into core benefits.• Policy Impact: Exclusion of anti-obesity pharmacotherapy from public reimbursement (e.g., Medicare, most Canadian provinces, NHS England) reinforces structural inequities and widens outcome disparities between socioeconomic groups.
CONCLUSIONS: Global dependence on OOP financing for obesity pharmacotherapy produces substantial inequities, with effective treatment disproportionately accessible to wealthier, more educated populations, while those at highest clinical risk remain untreated. Reframing obesity treatment as a health-system investment—rather than a discretionary cost—is essential for reducing long-term disease burden and addressing structural inequities. Policy reform will be required to integrate obesity pharmacotherapy into sustainable and equitable reimbursement pathways.