Over the past 15 years, I have met countless patients with severe and morbid obesity in my consultation room. Patients whose blood sugar, blood pressure, and cholesterol levels hover near dangerous thresholds, accompanied by various metabolic diseases, are common. Yet as a physician, what saddens me most is not the test figures but the way patients view themselves. "I think I'll never lose weight in my life because my willpower is weak." "In the end, it's my fault." Every time I hear such words, I feel deeply sorry.
Obesity is not a problem of laziness or lack of willpower. It is a chronic disease in which genetic, biological, and environmental factors act in complex combination. Nevertheless, social prejudice and stigma remain strong. Many patients accept a disease that requires treatment as a personal failure, and ultimately give up on visiting hospitals and on treatment itself.
The recent emergence of GLP-1 class obesity drugs has brought significant and important change to this situation. Not only do they reduce weight, but they also improve health indicators such as blood sugar, and some drugs have even been shown to reduce the risk of cardiovascular disease. Above all, patients have begun to regain the confidence that "I, too, can be treated." What obese patients need is not blame and stigma, but appropriate treatment and continued support.
Earlier this month, the Ministry of Food and Drug Safety gave administrative notice of a plan to designate GLP-1 class obesity drugs, such as Wegovy and Mounjaro, as "drugs with misuse and abuse concerns." The plan would attach a warning phrase, "drug with misuse and abuse concerns," to drug packaging, and would mandate hospital prescriptions even in exception zones under the medical-pharmaceutical division system, such as remote islands and mountainous areas where access to hospitals and pharmacies is difficult. I fully sympathize with the intent to prevent inappropriate use and protect public health. It is indeed true that, as the obesity drug market has recently overheated, some inappropriate cases have been raised as social problems.
However, the need to manage the misuse of obesity drugs and the act of attaching a negative image of "misuse concern" to the obesity drugs themselves are separate issues.
Obesity, like hypertension and diabetes, is a chronic disease requiring long-term treatment and management. The World Health Organization (WHO) also defines obesity as a disease, and has recently issued a conditional recommendation for GLP-1 class obesity drugs as a long-term treatment option for adult obesity patients, as part of comprehensive obesity management that includes lifestyle intervention. This reflects a shift in international perception that views obesity not as simple weight management but as a disease requiring active treatment.
This change is also evident in the policies of various countries. The United Kingdom provides GLP-1 class obesity drugs to obesity patients who meet certain criteria through its National Health Service (NHS), and in the United States, discussions to expand the coverage of obesity drugs, centered on some public and private insurance, are actively underway. Many countries, including China, are also recognizing obesity as a disease requiring treatment and developing policies in the direction of improving access to drug treatment. The international community views obesity drugs not as mere targets of regulation but as treatment options that should be appropriately utilized.
Countries around the world recognize obesity as a chronic disease rather than a matter of individual lifestyle, and are simultaneously pursuing two goals: expanding access to treatment and managing appropriate use.
By contrast, the regulatory approach of Korea's Ministry of Food and Drug Safety to uniformly designate obesity drugs as "drugs with misuse and abuse concerns" could end up acting as another stigma for patients who need treatment. If patients come to have a negative perception of the drugs, they are likely to reinforce the social stigma surrounding obesity treatment themselves, lowering patients' will to be treated and shrinking access.
What policy should regulate is not the treatment drugs that severely obese patients need, but the pathways of inappropriate prescription and illegal distribution of those drugs. As various safeguards, such as restrictions on non-face-to-face prescriptions, are already in place, intensifying focused management and crackdowns on illegal sales and inappropriate use pathways could be a more effective alternative.
Misuse of obesity drugs must certainly be prevented. But it must not become excessive regulation that shrinks patients' opportunities for treatment. A policy to protect public health must achieve two goals together: securing safety and ensuring access to treatment.
What is needed now is not blanket regulation that places another stigma on obese patients, but a sophisticated and balanced policy design that promotes appropriate use while selectively blocking illegal distribution. I hope that more reasonable alternatives will be prepared based on sufficient discussion with field experts, so that both treatment access for obese patients and safe drug use can be guaranteed together.
He is...
·Graduate of Korea University College of Medicine; Master's degree from the Graduate School of Medicine
·Former resident and clinical fellow, Department of Family Medicine, Korea University Anam Hospital
·Former chief of the Department of Family Medicine, Sahmyook Seoul Hospital
·Former clinical assistant professor, Department of Family Medicine, Korea University Guro Hospital
·Former clinical assistant professor, Department of Family Medicine, Korea University Anam Hospital
·Currently clinical associate professor, Department of Family Medicine, Korea University Anam Hospital, and Public Relations Director of the Korean Academy of Family Medicine
