GLP-1ra receptor agonists role in the management of obesity in Australia

As Australia faces a turning point in obesity management, researchers from Monash University have contributed new insights into the rapidly evolving use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in the Australian health care system.

Originally developed for type 2 diabetes, GLP-1 RAs have gained significant traction globally for obesity treatment. With 32% of Australians classified as living with obesity in 2022 and the cost of obesity projected to reach AUS$87.7 billion in Australia by 2032, a review for the Medical Journal of Australia highlights the critical need to carefully plan how these medications are used.

"We're at a watershed moment in obesity management. Because of how these new medications work, they're transforming the way we view obesity as a condition," said Associate Professor Suong Le, a gastroenterologist at Monash University's School of Clinical Sciences at Monash Health and CEO of Juno Healthcare, is a senior author on the review. "It's clear that obesity is not just a lifestyle choice, but should be regarded as a chronic inflammatory disease with links to cancer, brain function and autoimmune conditions."

The review was led by Dr Chris Kanelli, a graduate of medicine from Monash University and now a doctor at Monash Health, and thoroughly examines the Australian context, including funding models, prescribing pathways, and equitable access considerations.

The researchers emphasise that many questions remain unanswered, especially as demand for these drugs grows rapidly, including guidelines for treatment duration, prevention of rebound weight gain after cessation, long-term funding models, and appropriate use in paediatric populations.

"The weight loss clinical trials being conducted in the US are enormous in terms of sample size, partly because GLP-1RAs are priced higher there than in Australia, and partly due to the sheer size of the potential market," Le added. "In Australia, we need to focus on researching more niche, specific use cases where these medications can make a meaningful difference in our clinical practice while also developing a greater understanding on how exactly they lead to improved cardiovascular health, kidney function and neuroprotection. This helps us develop a more nuanced and scientifically comprehensive understanding of obesity as a condition and a risk factor for other diseases. We might not lead on large RCTs, but we can absolutely lead in conducting targeted clinical research in high-impact use cases. For example, we've studied the use of Mounjaro as a short-term, targeted therapy to help dialysis patients with obesity lose enough to be safely waitlisted for kidney transplants."

Le believes that researching short-term, focused applications for the GLP-1RAs where there is high economic impact is where Australia can have the greatest research contribution. Other promising clinical applications include pre-surgery weight reduction to minimise surgical complications, and addressing obesity sarcopenia, a condition involving low muscle mass in obese patients that can impair immune function.

Kanellis said the publication also highlights the supportive research environment for students at Monash University. "I've been very fortunate to be surrounded by wonderful mentors and educators through my studies and placements. I had an excellent experience working on this project and it has led to so many valuable learning opportunities."

As Australia navigates these complex health care considerations, this research from Le and Kanellis provides important guidance on striking a balance between addressing obesity-related health concerns, while maintaining the financial sustainability of our health care system.

The findings were reported in the paper, ‘The role of GLP‐1 receptor agonists in the management of obesity: risks and opportunities for the Australian health care system’, published in the Medical Journal of Australia. To access this paper, please click here