The health benefits conferred by GLP-1 medications can be quite literally life-changing and life-saving, so it is important to consider the ethics of prescribing these medications — especially as demand rises and shortages ebb and flow.

 

As GLP-1 medications continue to transform treatment options for patients with obesity and/or type 2 diabetes, new questions and concerns continue to emerge. While conversations about side effects and safety have been pushed to the center of GLP-1 discourse, the ethics of GLP-1 medications have remained on the margins. Although not a mainstream conversation topic, there are ethical challenges associated with GLP-1 medications that must be navigated.

 

Empirical evidence clearly suggests that GLP-1 medications can decrease cardiovascular risks and confer cardiovascular protection, improve blood glucose control, result in clinically significant weight loss, and decrease the risk of chronic kidney disease,^1,2,3,4 thereby reducing the risk of premature death and possibly extending one’s lifespan. The benefits conferred by GLP-1 medications can be quite literally life-changing. So, in the face of rising demand, shortages, and cost, what role does ethics play in prescribing these medications in a way that is equitable and responsible?

Framework for Fair Allocation

The field of bioethics offers guidance on navigating the ethical challenges of prescribing GLP-1 medications and has developed a fair-allocation framework underpinned by four fundamental ethical values that align with the allocation of scarce medical resources.^5,6

1. Benefiting people and reducing harm: maximizing years of life saved and minimizing suffering.
2. Equal moral concern: acknowledging the equal moral importance of each person regardless of race, sex, religion, or income.
3. Prioritizing disadvantaged people: prioritizing people who would be worse off without the intervention, such as those whose life-years would be prematurely shortened.
4. Rewarding social contribution: a factor in public health emergencies—not routine clinical contexts—acknowledging the past and future contributions of people through their work or other efforts.

Tiered Allocation System

GLP-1 medications exist in a liminal space between life-saving and life-enhancing therapies. These medications were originally intended for use in treating patients with type 2 diabetes and then evolved into weight-loss medications, irrespective of a patient’s diabetes status. While patients with obesity and without type 2 diabetes are entitled to therapeutic interventions, this does create an ethical quandary when demand exceeds supply.⁷

When considering the ethical issues associated with medical resources, it is important to anchor decisions to a framework. One such framework⁵ categorizes patients by illness severity:

 

1. Tier 1 — highest priority; includes patients with a BMI ≥ 40 or uncontrolled type 2 diabetes (HbA1c > 8%) who have been non-responsive to alternative therapies such as SGLT2 inhibitors. Objective: prevent premature death.
2. Tier 2 — includes patients with a BMI between 35.0–39.9 or uncontrolled type 2 diabetes who have not tried SGLT2 inhibitors or similar medications. Objective: prevent imminent medical complications.
3. Tier 3 — includes patients with a BMI between 30.0–34.9 or type 2 diabetes (HbA1c > 7%) who have previously tried alternative type 2 diabetes medications. Objective: prevent future medical complications.
4. Tier 4 — lowest priority; includes patients with a BMI of 25.0–29.9 or well-controlled type 2 diabetes. Objective: improve quality of life and social and emotional health.

 

Bioethicists argue that patients who are using GLP-1 medications for aesthetic or cosmetic purposes should not be prioritized when demand exceeds supply.⁵

 

Bioethicists recognize that BMI and HbA1c may not be perfect indicators of metabolic risk, though they remain the most widely accepted clinical tools for assessment. Given the current lack of more refined population-level metrics, BMI and HbA1c should be thoughtfully integrated and, when necessary, supported by clinical judgment.

 

This raises the question: Which patients should be prioritized — patients with obesity or patients with type 2 diabetes? Emanuel and colleagues⁵ argue that patients with obesity may warrant higher priority because (1) treating obesity can prevent or delay type 2 diabetes, reducing long-term complications and death, and (2) there are other medications, like SGLT2 inhibitors, that may be equally or more efficacious than GLP-1 medications for patients with type 2 diabetes.^8,9

Implications for Policy

While the tiered framework has merit and clarity, its implementation may be less straightforward. The current landscape of the U.S. health care system is fragmented, such that a fair-allocation framework would present challenges. For example, Medicare does not cover weight-loss drugs, which places older patients — who often have more limited finances — at a further disadvantage and increased health risk. Health care providers can support fair allocation by adopting the tiered system and using their clinical judgment.

While GLP-1 medications have been remarkably efficacious in helping patients control blood glucose and achieve clinically significant weight loss, their explosion in popularity is now pushing conversations about their ethical challenges from the margins to the center. Health care providers must now marry clinical expertise with ethical considerations in the treatment of obesity and type 2 diabetes.

Robard’s Role in Ethical, Evidence-Based Care

Robard supports clinicians with scientifically designed meal replacements (used in medically supervised programs) and Biocare, a GLP-1 companion dietary beverage formulated to help patients meet protein and micronutrient targets during therapy and as they transition off treatment. These tools can complement pharmacotherapy, help maintain nutritional adequacy, and provide practical options when GLP-1 access is limited or when patients are not candidates for medication. By pairing structured nutrition with clinical judgment, providers can deliver more equitable, outcomes-focused care across diverse patient needs. Follow this link to learn more.

 

Source(s):

1 Beyond blood sugar: A scoping review of GLP-1 receptor agonists in cardiovascular care

2 GLP-1 receptor agonists in the treatment of type 2 diabetes – state – of – the  art

3 Effects of GLP-1 agonists on proportion of weight loss in obesity with or without diabetes: systematic review and meta-analysis

4 GLP-1 receptor agonists in diabetic kidney disease

5 Fair allocation of GLP-1 and dual GLP-1–GIP receptor agonists

6 The shared ethical framework to allocate scarce medical resources: a lesson from COVID-19

7 The ethics of weight–loss drugs: Patient autonomy vs. societal beneficence

8 GLP-1 receptor agonists vs. SGLT-2 inhibitors: The gap seems to be leveling off

9 Efficacy and safety of GLP-1 receptor agonists versus SGLT-2 inhibitors in overweight/obese patients with or without diabetes mellitus: A systematic review and network meta-analysis

 

About the Author: Dr. Dawn M. Sweet has over 20 years of experience in the field of communication. Dr. Sweet has given several invited talks to and workshops for academic and private sector audiences on the role of nonverbal and verbal communication in achieving positive outcomes and mitigating bias. Her research has been published in several top ranked peer-review journals, and it has been featured on NPR’s River to River / All Things Considered, Buzzfeed, and Science Daily. Her research has also been used to inform expert testimony.

About Robard: Nationally recognized hospitals and physicians place their trust in Robard’s comprehensive medical weight management programs, evidence-based nutritional solutions, and specialized support designed to complement GLP-1 therapies, to effectively treat and manage patients with obesity. To learn more, visit us online at www.Robard.com, email us at info@robard.com, or call (800) 222-9201.