New oral weight loss medications could play a key role in addressing rising obesity and diabetes rates in low- and middle-income countries, according to health experts.
Injectable drugs like Wegovy and Mounjaro—containing semaglutide and tirzepatide—have gained popularity in countries such as the UK. Clinical trials show these drugs can help users lose more than 10% of their body weight. They are also used to manage type 2 diabetes.
However, the injections are expensive, require special storage, and must be administered using pens and needles. These limitations make them difficult to use widely in low-resource settings.
Experts believe new pill-based versions of these drugs could offer a more practical solution. Pills are cheaper, easier to distribute, and do not require refrigeration—factors that could significantly improve access in poorer regions.
“Medicines that can reduce diabetes and heart disease risk, while helping with weight loss, could bring major benefits to many low- and middle-income countries,” said Professor Naveed Sattar, a cardiometabolic medicine specialist at the University of Glasgow. “Obesity-related illnesses are increasing rapidly in these places as waistlines grow.”
Dr Louis Aronne, an obesity expert at Weill Cornell Medical College, said the focus is shifting toward prevention. “As we move forward, healthcare providers will want to stop complications of obesity before they start,” he said.
Aronne’s research has shown that giving tirzepatide to people with obesity and pre-diabetes for three years reduced their risk of developing diabetes by more than 90%.
He also stressed the importance of oral medication. “A pill doesn’t need refrigeration or needles. It can be packed in a bottle or box and used anywhere,” he said.
One promising new drug is orforglipron, a daily pill that helps regulate blood sugar and promotes weight loss. Like semaglutide, it mimics a hormone called GLP-1, which helps people feel full and boosts insulin production.
According to drugmaker Eli Lilly, a 40-week phase 3 trial of orforglipron in diabetes patients showed it lowered blood sugar and led to weight loss. Aronne said its effectiveness is similar to that of semaglutide.
Although semaglutide is available in pill form, it has drawbacks. It requires a higher dose than the injectable version and must be taken on an empty stomach, with no food for 30 minutes afterward.
Orforglipron may offer advantages. Unlike semaglutide, which is a peptide and easily broken down in the stomach, orforglipron is a small molecule. It can be taken with food and drink and is likely to require a lower dose, potentially reducing costs.
Trials are ongoing to test orforglipron in people without diabetes and to confirm its safety. This is particularly important after Pfizer halted development of a similar GLP-1 pill due to potential liver damage.
Researchers are also studying whether orforglipron offers the same cardiovascular protection seen with semaglutide, which has been linked to lower risks of heart attack, stroke, and death from heart disease.
Still, experts believe orforglipron and similar drugs could be valuable tools in the fight against obesity and diabetes—especially in regions where these conditions are growing fast.
“While better food and diets help prevent obesity, they often aren’t enough once obesity sets in,” said Aronne. “Changes in the brain make it hard to lose weight and stick to diets. That’s why medication is often necessary.”
Sattar noted that ethnicity plays a role in how obesity-related diseases affect populations. “South Asians and Black individuals are more likely to develop type 2 diabetes at lower weight gains than white people,” he said. “Even small increases in obesity can lead to a large rise in diabetes rates.”
He added that trial data suggest GLP-1 drugs may offer even greater heart benefits for Asian people compared to white people.
“The more safe and effective weight loss drugs we have—especially oral ones—the better the outlook for global health,” Sattar said.
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