Introduction
In Mexico, obesity has transitioned from a risk factor to a significant determinant of health for millions, as well as public finances. The emergence of new anti-obesity drugs presents an opportunity, but also poses challenges in determining who should pay for them, who will benefit, and under what rules they should be provided within the public sector.
The Obesity Epidemic in Mexico
Today, nearly 40% of adult Mexicans live with obesity, with even higher figures among women and those aged 40 to 59, the most productive working years. The National Health and Nutrition Survey documented an increase in obesity prevalence from 24.2% (2000) to 38.9% (2023). Including overweight, more than 75% of adults now fall into this category. Furthermore, morbid obesity has nearly doubled, signaling a future of increased disability, medical costs, and productivity loss.
Only a minority of Mexican adults have a healthy weight, and this proportion is even smaller in middle-aged groups. Obesity has become the “new normal” epidemiologically, with a healthcare system traditionally designed for acute rather than chronic conditions.
Obesity and Related Conditions
Obesity often co-occurs with type 2 diabetes, hypertension, cardiovascular disease, sleep apnea, fatty liver disease, and osteoarthritis, among other conditions. The positive news is that a sustained 5 to 10% reduction in body weight can lead to significant improvements in glucose, blood pressure, and lipids. Larger reductions of 15% or more can reverse the natural course of diseases like obstructive sleep apnea or metabolic hepatitis.
Global Healthcare Costs and Obesity
Globally, employers and insurers recognize that chronic disease burden, led by cardiovascular diseases, cancer, hypertension, and diabetes, will continue driving up medical costs in the coming years. By 2026, global medical trends are expected to rise by nearly 10%, with Latin America above this average and obesity and poor nutrition as central risk factors.
Ironically, the pharmacological treatment of obesity itself is becoming a significant cost driver in many markets, including Mexico. Private insurers only cover GLP-1 for diabetes, excluding their use for weight loss to control premium impact. Nevertheless, in some markets, up to a quarter of medical trend increases is attributed to the widespread use of these drugs.
Advancements in Obesity Pharmacology
Amidst this epidemiological surge, obesity pharmacology is experiencing a paradigm shift. Recent guidelines from the American Diabetes Association position GLP-1 receptor agonists and dual agonists (like semaglutide and tirzepatide) as cornerstones in treating obese patients with comorbidities due to their ability to induce weight loss exceeding 10-15% and improve cardiovascular, hepatic, and functional outcomes.
Meta-analyses demonstrate that lifestyle interventions, combined with medications like orlistat (around 3% additional weight loss), naltrexone-bupropion (approximately 5%), phentermine-topiramate (nearly 9%), semaglutide (about 12%), and tirzepatide (up to 16%) can significantly impact weight loss. These are no longer “cosmetic” drugs but genuine disease modifiers, comparable in effect size to certain bariatric surgeries for specific profiles.
In 2025, the FDA approved the first oral formulation of a GLP-1 for obesity treatment, achieving 13-16% weight loss in 64 weeks and authorizing the first generic of liraglutide for chronic weight management. This anticipates increased competition, potential price reductions, and growing political pressure to expand public and private coverage of these medications.
Simultaneously, the FDA has issued warnings against unregulated compounds mimicking semaglutide or tirzepatide due to safety concerns, uncertain quality, and severe adverse effects. Recent experiences show that when the regulated market fails to meet demand, unregulated markets will emerge, posing risks for patients.
Cost-Benefit Analysis and Policy Implications
A recent analysis by Aon, involving over 130,000 workers, showed that while the medical cost of those initiating GLP-1 increases in the first 12-15 months, after the second year, the spending trend reverses and becomes 7% lower than comparable patients not using these drugs.
This “savings” isn’t magical; it’s due to fewer heart attacks, strokes, hospital admissions, and diabetes progression. This lesson is crucial for a country like Mexico, where viewing obesity pharmacotherapy as an expense rather than investment ensures continued high costs for hospital beds, premature deaths, and disability.
However, the flip side is undeniable: models of simulation suggest that broad coverage of GLP-1 for both diabetes and obesity in employment insurance schemes like in the U.S. could increase premiums by 5-10% in the short term, depending on copayments and the breadth of eligible population.
The message for decision-makers is clear: it’s not about saying “yes” or “no” to GLP-1 but defining rigorously who, when, for how long, and with what support.
Policy Recommendations for Mexico
Mexico cannot merely import molecules; it must design public policy acknowledging obesity as a high-priority chronic disease, with explicit targets for prevalence reduction and complication mitigation, measurable through ENSANUT and other information systems.
Reform the regulations and recently published “PRONAM Obesity and Overweight” to explicitly integrate pharmacological treatment as a component of comprehensive care, with eligibility criteria based on evidence (BMI, comorbidities, previous intervention failure) and a person-centered approach emphasis.
Intelligent funding schemes are crucial. For the public sector, a phased and targeted use of GLP-1 and dual agonists in high-risk subgroups, such as those with obesity and established cardiovascular disease or high-risk prediabetes, could generate health and cost-saving returns within 5 to 10 years.
For the private sector, global data indicates that corporate programs combining medication, lifestyle management, and active adherence support are key, rather than standalone prescriptions without accompanying care.
Regulating the market firmly, monitoring and penalizing miracle products and unauthorized composite preparations, strengthening COFEPRIS in pharmacovigilance, and expediting generic and biosimilar entry processes to alleviate price pressures are essential.
Crucially, don’t forget the obvious: no single molecule replaces a robust primary prevention policy. The same reports highlighting GLP-1 costs emphasize physical inactivity, poor nutrition, and hypertension as the world’s three major risk factors driving medical cost curves. If Mexico doesn’t correct its obesogenic environment—from front-of-package labeling and sugary drink taxes to urban planning and child-directed advertising regulation—any pharmacological progress will always be insufficient.
In a world described by the World Economic Forum as “on the edge” due to converging geopolitical, economic, and technological risks, population health becomes a strategic asset. How Mexico responds to the obesity challenge—between the temptation for a quick fix and the discipline of long-term public policy—will say much about our country’s project for the next decade.
