OBJECTIVES: The burden of obesity is enormous and growing. We aimed to investigate if the condition is seen as a disease or rather a lifestyle issue by payers.

METHODS: Desk research, including the review of health technology assessment (HTA) reports for injectable glucagon-like peptide 1 (GLP-1) agonists approved for weight management, was conducted to investigate the perception of obesity by payers from Germany, France, the UK and the US.

RESULTS: Three reports for semaglutide (1 in the UK, 1 in France and 1 in the US) and two for liraglutide (1 in the UK and 1 in the US) in weight management were identified. No reports for tirzepatide were found. In Germany, weight management is not reimbursed. In the UK, both semaglutide and liraglutide are recommended in a restricted population, for a defined period of time, when prescribed by a specialist and only as an add-on to lifestyle modifications. In France, only semaglutide is reimbursed to a restricted population after nutritional management failure. In the US, a 2003 law prohibits Medicare from covering weight management, but the bill allowing access to these medicines under Part D was introduced in the House in July 2023. The reimbursement of semaglutide or liraglutide is possible through Medicaid in 14 states and private insurance.

CONCLUSIONS: The perception of obesity by payers in the countries of scope differs. While in France and the UK, obesity is considered a disease and can be reimbursed under certain conditions, in Germany, weight management, seen as lifestyle therapy, is not assessed. In the US, despite historical perception of weight management as cosmetic therapy, obesity is currently seen as a disease.