Beyond prescribing: GLP-1 care and obesity prevention in primary care
File(s)
Accepted version
Author(s)
Jerjes, Waseem
Pineda, Elisa
El-Osta, Austen
Majeed, Azeem
Type
Journal Article
Abstract
Background. GLP-1-based therapies have transformed obesity treatment, but their clinical benefits address a different stage of risk from population prevention. Understanding how treatment, prevention, access and primary care implementation relate is important for coordinated obesity care.
Objective. To systematically synthesise evidence on GLP-1-based obesity treatment, maintenance and withdrawal, population prevention, implementation and equity, and assess their relationship to the Integrated Obesity Response Framework.
Methods. A systematic review was conducted using the 35-source bibliography underpinning the original manuscript as a prespecified evidence corpus. Records were screened against predefined criteria and grouped into clinical effectiveness, population prevention, implementation and economic domains. Data were extracted on design, population, interventions or exposures, outcomes, effect estimates and methodological limitations. Heterogeneous evidence was synthesised narratively.
Results. Twenty-four reports met the criteria for outcome synthesis. Semaglutide and tirzepatide trials demonstrated substantial weight reduction, while randomised withdrawal studies showed weight regain after treatment cessation and maintenance of benefit with continued therapy. SELECT demonstrated cardiovascular benefit in adults with established cardiovascular disease without diabetes. Prevention evidence supported effects of food-environment measures on purchasing, dietary exposure and policy implementation, including lower taxed-beverage sales following sugar-sweetened beverage taxation. Observational studies identified high treatment discontinuation and inequalities in access, while economic findings depended strongly on medication prices and modelling assumptions. No included study evaluated the complete Integrated Obesity Response Framework as a single intervention.
Conclusions. GLP-1 treatment and population prevention address distinct but complementary components of obesity control. Effective obesity strategy requires treatment, implementation capacity, equity monitoring and sustained action on obesogenic environments.
Objective. To systematically synthesise evidence on GLP-1-based obesity treatment, maintenance and withdrawal, population prevention, implementation and equity, and assess their relationship to the Integrated Obesity Response Framework.
Methods. A systematic review was conducted using the 35-source bibliography underpinning the original manuscript as a prespecified evidence corpus. Records were screened against predefined criteria and grouped into clinical effectiveness, population prevention, implementation and economic domains. Data were extracted on design, population, interventions or exposures, outcomes, effect estimates and methodological limitations. Heterogeneous evidence was synthesised narratively.
Results. Twenty-four reports met the criteria for outcome synthesis. Semaglutide and tirzepatide trials demonstrated substantial weight reduction, while randomised withdrawal studies showed weight regain after treatment cessation and maintenance of benefit with continued therapy. SELECT demonstrated cardiovascular benefit in adults with established cardiovascular disease without diabetes. Prevention evidence supported effects of food-environment measures on purchasing, dietary exposure and policy implementation, including lower taxed-beverage sales following sugar-sweetened beverage taxation. Observational studies identified high treatment discontinuation and inequalities in access, while economic findings depended strongly on medication prices and modelling assumptions. No included study evaluated the complete Integrated Obesity Response Framework as a single intervention.
Conclusions. GLP-1 treatment and population prevention address distinct but complementary components of obesity control. Effective obesity strategy requires treatment, implementation capacity, equity monitoring and sustained action on obesogenic environments.
Date Acceptance
2026-09-18
Citation
Journal of Primary Care & Community Health
ISSN
2150-1319
Publisher
SAGE Publishing
Journal / Book Title
Journal of Primary Care & Community Health
Copyright Statement
Copyright This paper is embargoed until publication. Once published the Version of Record (VoR) will be available on immediate open access.
License URL
Publication Status
Accepted