It would be much more Instagrammable to appear in yet another reel promising a new panacea capable of solving a problem as complex as obesity. But the truth is bitter and almost no one wants to hear it. There are people who, yes, will need anti-obesity medications for the rest of their lives. Not for lack of will, but because obesity is a chronic, multifactorial and biologically determined disease.
GLP-1 analogues represent the biggest revolution in decades in the fight against this disease. Five-year studies show benefits that go well beyond weight: a significant reduction in the risk of diabetes, cardiovascular events, chronic kidney disease, heart failure and even certain types of cancer, such as colorectal and endometrial cancer. It is rare to see a therapeutic class having such a broad impact.
If science is progressing, why do we continue to fail? In a word: the price.
The annual cost of treatment with tirzepatide (active ingredient in Mounjaro) reaches R$32,700 per year in therapeutic doses. This value is prohibitive in a country where more than half of the population earns less than two minimum wages. And, at the same time, we are experiencing a global epidemic: obesity already affects more than a billion people and is expected to reach 2 billion by 2030.
This month, the World Health Organization released its first guidelines on the use of GLP-1 analogs, reinforcing their long-term treatment nature and the ethical need to ensure access to those who need them. But the recommendation comes up against a paradoxical and dangerous scenario in Brazil: expensive medicines, limited supply and, consequently, the explosion of the parallel market. Intense demand, strangled by fads, high prices and unavailability, opens the door to opportunists. And where the state fails, the underground market thrives.
But the crisis is even more serious: in the SUS, no medication is provided free of charge for the treatment of obesity. On the one hand, patients are blamed for being sick and not “curing” themselves willingly. On the other, a health system that insists on treating obesity as an aesthetic problem or an individual responsibility.
The consequence is cruel: inequalities are widening between those who can pay to treat a chronic illness and those who are condemned to live with its consequences: diabetes, cardiovascular diseases, physical limitations, stigma. There is no fairness possible in this model. In other words, while weight loss pens are booming in the parallel market for aesthetic purposes, 70 million obese Brazilians are left behind in the SUS.
Brazil must urgently face this crisis with serious public policies: taxation of sugary drinks, real incentives for a healthy food environment, revision of working hours to include physical activity in care and, above all, access to safe and effective treatments. Health is not a luxury. And treating obesity is not a matter of vanity, it is a question of dignity, humanity and collective responsibility.
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