As the World Health Organization (WHO) issues its first global guideline on the use of GLP‑1‑based therapies for obesity in adults, attention is shifting from scientific possibility to a more difficult question: how these advances can reach the people who need them most. The guideline recognises obesity as a chronic disease and calls for equitable, long‑term care, but also highlights the challenges of affordability, health‑system readiness and access, particularly in low‑ and middle‑income countries (LMICs). 

In this context, public‑health‑oriented approaches such as voluntary licensing, the core of MPP’s work, which have previously helped expand access to treatments for HIV, hepatitis C and other diseases, are increasingly part of global discussions on how to scale access to new obesity medicines responsibly and affordably.

For Ogweno Stephen, obesity has never been an abstract policy issue. It has been part of his life since childhood.

“I was born with childhood obesity,” he says. “For a long time, it was even seen as a good thing.”

Growing up in Kenya, Ogweno recalls how cultural perceptions shaped early experiences of weight. In many African families, a chubby child is often seen as a sign of good care and prosperity. “When your aunties and uncles visit, they commend your parents,” he explains. “Chubby equals healthy in most of our local context.”

But behind that outward approval were challenges that went largely unseen, and unspoken.

Growing up with obesity: the hidden cost

Despite being an active child, Ogweno experienced early medical complications linked to obesity. “I developed gastrointestinal reflux disorder,” he says, describing involuntary regurgitation that later led to dental problems. These were early warning signs of a disease few around him recognised as such.

The social impact became more pronounced as he entered adolescence. One moment, in particular, has stayed with him. At around 11 years old, after a school sports session, Ogweno watched his classmates comparing their flat stomachs and talking about future six-packs. “I was standing there with a belly, completely outside that conversation,” he recalls. “They made sure I knew I wasn’t going to look like them.”

A few years later, starting boarding school at 14 or 15, another experience reinforced that sense of difference. “The largest school uniform they had couldn’t fit me,” he says. “I stayed in my home clothes for almost a week while they made a custom uniform. Imagine how that feels when everyone else looks the same.”

These moments, he explains, created a quiet but persistent sense of isolation and shame, emotions shared by millions of adolescents living with obesity today.

A growing crisis, still overlooked

While Ogweno’s story is deeply personal, it reflects a much broader reality. Childhood and adolescent obesity is rising rapidly across LMICs, yet it remains largely overshadowed by other health priorities.

“By the time you get to obesity, it’s not considered a problem,” Ogweno says. “People are focused on food insecurity, housing, education, all very real issues.”

Cultural beliefs also play a role. In communities historically shaped by drought and undernutrition, weight has long been associated with wealth and stability. “Having a belly becomes a sign that you’re doing well,” he explains.

At the same time, weak regulation and limited public health education have allowed unhealthy food environments to flourish. “In some places, soda is cheaper than water,” Ogweno notes. “There has been very little awareness that obesity is actually a disease.”

The result is a convergence of cultural norms, commercial pressures, and health systems that were never designed to prevent or manage chronic disease in young people.

Stigma amplified by social media 

If stigma shaped Ogweno’s adolescence, he believes today’s young people face even greater challenges. “It’s worse now,” he says. “Much worse.”

During his school years, social media was limited. Today, platforms like TikTok and Instagram dominate adolescent life. “The comparisons are constant,” Ogweno explains. “Fashion, bodies, trends, none of it includes young people living with obesity.”

This exclusion, he says, pushes many adolescents into deeper isolation. “They’re less involved in social activities. They withdraw. And there’s no clear solution being offered.” Meanwhile, mixed messages persist. A child may be praised at home for looking healthy, only to be bullied at school or online for looking different. “That transition, from being told you’re healthy to being told you’re the odd one out, is very confusing,” Ogweno says. “And it stays with you.”

Why lived experience must shape policy

Today, Ogweno sits at global policy tables, including as a lived-experience representative in the WHO Guideline Development Group for obesity medicines. He believes adolescents and young people must be central to shaping solutions.

“They did not choose this,” he says firmly. “They were born with certain genetics, or into environments that don’t protect them.” Too often, policy responses have relied on simplistic advice. “For years, policymakers told us: eat less, move more, and you’ll be fine,” Ogweno says. “But science and lived experience show that’s not true.” As a teenager and young adult, Ogweno played rugby, exercised regularly, and followed strict diets, yet his weight continued to rise. “Every time I stepped on the scale, it just kept going up,” he recalls. Without the voices of those living with obesity, policies risk repeating these failures. “The language matters,” Ogweno adds. “We say ‘people living with cancer,’ but for years we’ve called people ‘obese.’ We’re naming the disease instead of the person.”

Including lived experience, he argues, improves not just compassion but effectiveness. “When interventions are designed without the people they’re meant to serve, they don’t get adopted. Funding ends. Programs fail.”

Beyond prevention: care, dignity, and treatment

 Prevention remains essential, Ogweno stresses, but it cannot be the end of the conversation.

“There are already more than one billion people living with obesity globally,” he says. “Where do we take these people?” For adolescents and adults already living with obesity, access to care can be transformative. “When people get proper treatment, their quality of life improves,” Ogweno explains. “Their health spending goes down. They become more productive. Families and economies benefit.” This is why he sees treatment, management, and long‑term care as inseparable from prevention. “Stopping at prevention leaves millions behind,” he says.

Kenya, August 2025

What equitable access could have changed

Asked what access to effective obesity medicines would have meant earlier in his life, Ogweno pauses. “I would have turned out very differently,” he says. “I would have suffered less. I would likely have avoided other conditions, gastroesophageal reflux, dental problems, prediabetes, anxiety.”

“We’re at a moment where the solution exists,” Ogweno says. “We can either act early and ensure equitable access or repeat the mistake of letting innovation benefit wealthy countries first.” From his perspective, the HIV response showed how public‑health‑driven tools, including voluntary licensing models supported by organisations such as MPP, can help translate scientific breakthroughs into affordable access at scale.

A turning point, if countries choose to act 

The recent WHO guidelines on GLP-1 therapies for obesity represent a major shift. “They came out fast,” Ogweno notes. “Usually, new interventions benefit the West for years before there’s global guidance.”

For countries in the Global South, the guidelines offer something powerful: a starting point. “They confirm that obesity is a disease, not a personal choice, and that treatment is legitimate,” he explains. “They give us a place to start.”

Looking ahead, Ogweno is clear about what leadership on adolescent obesity must look like: education, regulation of unhealthy food marketing, inclusion of obesity care in universal health coverage, pooled procurement to reduce prices, and meaningful involvement of young people living with obesity at every stage.

“These young people are not the problem,” Ogweno says. “They are part of the solution.”

As we celebrated World Obesity Day this week, his message is both urgent and hopeful. Adolescent obesity in LMICs is no longer a side issue. It is a defining health and equity challenge of our time,and one that can still be shaped by the choices made today.