On World Obesity Day, the Medicines Patent Pool (MPP) shines a spotlight on the pressing issue of obesity in low- and middle-income countries (LMICs), zooming in on people living with HIV (PLWHIV). We also explore how the MPP model can support access to innovative medicines that could turn the tide on this growing disease. Additionally, we present the inspiring thoughts of Dr. Nomathemba Chandiwana, Chief Scientific Officer at the Desmond Tutu Health Foundation and a passionate advocate in South Africa, to illustrate the critical need for action in these regions.

The global obesity crisis

According to the World Health Organization (WHO), 1 in 8 people worldwide were living with obesity in 2022. The prevalence of adult obesity has more than doubled since 1990, and adolescent obesity has quadrupled. Obesity and type 2 diabetes are intricately linked, serving as major drivers of cardiometabolic conditions like cardiovascular and kidney diseases which pose significant health challenges particularly in LMICs.

Obesity in low- and middle-income countries

78% of non-communicable disease-related deaths linked to overweight and obesity occurred in LMICs in 2024 according to the World Obesity Atlas. By 2035, 79% of individuals with a body mass index (BMI) over 30 will be in LMICs (for adults, WHO defines obesity as a BMI greater than or equal to 30). Many LMICs face a double burden of malnutrition, dealing with both undernutrition and a rapid increase in obesity. Children in these countries are particularly vulnerable to inadequate pre-natal, infant, and young child nutrition. At the same time, they are exposed to high-fat, high-sugar, high-salt, energy-dense, and micronutrient-poor foods, which are often lower in cost but also lower in nutrient quality.

Dr. Nomathemba Chandiwana’s journey

Dr. Nomathemba Chandiwana, the Chief Scientific Officer and Head of the Non-Communicable Diseases (NCD) Portfolio at the Desmond Tutu Health Foundation in Cape Town, South Africa, shares her perspective on the issue: ” As a clinician-scientist with expertise in HIV and obesity and its complications, my work focuses on the intersections of obesity, cardiometabolic disease, and sleep health—especially among women living with and without HIV. My career began during the height of the HIV epidemic in South Africa, where I witnessed how evidence-based interventions and community-led advocacy could change lives. Over time, I extended these principles to the challenge of obesity, recognising that, like HIV, it is a complex, systemic issue requiring long-term, collaborative solutions.”

Challenges and barriers

Dr. Chandiwana highlights the challenges faced by people with obesity in LMICs:

“People in low- and middle-income countries, especially Africa, face many hurdles when managing obesity. In South Africa, which has some of the highest rates of overweight and obesity globally, people with obesity—especially women and girls—often have limited access to affordable, nutritious foods and safe spaces for physical activity. Inadequate urban planning, socioeconomic disparities, and social stigma further restrict their ability to adopt healthier lifestyles. These factors combine to create significant barriers to effective obesity management.”

Obesity and HIV

Obesity trends and metabolic dysregulation are increasing among people living with HIV (PLWHIV). Thanks to longer life expectancy, this population is experiencing a higher incidence of non-communicable diseases, including cardiovascular disease (CVD) and diabetes. In South Africa a recent study showed that 63% of PLWHIV are overweight or obese, and 6% have diabetes.

As Dr Chandiwana notes: “Both HIV and obesity share common roots in social and economic inequities. They require community engagement, sustained care, and supportive policy measures. However, while HIV is an infectious disease with a clear biological target, obesity is a noncommunicable condition influenced by lifestyle, genetics, environment, and socioeconomic factors. […] Ensuring affordable access to new therapies is essential for improving health outcomes.”

MPP’s peer-reviewed publication, ‘Novel Anti-Obesity Drugs for People with HIV,’ published in The Lancet HIV, addresses the growing issue of obesity among people with HIV and the potential of GLP1-RA based therapies to tackle this challenge. Integrating metabolic health management into routine HIV care is essential, and research is needed to determine the application of these interventions. Addressing accessibility and affordability concerns is vital, as the high cost of current medications poses significant challenges, particularly in developing countries with high HIV prevalence.

Innovative treatments and accessibility

Dr Chandiwana mentions that some novel anti-obesity medications show great promise in addressing clinical obesity: “For instance, GLP-1 receptor agonists have been effective in promoting weight loss and improving metabolic health. Emerging therapies that target appetite regulation and energy balance are also in development. These innovations offer hope for more personalised and effective obesity care, especially in less resourced settings.”

While prevention remains essential, ensuring access to effective treatment is equally critical to meeting the urgent needs of millions of people living with obesity and achieving the highest standard of care, ultimately reducing health inequities.

MPP has prioritised GLP1-RA based therapies,  including  semaglutide, for in-licensing as MPP believes that making these innovative products more widely available in LMICs could significantly impact public health. Affordability often remains the main barrier to access to these products in LMICs. By negotiating licences with the patent holders, MPP can make novel treatments more affordable for LMICs, closing the inequity gap.

Dr Chandiwana adds: “To make these treatments more accessible, we must reduce costs through mechanisms like bulk purchasing, tiered pricing, and strategic licensing via patent pools. Strengthening primary healthcare and integrating these therapies into community-based services will also help. These steps are vital for ensuring that breakthrough treatments reach those who need them most.”

Roles for MPP, Governments, NGOs, and the Private Sector

In addition to MPP’s intervention to make novel treatments affordable and available in low-resource settings, Dr Chandiwana thinks other partners need to play their part: “Governments need to create supportive regulatory frameworks and invest in health infrastructure. NGOs can advocate for patient rights and raise awareness, while the private sector can adapt innovations to local needs and reduce production costs. Together, these stakeholders can build an equitable pathway to access.” 

Dr Chandiwana’s message for World Obesity Day

“World Obesity Day reminds us that obesity is a systemic issue that demands a coordinated, multisectoral response. It calls on all of us—from policymakers and healthcare providers to community organisations—to drive policy changes, innovate in healthcare, and create supportive environments for healthier lives.”

Final thoughts from Dr Chandiwana

“The successes achieved during the HIV epidemic prove that coordinated, community-driven action can transform public health. By applying these lessons to obesity, we have a unique opportunity to reshape our health systems and create sustainable change”. Dr. Chandiwana encourages all stakeholders to collaborate, innovate, and ensure that breakthrough treatments reach everyone—especially those in the most vulnerable communities.