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Abstract
PURPOSE OF REVIEW: This review evaluates the strength and scope of clinical evidence for GLP-1RAs—liraglutide, semaglutide, and tirzepatide—across obesity and associated complications, providing a structured rationale for prioritisation in clinical practice and policy. RECENT FINDINGS: GLP-1RAs demonstrate significant and reproducible weight loss—approximately 15% with semaglutide and 20% with tirzepatide at one year. Their efficacy in obesity-related health conditions has been best demonstrated through large clinical trials in cardiovascular disease, type 2 diabetes, obstructive sleep apnoea and metabolic dysfunction-associated steatotic liver disease. There is emerging evidence in the form of clinical trials and large retrospective studies for a number of other health conditions including chronic kidney disease, polycystic ovary syndrome, osteoarthritis, and other inflammatory conditions. Finally, GLP-1RAs may be a safe and effective treatment in time-critical contexts requiring rapid weight reduction for access to interventions such as organ transplantation, oncology surgery, sight-threatening idiopathic intracranial hypertension, and assisted conception. While all individuals meeting NICE eligibility criteria should ultimately access GLP-1RA therapy, current capacity constraints necessitate a phased approach prioritising high-evidence or time-sensitive conditions. This framework provides a scientifically grounded and evidence-based model to support clinical decision-making and service development in obesity management. Continued research is warranted to expand the evidence base, optimise cost-effectiveness, and ensure equitable implementation of obesity pharmacotherapy within public health services.