Experts in Belgium call for expanded reimbursement for GLP-1 medications, citing their potential to prevent serious health conditions and improve patients’ quality of life, as current criteria may be too restrictive amid rising obesity rates.
Belgium is facing a growing burden of excess weight among an ageing population, and clinicians say the health system is still treating the problem too narrowly. Luc Van Gaal, an endocrinologist at Antwerp University Hospital, told De Morgen that the country has spent decades failing to tackle obesity properly, a delay he says is now showing up in the health data.
The numbers help explain why the debate has intensified. According to Belgium’s health insurer, the RIZIV, reimbursements for diabetes medicines such as Mounjaro and Ozempic rose to 122.2 million euros last year from 58.3 million euros in 2021. The insurer said it counted 58,000 unique patients that year, rising to 114,500 by 2025. The comparison is not exact, however, because Mounjaro has been covered under a confidential deal for about a year, meaning the state receives an undisclosed rebate.
Even so, the trend is awkward for a healthcare system under pressure to cut spending. At present, these drugs are not automatically reimbursed for people with obesity alone. In practice, coverage is largely limited to patients with diabetes whose condition remains poorly controlled, and the criteria were tightened again earlier this year.
Doctors interviewed by De Morgen argue that the rules lag behind the evidence. Bart Van Der Schueren, an endocrinologist at KU Leuven, said the reimbursement bill tells only part of the story because it should also be weighed against costs avoided elsewhere in the system. Yale Medicine says GLP-1 medicines, the class that includes Ozempic, can do more than lower blood sugar: they may reduce the risk of heart attacks and strokes, support kidney and liver health, and help lower blood pressure and cholesterol. Harvard Medical School likewise says these drugs mimic a natural gut hormone that regulates appetite, blood sugar and digestion, which helps explain why they can also drive weight loss.
Van Gaal said the case for wider access is becoming stronger as the drugs show benefits beyond diabetes. He cited evidence pointing to fewer heart attacks, fewer strokes, less severe fatty liver disease, less sleep apnoea and fewer cancers. Other reviews of GLP-1 medicines have also pointed to possible benefits in obesity-related conditions and, more tentatively, in substance-use disorders. On that basis, Van Gaal argued that current reimbursement criteria are not scientifically sound and force patients to be in far worse shape than they should be before getting help.
The issue is not abstract. De Morgen highlighted the case of Flora Theunis, 73, who has taken Mounjaro for nearly a year after a stroke and on her cardiologist’s advice to lose weight. Because her body mass index was above 30, she qualified for a prescription, but she pays 330 euros a month herself. She said she has lost 15 kilos and feels less strain on her back and pelvis. Van Der Schueren said the argument should not be about helping celebrities shed a few kilos, but about giving seriously ill patients a chance to regain mobility, work and quality of life. He also noted that lower-cost generic versions could arrive after patent expiry in some markets, which may eventually ease pressure on public budgets.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
