Panama's 2026 Obesity Guideline and PAHO's GLP-1 Alert

Complete guide: GLP-1 drugs: a complete guide to semaglutide and beyond

In Panama, the Ministry of Health (MINSA) and the Social Security Fund (CSS) now have an officially backed national guideline for adult obesity: the «Evidence-Informed Clinical Practice Guideline for Addressing Obesity in Adults», presented on 4 March 2026, World Obesity Day, with technical cooperation from PAHO/WHO¹. It updates the comprehensive-care guide in force since 2009, was built through a systematic adaptation using the GRADE methodology, and PAHO calls it «a living instrument» that will need updating as new evidence emerges¹. Five days earlier, on 27 February, the Pan American Health Organization (PAHO) had issued an epidemiological alert on the misuse of GLP-1 receptor agonists⁴. This article sets the two documents side by side to answer a practical question: where does GLP-1 stand in Panama?

The MINSA and CSS obesity guideline: what it is and who it binds

MINSA Resolution 128, dated 3 March 2026 and published in Gaceta Oficial No. 30479-B on 10 March, approves the guideline «for use in all facilities of the Public Health System»³. According to PAHO, 71.7 % of Panama's population is overweight or obese and 35.3 % has obesity¹; the 36.1 % adult obesity figure cited by MINSA comes from the 2019 ENSPA survey⁹. For the difference between «excess weight» and «obesity», see our earlier analysis, Obesity and diabetes in Panama: the numbers and GLP-1.

The summary version (dated 2025) defines the target population as adults aged 20 or older with obesity and excludes pregnant women and people with obesity secondary to endocrine disorders, of genetic cause or drug-induced². It is aimed at staff in MINSA and CSS facilities: general and family physicians, internists, endocrinologists, psychiatrists, physiatrists, bariatric surgeons, nurses, nutrition and social work staff, among others².

The recommendations: lifestyle, team care and follow-up come first

The summary lists nine recommendations, all rated «strong in favor» on the guideline's own GRADE scale². The first two are personalized nutrition therapy and combined treatment with a meal plan, exercise, patient education and psychological interventions, both with low and very low certainty of evidence². The third proposes combined exercise: aerobic 3 to 5 times a week, 30 to 60 minutes per session, plus strength work 2 to 3 times a week, with very low certainty². A good-practice point states that every patient with obesity should be treated by a multidisciplinary team².

Bariatric surgery also gets a strong recommendation (moderate and low certainty) for adults with a BMI of 35 kg/m² or more, or a BMI of 30 to 34.9 kg/m² with metabolic disease, criteria the document labels expert consensus².

Drug treatment in the guideline: recommendation 5

Recommendation 5 is the one that matters to prescribers: «It is recommended that adult patients with obesity who are on combined treatment with a meal plan, physical activity, education and psychological interventions have adjuvant drug treatment added on an individualized basis»² (our translation). It is a strong recommendation in favor, with low and very low certainty of evidence². Two details matter. First, the medicine is an adjunct: it is added to a combined treatment already under way. Second, the recommendations summary names no drug and sets no BMI or comorbidity thresholds for drug treatment, although it does for surgery².

The good-practice points attached to it ask that treatment be personalized and based on a comprehensive assessment by a multidisciplinary team; that the choice of medicine and the duration of use be set by the physician through a «reasoned and well-founded prescription» (our translation); that comorbidities, mechanism of action, interactions, side effects, follow-up requirements and the effect on the patient's motivation be weighed; and that every adverse drug reaction be reported to the National Pharmacovigilance Center².

PAHO's alert and the WHO list: a narrower frame

The 27 February 2026 epidemiological alert reports «an increase in countries that have reported adverse effects of varying severity» linked to misuse of these medicines and asks for stronger pharmacovigilance (our translation)⁴. PAHO's 3 March release names semaglutide, dulaglutide, liraglutide and tirzepatide; it says the most frequent adverse events are gastrointestinal and usually temporary, and that less common but potentially serious ones are acute pancreatitis, gallbladder disease and intestinal obstruction⁵. It asks countries to limit use to indications approved by the national regulator, within a long-term management plan, and warns that purely aesthetic use without clinical assessment exposes people to unnecessary risk and diverts resources from patients with a clear need⁵.

The most relevant nuance for a Panamanian physician comes from the World Health Organization (WHO). According to PAHO, the 24th Model List of Essential Medicines includes these drugs as additional therapy for adults with type 2 diabetes, established cardiovascular or chronic kidney disease and obesity (BMI of 30 kg/m² or more), and its committee did not recommend them for people with obesity without type 2 diabetes or other comorbidities⁵¹⁰.

That is only part of the picture. On 1 December 2025 WHO issued its first clinical guideline on GLP-1 medicines for obesity, with two conditional recommendations: these therapies may be used by adults, excluding pregnant women, for the long-term treatment of obesity, and intensive behavioral interventions may be offered to those who receive them; it covers liraglutide, semaglutide and tirzepatide⁶. The two WHO documents answer different questions (what belongs on a model list, and how to treat an adult with obesity), but together they draw a more cautious frame than the discretion recommendation 5 leaves.

What the DNFD registered and what Panamanian pharmacovigilance has received

Safety note 0014-26 from the National Directorate of Pharmacy and Drugs (DNFD), dated 11 February 2026, passes on the FDA's request to remove the suicidal ideation and behavior warning from the labels of Saxenda (liraglutide), Wegovy (semaglutide) and Zepbound (tirzepatide), after a meta-analysis of 91 placebo-controlled trials and 107,910 patients found no increased risk⁷⁸. The FDA announced the move on 13 January 2026⁸. Under «Situation in Panama», the note lists the health registrations that carry liraglutide, semaglutide and tirzepatide: Saxenda, Xultophy, Victoza, Ozempic (Dualdose and Fixdose), Rybelsus tablets and several strengths of Mounjaro KwikPen; Wegovy and Zepbound do not appear in that table⁷.

The National Pharmacovigilance Center (CNFV) had received suspected adverse-reaction reports: 104 for semaglutide and 141 for liraglutide; the note gives no figure for tirzepatide⁷. The most reported reactions in the class were diarrhea, constipation, nausea, vomiting, headache, dry mouth, disorientation, stomach discomfort, hives, hematoma and decreased appetite⁷. That is what the formal reporting system measures; it does not capture products bought through unofficial channels, such as those described in Fake Ozempic and Mounjaro in Panama.

What the evidence says and why continuity matters

The trials behind adjunctive use are well known and were funded by the manufacturers¹¹¹²¹³. In STEP 1, semaglutide 2.4 mg weekly produced a mean weight change of -14.9 % at 68 weeks versus -2.4 % with placebo¹¹. In SURMOUNT-1, tirzepatide achieved -15.0 %, -19.5 % and -20.9 % at three doses at 72 weeks versus -3.1 % with placebo¹². In SELECT, in adults with established cardiovascular disease and overweight or obesity but no diabetes, the primary cardiovascular endpoint occurred in 6.5 % with semaglutide and 8.0 % with placebo (HR 0.80)¹³.

The other datum that conditions recommendation 5 is duration. One year after semaglutide and lifestyle support were withdrawn, participants in the STEP 1 extension regained 11.6 percentage points of a mean 17.3 % loss¹⁴. In SURMOUNT-4, after 36 weeks of tirzepatide, those switched to placebo regained weight (+14.0 % between weeks 36 and 88), while those who continued lost a further 5.5 %¹⁵. That fits a guideline that leaves duration to medical judgment and the view of obesity as a chronic disease; it also forces attention to follow-up and to long-term cost for a public system.

What remains open

• The full version. This analysis rests on the summary version of the guideline; the full version, also published by MINSA, was not reviewed and may spell out criteria the summary does not².
• The text of Resolution 128. Only its title, dates and Gaceta Oficial publication were verified; the articles were not available in open access³.
• A living document. PAHO says the guideline will be updated as evidence emerges; WHO also plans to update its GLP-1 guideline¹⁶.
• Products outside the official channel. PAHO warns that products sold online and on social media may contain incorrect doses, different active ingredients or undeclared substances¹⁰.
• The national plan. PAHO links the guideline to the 2025 national plan; MINSA presented it as the Plan to Accelerate the Halt of Obesity (PADO) 2025-2030, centered mainly on food environments, labeling and primary care¹⁹.