MALAYSIA faces a significant obesity burden, with about one in two adults being overweight, yet treatment remains fragmented and under-utilised. Doctors say this mismatch — high prevalence, limited access and high out-of-pocket costs — has created fertile ground for misuse.
GLP-1 receptor agonist drugs such as Ozempic, Wegovy and Mounjaro have reshaped obesity treatment for many patients. However, their high cost and uneven access are widening an equity gap and quietly fuelling the illegal online sale of prescription-only weight-loss injections.
Monthly treatment costs typically range from RM600 to more than RM1,300, placing long-term use beyond the reach of many Malaysians. For a chronic condition that requires sustained care, affordability is not just a financial concern but a clinical one.
“Affordability directly affects outcomes. When patients stop treatment because they cannot sustain the cost, weight regain is common. That frustration pushes some to seek cheaper, unregulated alternatives,” said Dr Ting Pey Woei, Consultant Internal Medicine Physician at Batu Kawan Columbia Asia Hospital.
Those alternatives increasingly come from online sellers, where GLP-1 injections are marketed without prescriptions, medical screening or follow-up. Doctors say this is not simply a matter of individual risk-taking, but a predictable consequence of access barriers within the formal healthcare system.
“When regulated treatment becomes inaccessible, patients look elsewhere. That is how unsafe markets emerge," she said.
Meanwhile, Consultant Physician and Endocrinologist at Avisena Specialist Hospital Shah Alam Dr Fadzliana Hanum Jalal warned that the medical risks of unsupervised use are significant.
“These medicines require counselling, dose titration and monitoring. Buying them online removes all safeguards and exposes patients to unnecessary harm," she said.
She added that gaps in some private and online services including limited assessment, poor continuity of care and a lack of coordinated support further compound the problem.
“Obesity treatment cannot be reduced to an injection alone,” she said.
Obesity is a multifactorial, chronic disease, shaped by genetics, behaviour and environmental factors. Effective management requires a comprehensive, individualised approach that includes nutrition counselling, physical activity, psychological support, stress management and screening for obesity-related complications.
“Quick fixes are not obesity care. The goal is long-term health and functional wellbeing,” Dr Fadzliana said.
Without equitable access to structured care, experts warn that innovative therapies risk deepening health inequalities. Those who can afford long-term treatment benefit from supervised, evidence-based care, while others are pushed toward unsafe, illegal channels.
From an industry perspective, GLP-1 medicines are intended to support, not replace, lifestyle change.
Novo Nordisk Malaysia general manager Dr Praful Chakkarwar said drugs such as Wegovy help patients feel fuller, reduce food intake and sustain weight loss when combined with behavioural interventions.
“Lifestyle modifications alone are often difficult to maintain. Medications can help patients adhere to healthier habits, but they must be prescribed appropriately and used within a comprehensive care plan,” Dr Praful said.
He stressed, however, that access must be expanded responsibly.
“Those who need treatment should be able to access it safely. At the same time, these are prescription medicines and must be used under medical supervision.”
Discussions are ongoing between the Health Ministry, policymakers and healthcare providers on how to expand access while ensuring proper assessment, follow-up and patient education. Given the cost of GLP-1 therapies, access may initially follow a stepwise approach, prioritising patients with the greatest medical need.
Clinically, GLP-1 drugs reduce hunger and cravings, with most weight loss coming from fat reduction — delivering meaningful metabolic and quality-of-life benefits. In the medium term, treatment can reduce hospitalisations and complications; over the long term, it may help prevent costly chronic disease.
However, Dr Praful cautioned against self-medication. “Every patient’s obesity has different causes — genetics, environment and behaviour all play a role. GLP-1 drugs are tools, not standalone solutions.”
Doctors warn that unless affordability, access and enforcement are addressed together, Malaysia risks entrenching a two-tier system of obesity care: supervised, evidence-based treatment for those who can afford it, and unsafe online injections for those who cannot.
They say policy responses must move beyond warnings and education to include stronger enforcement against illegal online sales, clearer prescribing standards across public and private care, tighter supply-chain controls, and platform accountability for illicit drug listings.
At the same time, expanding access through structured, affordable obesity programmes is essential to reduce demand for unregulated alternatives.