A public health feature | February 2026
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A City-State at a Crossroads
Singapore has long been regarded as one of Asia’s model nations — a place of efficient governance, world-class infrastructure, and a healthcare system routinely ranked among the globe’s finest. Yet for all its accomplishments, the city-state is quietly losing a slow-burning battle against two of the most consequential chronic diseases of the modern age: obesity and type 2 diabetes.
The numbers are stark. According to the Ministry of Health’s National Population Health Survey (NPHS) 2024, the proportion of obese residents — those with a body mass index (BMI) of 30 or above — has climbed from 10.5% in 2019–2020 to 12.7% in 2023–2024, a near 21% relative increase in just four years. When the lens widens to include those with a BMI of 27.5 or above — the threshold at which Asians face meaningfully elevated risk of metabolic complications — roughly one in four Singapore residents now falls into that category.
Diabetes is equally alarming. As of 2024, there are nearly 700,000 adults aged 20 to 79 living with the disease, representing a prevalence of approximately 11.6% — one of the highest among developed nations. The International Diabetes Federation projects that figure will exceed 780,000 by 2050 if current trends are left unchecked. More troubling still, a rising proportion of cases are appearing in patients under 40, as lifestyle factors intersect with a fast-ageing population to create what one Singapore Medical Journal analysis described as “twin engines” driving chronic disease: obesity and ageing, working in lockstep.
Into this landscape has arrived a drug that is, by any measure, extraordinary. Semaglutide — sold under the brand names Ozempic, Wegovy, and Rybelsus — has reshaped global conversations about obesity treatment in a way not seen since statins transformed cardiovascular medicine. And in mid-2025, it arrived officially in Singapore.
The question now is not merely whether semaglutide works. The clinical evidence for that is increasingly unambiguous. The more pressing question — the one that will determine whether this drug becomes a genuine public health instrument or a premium luxury reserved for the affluent — is whether Singapore can harness it equitably, responsibly, and sustainably.
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What Semaglutide Actually Does
To understand semaglutide’s potential, it helps to understand the biology it targets.
After a meal, the gut releases a hormone called glucagon-like peptide-1, or GLP-1. This hormone performs several functions at once: it signals the pancreas to release insulin, it slows the rate at which the stomach empties, and — crucially — it communicates with the brain’s appetite centres to induce satiety. In people with obesity or type 2 diabetes, this signalling system is often blunted or dysregulated, making it harder to feel full and easier to overeat.
Semaglutide is a GLP-1 receptor agonist. It mimics this natural hormone but with far greater potency and a much longer half-life, meaning a single weekly injection maintains therapeutic levels throughout the week. The drug was originally developed by Danish pharmaceutical company Novo Nordisk for type 2 diabetes management (Ozempic, 0.5–1 mg weekly), but subsequent trials at a higher dose of 2.4 mg weekly, branded as Wegovy, revealed weight-loss outcomes that stunned the medical community.
In the landmark STEP trials — a series of large phase 3 randomised controlled trials — participants using Wegovy alongside lifestyle counselling lost an average of approximately 15% of their total body weight over 68 weeks. For a person weighing 100 kg, that is 15 kg. No previous weight-loss medication had come close to this magnitude of effect. The results were comparable, in some analyses, to bariatric surgery outcomes — without the operating theatre.
But the story does not end at weight loss.
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Beyond the Scale: A Cardiovascular Revolution
The SELECT trial, published in the New England Journal of Medicine in late 2023, changed the terms of debate entirely. In a multinational, double-blind, placebo-controlled study enrolling 17,604 adults with pre-existing cardiovascular disease and overweight or obesity but without diabetes, weekly subcutaneous semaglutide at 2.4 mg reduced the composite risk of cardiovascular death, non-fatal heart attack, or non-fatal stroke by 20% compared to placebo, over a mean follow-up of nearly 40 months.
That cardiovascular benefit was, in a later Lancet analysis, found to be largely independent of the degree of weight loss achieved. Patients who lost relatively little weight still experienced meaningful protection. This finding has significant implications: semaglutide increasingly looks less like a weight-loss drug with cardiovascular side-benefits, and more like a disease-modifying cardiometabolic agent that also causes weight loss. The drug is being reconceptualised, in the words of one Lancet editorial, as a medication for which “prescribing restrictions based on BMI thresholds or weight-loss targets may not be appropriate.”
Singapore’s Health Sciences Authority (HSA) took note. Having already approved Ozempic for type 2 diabetes management in April 2021, the regulator subsequently recognised a cardiovascular risk-reduction indication for Wegovy in August 2025 — the higher-dose semaglutide formulation for patients with established cardiovascular disease who are overweight or obese. Rybelsus, the oral tablet formulation, is also registered locally.
In a population where diabetes is the leading cause of kidney failure and a major contributor to heart disease and stroke, these are not abstract data points. They are directly relevant to hundreds of thousands of Singaporeans alive today.
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The Asian Dimension: Why Standard BMI Thresholds May Mislead
One of the most clinically important — and least publicly discussed — aspects of semaglutide in the Singapore context is the question of who, exactly, should be eligible for treatment.
Global clinical trial thresholds for obesity drugs typically use a BMI of 30 or above (or 27 with comorbidities). These cutoffs were derived largely from studies in Western, predominantly white populations. But Asians, including Singaporeans of Chinese, Malay, and Indian descent, develop metabolic complications at lower BMI thresholds. The WHO and Singapore’s own MOH have long adopted a BMI of 27.5 as the marker for elevated chronic disease risk in Asian populations — equivalent in health impact to a BMI of 30 in Western populations.
This means a substantial proportion of Singaporeans who could benefit from semaglutide — people with excess visceral fat, pre-diabetes, or early cardiovascular risk — fall below the conventional 30 kg/m² threshold that many prescribing guidelines and insurance frameworks use. They may be neither obese by international definitions nor eligible by standard criteria, yet they carry significant cardiometabolic burden.
The OASIS 2 trial, a phase 3 randomised controlled trial specifically studying oral semaglutide in East Asian populations with overweight or obesity, found a mean body weight reduction of approximately 14.3% over 68 weeks — results closely mirroring those in Western populations and providing direct ethnicity-relevant evidence. However, the trial also confirmed that gastrointestinal side effects, including nausea and constipation, occur at higher rates in Asian participants compared to other groups. Studies in Japanese populations have shown elevated rates of GI intolerance relative to other GLP-1 receptor agonist medications — a factor that clinicians in Singapore need to factor into patient counselling and dose escalation strategies.
Additionally, research has highlighted that older Asian adults with lower BMI are more likely to discontinue semaglutide due to side effects, including weight loss that may verge on being excessive. Careful patient selection and more conservative dose titration schedules may be warranted for the local population — a point that commercial telehealth platforms offering standardised dosing protocols may be ill-equipped to address.
The ethnic heterogeneity of Singapore’s population adds another layer of complexity. Malay and Indian Singaporeans carry disproportionately higher rates of diabetes and obesity compared to their Chinese counterparts — with Indian men historically showing prevalence rates of diabetes well above the national average. Whether semaglutide’s cardiovascular benefits are equally distributed across these ethnic groups remains an active area of research, though SUSTAIN 6 trial subgroup analyses suggested that hazard ratios for major adverse cardiovascular events in Asian patients were, if anything, more favourable than the overall population.
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Singapore’s Regulatory Architecture: Cautious but Catching Up
The trajectory of semaglutide’s regulatory approval in Singapore follows the country’s characteristic approach to novel therapeutics: methodical, evidence-led, and conservative relative to the United States and European Union, but increasingly responsive to compelling data.
Ozempic was approved by the HSA in April 2021 for type 2 diabetes management. Wegovy’s launch for weight management came in mid-2025, making Singapore relatively late compared to the US (2021), the UK (2023), and several European markets. The additional cardiovascular risk-reduction indication for Wegovy was recognised in August 2025, shortly after equivalent approvals elsewhere.
All three formulations — Ozempic, Wegovy, and Rybelsus — are classified as prescription-only medicines (POM) under HSA regulations. This is not merely bureaucratic formality. It reflects a genuine and appropriate clinical safeguard: semaglutide carries contraindications (including a personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2), requires baseline and ongoing metabolic monitoring, and demands careful dose titration. Its interaction with insulin and sulphonylureas in patients with type 2 diabetes can precipitate serious hypoglycaemia if not managed.
Critically, the prescription-only designation means that platforms operating from outside Singapore — including the US-based “Buy Stufz” type operations that have recently begun generating paid press coverage — cannot legally service Singaporean patients without violating both HSA regulations and the Medicines Act. Purchasing semaglutide from unverified overseas online sources is not merely inadvisable: it is illegal, and it exposes patients to risks ranging from counterfeit product and improper cold-chain storage to absent medical oversight.
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The Affordability Gap: Singapore’s Most Consequential Barrier
If regulatory compliance is the first challenge for responsible semaglutide deployment in Singapore, cost is the second — and arguably the more consequential.
Currently, Wegovy for weight management in Singapore costs approximately SGD 600 to 800 per month, depending on dosage and provider. That amounts to SGD 7,200 to 9,600 annually. For a drug that may need to be taken indefinitely to maintain its benefits — clinical studies have consistently shown weight regain following discontinuation — this represents a sustained financial commitment that is realistically accessible only to upper-income households.
The insurance picture is complicated. Medisave and CHAS subsidies for Ozempic are available in specific, narrowly defined clinical scenarios: namely, where the drug is prescribed for type 2 diabetes management and the patient has a BMI of 27.5 or above. Ozempic prescribed off-label for weight loss in patients without diabetes is not covered under standard insurance plans. Wegovy, as a newer and more expensive weight-management formulation, does not yet feature on MOH’s subsidised drug list or the Medication Assistance Fund (MAF) — the scheme through which Singapore Citizens can receive up to 75% subsidies for eligible medications at public healthcare institutions.
This creates a meaningful equity gap. The populations in Singapore who carry the greatest burden of obesity and diabetes — lower-income households, Malay and Indian communities, the elderly — are precisely those least able to afford an out-of-pocket monthly cost of hundreds of dollars. Meanwhile, the drug’s benefits flow disproportionately to those who can afford private specialist care and full-price prescriptions.
This is not a uniquely Singaporean problem — similar access tensions are playing out in the United Kingdom, where NHS rationing has been cautious, and across the United States, where payer coverage remains inconsistent. But for a country that has built its healthcare identity on the principle of affordable access through a tiered subsidy system, the gap between what the clinical evidence says semaglutide can do and who can actually afford it is a genuine policy contradiction.
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Healthier SG and the Long Game
Singapore’s healthcare transformation strategy offers one possible framework for thinking about where semaglutide fits into the national picture. The Healthier SG initiative, launched in 2023, represents a fundamental shift in emphasis: from treating disease after it occurs towards preventing it from developing in the first place, through population-level primary care enrolment, preventive health screenings, and chronic disease management at polyclinic level.
Within this framework, semaglutide occupies an interesting position. For patients already diagnosed with type 2 diabetes, it offers superior glycaemic control and cardiovascular risk reduction relative to many existing agents — an argument for it to be more systematically subsidised through the public healthcare system. For those with pre-diabetes and obesity — a population estimated to number in the hundreds of thousands in Singapore — it could, in theory, delay or prevent diabetes onset altogether, generating long-term healthcare cost savings that dwarf the drug’s immediate price tag.
The economics of diabetes in Singapore are not trivial. Medical expenses and productivity losses attributable to diabetes were estimated at SGD 940 million in 2014. Diabetes Singapore projects that figure will rise to SGD 1.8 billion by 2050. If semaglutide can shift even a fraction of the pre-diabetic population away from a diabetes trajectory, the cost-benefit calculation may look very different from simply comparing the drug’s price against its clinical benefit in isolation.
But public health cost-effectiveness analyses of novel obesity medications are complex, politically sensitive, and dependent on assumptions about duration of use, adherence, and behaviour change. Singapore’s MOH has thus far taken a cautious position — approving the drug, enforcing the prescription-only requirement, and allowing the private market to lead initial uptake while observing safety signals and gathering local real-world data.
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Telehealth: Promise and Peril
The emergence of telehealth platforms offering semaglutide prescriptions in Singapore — licensed local providers operating within HSA and MOH regulations — represents a genuine expansion of access, particularly for working adults who face barriers to traditional clinic visits. Platforms operating under registered telemedicine infrastructure can issue legitimate prescriptions, facilitate doorstep delivery, and offer follow-up consultations digitally.
The clinical appropriateness of this model, however, is contingent on several safeguards that are easier to describe in press releases than to implement in practice: comprehensive medical history review, exclusion of contraindicated patients, structured dose escalation, monitoring of metabolic parameters, and management of adverse effects. Semaglutide in the STEP trials was administered within carefully controlled research environments with frequent protocol-specified monitoring visits. Real-world telehealth delivery, compressed into asynchronous questionnaires and occasional WhatsApp check-ins, is a meaningfully different clinical context.
The risk of patient-driven dose escalation — accelerating past the medically recommended titration schedule in pursuit of faster results — is real and poorly studied in Asian populations. The risk of inappropriate prescribing to patients with undisclosed contraindications is real. And the risk of what clinicians call “cosmetisation” — the use of a cardiometabolic disease drug for primarily aesthetic weight loss in patients without clinical indication — is not hypothetical. It is already occurring in markets where semaglutide is more freely available.
HSA’s prohibition on advertising prescription-only medicines directly to the public is, in this context, an important guardrail. The explosion of paid press coverage and advertorial content — including the kind of material that prompted this article — represents a grey-zone challenge to that prohibition, and warrants regulatory attention.
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What the Evidence Still Does Not Tell Us
Candour requires acknowledging the genuine limitations of the current evidence base as it applies to Singapore’s population.
The major semaglutide trials — STEP 1 through 8, SELECT, SUSTAIN 6 — enrolled predominantly Western, white, and middle-to-older-aged populations. Asian representation in these trials was limited, and Southeast Asian populations specifically were significantly underrepresented. The OASIS 2 trial in East Asian populations studied oral semaglutide rather than the injectable formulation, and was conducted in Japan and South Korea rather than Singapore or Southeast Asia.
Long-term safety data beyond five years is sparse for any formulation. Concerns about rare but serious adverse events — including pancreatitis, thyroid C-cell tumours in rodent models (whose human significance remains uncertain), and adverse psychiatric effects in a small subset of users — have not been definitively resolved. The optimal duration of treatment remains an open question. Whether benefits persist if the drug is discontinued after a defined period, or whether this is genuinely a lifelong commitment for most patients, has profound implications for both healthcare budgets and individual treatment decisions.
And critically: semaglutide does not, in any of its trial contexts, replace lifestyle modification. Every major trial was conducted alongside dietary and exercise counselling. The drug appears to augment the benefits of lifestyle change — not substitute for them. Singapore’s existing infrastructure of Health Promotion Board programmes, Nutri-Grade labelling, and polyclinic-based chronic disease management is not peripheral to semaglutide’s clinical deployment. It is foundational to it.
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The Path Forward
Semaglutide’s arrival in Singapore is not a solution to the country’s obesity and diabetes crises. It is a powerful new tool — one with clinical evidence of a calibre rarely seen in pharmacotherapy — that must be deployed within a carefully considered public health framework.
Several questions demand policy attention in the coming years.
Should Wegovy and Ozempic, for specific clinical indications, be added to MOH’s subsidised drug list and the Medication Assistance Fund? The argument for doing so — at least for patients with established cardiovascular disease or type 2 diabetes and a BMI above 27.5 — grows stronger with each successive trial. Leaving these patients unable to access a drug that can reduce their risk of heart attack and stroke by 20% because they cannot afford SGD 700 a month is a policy choice, not an inevitability.
Should Singapore’s public hospitals and polyclinics develop structured, supervised weight management programmes that incorporate GLP-1 receptor agonists where clinically appropriate? The model of physician-supervised, outcome-monitored pharmacotherapy in a subsidised primary care setting is entirely consistent with how Singapore manages other chronic disease medications.
And should the MOH develop Singapore-specific clinical practice guidelines for GLP-1 receptor agonists in obesity and cardiometabolic risk — including BMI thresholds adjusted for Asian populations, ethnic-specific dosing guidance, and clear criteria distinguishing clinical indication from cosmetic use? The existing guidelines predate the semaglutide era and are in urgent need of updating.
Singapore’s healthcare system has repeatedly demonstrated the capacity to move deliberately — and then decisively. The country’s response to its diabetes burden over the past decade, including the War on Diabetes initiative launched in 2016, has included national screening programmes, sugar levies, and food labelling reforms. The integration of semaglutide into that strategic architecture, done properly, could be genuinely transformative.
Done improperly — or left entirely to the market — it risks becoming one more expensive intervention that widens rather than narrows the gap between Singapore’s healthiest and most vulnerable citizens.
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A Final Word on Context
There is something worth naming directly: the drug that is the subject of this article has, in recent months, also become the subject of a remarkable volume of commercially motivated health content — paid press releases dressed as journalism, telehealth platform advertorials, and international online pharmacies eyeing Singapore’s affluent, health-conscious population as a target market.
That context matters. Semaglutide is a genuine scientific breakthrough. The clinical evidence is real and robust. But it is also a product that generates billions of dollars in annual revenue for its manufacturer, and the commercial incentives to expand its market — to lower the threshold for prescribing, to minimise discussion of side effects, to frame obesity pharmacotherapy as a consumer convenience rather than a medical decision — are powerful and pervasive.
Singapore’s patients deserve to encounter semaglutide through a lens that is clinical, honest, and oriented to their long-term health. That lens begins with a doctor who knows their history, monitors their progress, and is accountable to professional and regulatory standards — not a questionnaire, a credit card form, and an overnight delivery.
The drug is extraordinary. The conditions for using it wisely are not.