Cayman obesity: STEPS data meets semaglutide and tirzepatide

The STEPS 2023 National Health Survey, run by the Ministry of Health and Wellness with the Pan American Health Organization and published on 16 December 2024, is the most complete picture of metabolic risk in the Cayman Islands¹². Its headline is stark: around 7 in every 10 adults (69.6%) are overweight or obese, above the regional average for the Americas cited in the report (67% for men, 68% for women)¹. As GLP-1 drugs reshape obesity care elsewhere, the numbers frame the conversation physicians in the Cayman Islands are now having with patients.

What STEPS 2023 found

The survey drew a representative household sample across all three islands, with 1,979 participants¹. Obesity prevalence was 32.7%, significantly higher in women (41.1%) than men (24.6%) and in adults aged 45 to 69 (39.7%) than those aged 18 to 44 (27.4%). Mean BMI was 27.3 kg/m² in men and 29.6 kg/m² in women, which the report notes means the average woman is overweight and "very close to being obese"¹.

The cardiometabolic picture follows. About 1 in 4 residents has been diagnosed with raised blood pressure; among those with raised blood pressure, 35.2% were undiagnosed and only 27.2% were diagnosed and controlled on medication¹. Some 10.8% reported ever being diagnosed with raised blood sugar or diabetes, 8.3% of the population was on medication for diabetes, and a further 1.6% had raised blood glucose but were undiagnosed. Nearly 1 in 4 adults (23.6%) had never had their blood sugar measured¹. Cardiovascular disease caused 27% of deaths in 2022 and diabetes 8.3%¹.

When the key findings were released in October 2024, Dr. Gent added that "The cost, or fear of the cost, of health care is now a major barrier to many people", and National Epidemiologist Rachel Corbett reported no significant change in behavioral risk factors since 2012³. PAHO recognized the Cayman Islands for implementing the survey and highlighted that more than one-third of people with raised blood pressure remained undiagnosed⁴. The report itself notes that 5% of respondents had no health insurance and 17% were on a Standard Health Insurance Contract plan¹.

What the GLP-1 trials add

The drugs patients ask about have strong randomized evidence. In STEP 1, 1,961 adults with overweight or obesity lost a mean 14.9% of body weight with once-weekly semaglutide versus 2.4% with placebo⁷. In SURMOUNT-1, 2,539 adults lost 15.0%, 19.5% and 20.9% with tirzepatide 5, 10 and 15 mg versus 3.1% with placebo over 72 weeks⁸. In SELECT, 17,604 adults with cardiovascular disease and overweight or obesity but no diabetes had a 20% lower risk of the primary cardiovascular endpoint with semaglutide (6.5% vs 8.0%; HR 0.80)⁶. Both belong to a class that, by a 2021 review, already counted more than 80 peptide drugs on the market⁵.

On 1 December 2025 the World Health Organization issued its first guideline on these medicines, conditionally recommending that GLP-1 therapies may be used by adults, excluding pregnant women, for long-term obesity treatment, alongside intensive behavioral interventions. WHO estimates obesity affects more than 1 billion people and projects the drugs will reach fewer than 10% of those who could benefit by 2030⁹. Uptake elsewhere is already large: in a November 2025 poll, 12% of US adults said they were currently taking a GLP-1 drug¹².

The risks that come with demand

Trial safety data are well characterized: discontinuation for adverse events was 16.6% with semaglutide versus 8.2% with placebo in SELECT⁶, and 4.3% to 7.1% with tirzepatide versus 2.6% with placebo in SURMOUNT-1⁸. The bigger risk lies outside trials. In March 2026 PAHO said several countries had reported adverse events of varying severity linked to these medicines, listed less frequent but potentially serious risks including acute pancreatitis, gallbladder disease and intestinal obstruction, and warned that demand can push sales into unofficial channels, including the internet and social media, where products may contain incorrect doses, different active ingredients or undeclared substances¹⁰. In April 2025 the US FDA warned that several hundred units of counterfeit Ozempic (semaglutide) injection 1 mg had been found in the US drug supply chain¹¹.

What it means for physicians in the Cayman Islands

The STEPS report recommends low-cost accessible care, wider screening in the prescribed health insurance benefits, standardized care pathways, national data collection on NCD diagnosis and treatment, and PAHO's HEARTS initiative¹. GLP-1 drugs fit inside that frame, not instead of it: WHO pairs them with behavioral support⁹, and PAHO asks countries to limit their use to indications approved by the national regulatory authority and to strengthen pharmacovigilance so adverse events are detected and reported¹⁰. With nearly a quarter of adults never tested for blood sugar¹, finding the patients who would qualify may matter as much as the prescription itself.