“They’ve empowered patients to address their weight, change their lives and embrace a new outlook.” Leading the charge is retatrutide, a next-generation obesity drug developed by Eli Lilly that’s generating unprecedented excitement. For years, drugs like Ozempic and Wegovy have transformed how doctors treat… —Follow for updates as these therapies progress through clinical trials and FDA review. So she talked to her doctor about medications that could help manage the factors contributing to her weight gain. Her weight loss had plateaued, and she was concerned about how it could affect her overall weight management. This page is not designed to give specific medical advice to patients, nor to their health care providers. I am passionate, enthusiastic, and driven to help conquer the stigma against obesity; educate health care professionals and the public about obesity and diabetes; and to help us become a healthier society! Thus, some are being pursued as obesity treatment, some for type 2 diabetes, and/or some for fatty liver disease. Deficiencies in this pathway manifest clinically as hyperphagia, impaired pubertal development, obesity, and insulin resistance with individuals who are homozygous or compound heterozygous for deleterious mutations in POMC also presenting with adrenal insufficiency and hypopigmentation. Even though the relevance of this observation to humans has not been determined, a personal or family history of medullary thyroid cancer or multiple endocrine neoplasia type 2 (MEN 2) is considered a contraindication for treatment with this medication (80). In a secondary analysis of these trials, treatment with liraglutide 3.0 resulted in dose-independent, reversible increases in amylase/lipase activity (7% for amylase and 31% for lipase) (79). The mean body weight change from baseline was higher with semaglutide as participants had significantly greater odds of achieving 10% or more, 15% or more, and 20% or more weight loss with semaglutide vs. liraglutide . In 2017, injectable semaglutide (Ozempic®) was FDA-approved for T2DM, and in 2021, it was FDA-approved for weight loss under the brand name Wegovy® . Despite the successful efficacy of liraglutide in T2DM and obesity management, the discomfort of once-daily injection posed a barrier for patients, thereby leading to the design of a once-weekly injectable GLP-1 receptor agonist, semaglutide . Later, in 2020, it was reapproved again for chronic weight management among pediatric patients aged 12 and older who are obese. Liraglutide was also approved by the FDA under the brand name Saxenda® in 2014 for chronic weight management in adults and again in 2020 for chronic weight management among pediatric patients aged 12 and older who are obese. Following a healthy diet and staying physically active can help. Keeping your weight in check sometimes can be a lifelong challenge. If you are a Mayo Clinic patient, we will only use your protected health information as outlined in our Notice of Privacy Practices. These pharmacies make versions of medicines, such as semaglutide and tirzepatide. Side effects include headache, skin darkening, upset stomach, loose stools, belly pain, depression and thoughts of suicide. According to a report by GlobalData, the market for obesity drugs is predicted to be worth $37.1bn in 2031. With an estimated market value of $37.1bn in 2031, the race for the development of obesity drugs is on. Unlike treatments that are currently available, the drug improves insulin sensitivity and increases energy expenditure – the capacity of the body to burn calories. Weight-loss drugs based on the hormone GLP-1 benefits millions of people across the world. The healthcare field now has a new strategy for meaningful weight loss, but there are still more questions than answers. Bariatric surgery helps people lose an average of 25–30% of their body; however, these procedures are underutilized because not all patients are able or willing to undergo bariatric surgery. However, to have a significant impact on comorbid medical conditions, a weight loss of 5–15% is recommended (Crowley et al., 2019). Since weight gain occurs gradually, long-term medical weight loss interventions should be administered with lifestyle modifications. Other trials being conducting testing the drugs efficacy in NASH patients are currently at Phase I and Phase II. Denmark-based Novo Nordisk’s are reaching the end of the OASIS trials for another oral version of semaglutide (NN-9932) specifically for the use of patients with obesity. It is expected that due to recent advancements in obesity medication drugs targeting GLP-1’s as well as dual and triple-agonists will remain the primary mechanism of action (MOA). It’s Time to Stand Up for Science Such information will enable doctors to give more personalized advice because interventions can be done in real time based on the feedback provided by the patients and the trends of their behavior.The FDA's approval expands the use of semaglutide to people with a BMI of 27 or higher (qualified as overweight or obese) with a history of cardiac events.In the 1 head-to-head trial, semaglutide achieved greater weight loss than liraglutide.26 None of these drugs have assessed long-term outcomes in adults without preexisting diabetes mellitus, and thus there is uncertainty around long-term benefits, such as cardiovascular morbidity and mortality.The therapeutic landscape for obesity has been revolutionized by breakthrough medications that achieve weight loss previously only attainable through bariatric surgery.A 2021 study showed that once-weekly injections of Wegovy over the course of 68 weeks resulted in about a 15 percent loss of body weight in adult participants with obesity.All participants in STEP 3 received 30 brief visits with an RD over 68 weeks, which included, for the first 8 weeks, a 1000–1200-kcal/day meal-replacement diet, given the greater weight loss with this approach compared with an isocaloric, self-selected diet .Beyond biosimilars, companies in India and China are also developing new obesity drugs. This genetic role of lipase has made possible the development of lipase inhibitor drugs, orlistat and cetilistat, for weight loss in obese patients. As these drugs evolve, they could transform obesity management and significantly improve health outcomes. When these medications are combined with lifestyle and diet modifications under the guidance of a healthcare professional, weight loss can become significantly easier. This article explores the future prospects, current research, and challenges facing weight loss medications, highlighting their potential impact on managing obesity effectively. Significant demand for weight-management medicines has impacted the availability of Novo Nordisk obesity medications, including Saxenda®. • Based on their psychiatric history, have a risk of psychosocial distress (e.g., suicidal thoughts/behaviors, anxiety, depression, relationship changes) or a desire to continue losing weight below an appropriate BMI (e.g., kg/m2)? • Refer to certified clinical exercise physiologist for patents with clinically significant problems or who want more education/support • Use brief interview, activity diary, or step counter to assess baseline physical activity and changes during treatment • Increase their physical activity (planned and lifestyle) to improve their cardiometabolic health (e.g., cardiorespiratory fitness)? • Recommend reduced-calorie diet (500 kcal/d deficit) that promotes cardiometabolic health and encourages consumption of lean proteins, fruits, and vegetables and fewer highly processed foods (i.e., high in fat and sugar) These complementary therapies are targeted at the restoration and support of a healthy microbial balance that could contribute to sustainable weight management. As the link between gut health and overall wellness becomes clearer, 2025 is expected to see a stronger focus on the role of the gut microbiome in weight management. As mental health becomes increasingly recognized for its role in weight management, many programs now include mental health professionals as part of their care teams. Methods like mindfulness, meditation, and exercise can help patients manage stress levels, thereby helping in weight management on a physiological and psychological level. Both of these features assist the patient in their search for a healthy, balanced lifestyle to support the objectives of weight loss. “A small number of patients have such significant nausea and vomiting that they cannot take this medicine.” If you aren’t losing weight, they may increase the dose. You may get a prescription from your primary care doctor, obesity medicine specialist, endocrinologist or cardiologist. Zepbound and Mounjaro are brand names for a newer medication called tirzepatide. And I have many patients who have come off blood pressure medications using the newer weight loss medications. In a Q&A, Moreno discusses the effectiveness of second-generation weight loss medications, their impact on other aspects of health, and how they change our relationship with food. A transformative study has shown that combining Endoscopic Sleeve Gastroplasty (ESG) with GLP-1 receptor agonist drugs, such semaglutide, delivers superior weight loss results compared to ESG alone. Our investigation encompassed anti‐diabetic medications known to induce weight loss, such as semaglutide, dulaglutide, liraglutide, tirzepatide, empagliflozin, dapagliflozin and canagliflozin. Many states do not cover weight-management medications under their pharmacy benefit."But whether they can be safely used for all people who simply want to lose an extra 10 to 20 pounds is questionable."Oral semaglutide 50 mg represents a significant advancement in patient convenience, offering the efficacy of injectable semaglutide in an oral formulation.The telehealth industry grew about 24% in 2023 alone and is expected to continue as more practices implement remote care solutions.Legislation that would allow medication coverage in Medicare — the Treat and Reduce Obesity Act — has not made progress despite being reintroduced every congressional session since 2012.This includes eating a balanced diet rich in whole, nutrient-dense foods, staying active through regular exercise, and incorporating natural supplements to support your body’s needs.The average weight loss was 0.1 kg, 2.1 kg, and 5.6 kg in the placebo, metformin, and ILI groups, respectively (P14).At the end of 36 weeks, average weight loss was 20.9% with tirzepatide vs --- with placebo. Core Building Blocks: Protein, Healthy Fats, and Smart Carbs For example, loss of control over eating, obsessive behaviours, rigidity (eg rigid calorie counting), greater than expected weight loss, excessive self-weighing and/or weight fluctuations.9 A third provision of the law will cap out-of-pocket Medicare Part D spending for covered drugs at $2,000 in 2025, which would certainly help to make these drugs more affordable. Without Medicare coverage, Black beneficiaries may be least able to afford these new drugs, given their substantially lower incomes and assets than White beneficiaries. “Just like other diseases that you may need to manage, like hypertension or diabetes … you still have to have a treatment plan that you follow to try to make sure that you're maintaining success. For instance, Tedder currently takes a medicine that helps manage insulin resistance (research has shown that insulin resistance and Type 2 diabetes can be drivers in obesity). Lofton explained that the weight loss that can be achieved with some of the newer AOMs is significant. This competition may finally lead to lower prices and greater supplies of these highly effective drugs, and maybe replace some injectables with pills. NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. The Longitudinal Assessment of Bariatric Surgery (LABS) study looked at the effects of two types of weight-loss surgery in adults, gastric bypass and adjustable gastric band. The trial was extended to study the long-term effects in older adults with type 2 diabetes. Your insurance may cover tirzepatide for diabetes control. Some people may be prescribed up to 15 milligrams. Quitting it can lead to regaining much of the weight you lost. The other novel medication in the news lately, Mounjaro, acts like a semaglutide, stimulating GLP-1, but it also mimics a second hormone called glucose-dependent insulinotropic polypeptide. For this reason, Ozempic received approval from the FDA in 2017 as a treatment for type 2 diabetes. In my view, they warrant much more research before they become the basis for a new weight management protocol. In my lectures, I present data on the detrimental impacts on personal health of being overweight or obese. CONTRAVE may cause serious side effects, including: Managing a long-term disease like obesity requires more than willpower alone. Many of my patients who have always experienced food noise didn't know that it wasn't quote, unquote normal. Many of my patients describe intrusive thoughts about food, often called food noise. But if we treat obesity, it'll cascade down to treat all these other conditions. If you don't lose 5% of your weight after 12 weeks of taking Contrave, your doctor may tell you to stop taking it because it's unlikely to work for you, the FDA says.With contributions from weight management experts, this book provides an in-depth exploration of adult weight management.Though in its infancy, fecal microbiota transplant treatment has shown promising results in weight management trials.The FDA recommends that semaglutide be used as an adjunct to a reduced calorie diet and increased physical activity , long considered the cornerstone of obesity management when combined with behavior-change strategies 5, 6.Recently, approved the use of GLP-1 RA (e.g., semaglutide) and off-label use of GLP1-GIP 1 agonists (e.g., tirzepatide) resulted in significant weight loss that is comparable to weight loss with gastric bypass surgery. Most dietary clinical trials are small, low-intensity, and low-quality — a hundred of these can’t produce the knowledge of one good study.” While major pharmaceutical companies have spent billions developing the new GLP-1 agonists, the National Institutes of Health doled out just $250 million in 2022 to scientists across the country to investigate childhood obesity, an amount equivalent to a single, Phase 3 drug trial. This means that around two-thirds of the adult population were above a healthy weight – defined as having a BMI of 25 or above. The 2019 Health Survey for England estimated that over 12 million adults were living with obesity – 28 per cent of the population in England – while a further 16 million (36 per cent) were overweight. Choosing the right weight loss medication is something you should do in coordination with your healthcare provider. The safety of using weight loss meds for the long haul can depend a lot on the particular drug and your overall health. Different types of weight loss medications can be valuable tools to take weight off. That’s why having a personalized weight loss plan is so important, and why weight loss medications could play a vital role in your plan. Am I a candidate for GLP-1 medications? While doctors had sometimes prescribed stand-alone phentermine for obesity in the past, using the drug on its own often led to insomnia, anxiety, headaches, and increased blood pressure and heart rate. Over the years, many AOMs have been pulled from the market after serious side effects such as psychiatric disturbances, damage to the heart, and drug misuse or dependence. Like any disease, obesity is highly complex and personal, so having individualized options for anti-obesity medication (AOM) has helped her manage her condition. I receive honoraria as a continuing medical education speaker and consultant from the makers of semaglutide (Novo Nordisk) and tirzepatide (Eli Lilly). So far, Mounjaro has only been approved for type two diabetes, but it’s very effective for weight loss. More weight loss drugs are coming to market, and their affordability is promising. Greenberg believes that perhaps the most important benefit of this new class of drugs is that “doctors and patients are now accepting that obesity and its complications are an issue that can be treated.” Once efficiently priced drugs can be taken to reduce these health complications of obesity, the cost-benefit analysis may actually be competitive in terms of preventing costs to insurance companies by prescribing these drugs.” Women of child-bearing age need to be aware that the new weight loss medications may interfere with oral contraceptives. We’re hopeful that these new developments will make weight loss drugs more accessible to all who need them, and we will be incorporating them into our virtual practice as they become available. So far, in trials, people are losing 24% of their total body weight in about 48 weeks. Retatrutide is brand new and currently in trials with Eli Lily, showing incredible results because it uses three hormones to combat obesity instead of just one or two like the currently available drugs. As effective as these drugs are in causing weight loss, one concern has been that up to 40% of that weight loss is not due to fat loss but rather due to muscle loss. Despite numerous drugs that were taken into clinical trials for a wide range of conditions characterized by muscle loss and weakness, the results of those trials were initially disappointing in terms of improving clinical outcome — until now. Meanwhile, participants taking orforglipron, the drug Wharton’s team is developing, in a phase 2 trial lost 15 percent of their body weight—about middle of the pack compared to other drugs. In a phase 2 trial of the drug—dubbed CagriSema—participants with type 2 diabetes experienced reduced blood sugar and a 16 percent loss in body weight. What Happens If You Stop Weight Loss Medication — And How to Restart... People with very high end of the weight range who have severe obesity are going to be able to be treated and get much better with the injectable agents. “I think that the oral formulations are going to be equally effective to the injectable formulation because the plasma levels of the medications will be exactly the same,” says le Roux. The trial is evaluating the efficacy and safety of the drug in adults with obesity. OASIS1 has already reached the primary endpoint in a Phase IIIa trial, with results published in May 2023 with reports of 15.1% weight loss, a similar efficacy rating to Wegovy. “The first-generation drugs were always 5%, 6%, 7% and it looked like we were never going to breakthrough. GLP-1/GIP RAs The SURMOUNT-5 trial provided the first direct head-to-head comparison between the 2 most effective obesity medications currently available. Clinical trials demonstrate an additional weight loss of 2 to 3 kg beyond diet and exercise, with 37% of participants achieving a weight loss of 5% or more. The COR clinical trial program demonstrated a 5% to 6% weight loss at 56 weeks, with 42% to 50% of participants achieving a weight loss of 5% or greater. The CONQUER and SEQUEL trials demonstrated 6.6% to 8.6% weight loss at 56 weeks, with 62% to 70% of participants achieving 5% weight loss or more. The SCALE clinical trial program demonstrated a 5.4% to 8.0% weight loss at 56 weeks, with 63.2% of participants achieving a weight loss of 5% or greater. “Some patients don’t want to commit to using a medication for that long, so they need to discuss this with their doctor.” Weight loss of 10-20% of your body weight is common. By 12 weeks, your doctor is looking for a loss of at least five percent of your body weight. The U.S. Food and Drug Administration (FDA) has guidelines for who is eligible for drugs like Wegovy. Over time, you can lose 10-20% of your body weight. As the field evolves rapidly, staying current with emerging evidence and focusing on health equity will be essential for optimizing patient outcomes and effectively addressing the global obesity epidemic. The future of obesity medicine lies in precision approaches combining optimal pharmacotherapy with comprehensive lifestyle interventions, advanced monitoring technologies, and personalized treatment algorithms. However, realizing the full potential of these therapeutic advances requires addressing persistent barriers, including high medication costs, limited insurance coverage, and significant health disparities in access to care. The robust pipeline of emerging therapies promises even greater efficacy, with retatrutide demonstrating potential for 24% weight loss and novel combination approaches targeting multiple pathways simultaneously. Thus, our review provides encouraging findings for the implementation of weight management interventions delivered in primary care.Existing medications are “in a form that we can use easily, but we can’t make an injectable all that easily,” says Sean Wharton, an adjunct professor at McMaster University and medical director of the Wharton Medical Clinic who is leading the research on orforglipron.A healthy diet rich in anti-inflammatory foods and strategic supplements can improve joint cushioning, muscle recovery, and tissue repair.Cessation of effective medications for weight management results in loss of effect, often leading to rapid weight regain.The GLP-1 medicines are already used to treat diabetes, and they generate $23 billion in annual sales.In today’s increasingly globalized world, patients are more conscious of the environmental and cultural implications of their food choices.GLP-1 receptor agonists also contribute to glycemic control via a reduction in body weight, which is beneficial for patients with type-2 diabetes . The New England CEPAC votes on “potential other benefits” and “contextual considerations” as part of a process intended to signal to policymakers whether there are important considerations when making judgments about the long-term value for money not adequately captured in the analyses of clinical effectiveness and/or cost-effectiveness. The New England CEPAC is an independent appraisal committee composed of medical evidence experts, including practicing clinicians, methodologists, and leaders in patient engagement and advocacy. At the current price net of rebates, the incremental cost-effectiveness ratio for semaglutide and liraglutide exceeded the commonly accepted thresholds (Table 3). In addition, for all interventions, there is uncertainty about whether weight regain occurs over time despite continued therapy. Orforglipron does not have dietary restrictions, and will also offer an option for patients who could benefit from treatment but are afraid of needles.At the earliest, a negotiated price for semaglutide, for example, would not be available before 2027 (based on FDA approval in late 2017) and not before 2031 for tirzepatide (based on FDA approval in 2022).By addressing weight management issues early in and throughout adulthood, providers are more likely to diminish the toll of obesity on lifetime health and improve outcomes at reduced healthcare costs.Ozempic® is intended for the treatment of type 2 diabetes but has been increasingly prescribed off-label without the benefit of an FDA-reviewed analysis of safety and efficacy data .Wegovy® intended utilization is for adults with obesity (BMI ≥ 30 kg/m2) or overweight (BMI ≥ 27 kg/m2) who also have additional weight-related problems and adolescents with an initial BMI at or above the 95th percentile for age and sex .Weighed 198 lbs, a 40-lb weight loss with four inches off his waistline.Side effects seen with chronic use include irritability, personality changes, insomnia, and even psychosis similar to schizophrenia."A second issue is that patients tend to regain weight after discontinuing currently available GLP-1 related drugs," said Beinborn, who notes that lifestyle changes should ideally be a complement to medication treatment. As with anyone who loses a lot of weight, patients on these medications experience loss of skin elasticity and skin folds. The latest generation of weight loss drugs—Wegovy and Zepbound—are taken as weekly injections. Another new weight loss medication, Eli Lilly’s Zepbound (tirzepatide), was approved in 2023. Made by Novo-Nordisk, Wegovy and the company’s type 2 diabetes medication Ozempic, contain a newer GLP-1 agonist, semulglutide, that makes weight loss even more successful. All the new weight loss drugs mimic the action of a naturally occurring substance called glucagon-like peptide 1 (GLP-1). Although approved for short-term use, sympathomimetic amines are often used for longer periods. Naltrexone/bupropion ER is contraindicated in patients with seizure disorders; individuals with hypertension should be monitored. Topiramate is a teratogen, which requires that women have effective contraception if they use this medication. Despite the concern for increased blood pressure with phentermine monotherapy, improved blood pressure control was observed after phentermine/topiramate ER treatments. Liraglutide requires a daily injection, whereas semaglutide requires a weekly injection. Nonetheless, the combination of high demand, new uses, and high prices for these treatments is likely to place tremendous pressure on Medicare spending, Part D plan costs, and premiums for Part D coverage over time. According to the Centers for Medicare & Medicaid Services, the proposal would increase Medicare spending by $25 billion and Medicaid spending by $15 billion over 10 years (net of rebates) and would apply to around 3.4 million people with Medicare and 4 million people with Medicaid. In the coming year, expect to see more companies entering the final stages of trials and seeking approval as demand skyrockets. ” This new toolkit is available on the Weight Management Dietetic Practice Group website and aims to assist RDs who counsel adults with type 2 diabetes to integrate shared decision making with counseling. • Read the upcoming book Health Professional’s Guide to Treatment of Overweight and Obesity, edited by Hollie A. Raynor, PhD, RD, and Linda M. Gigliotti, MS, RDN, CDCES, CSOWM. • Join the Diabetes Dietetic Practice Group () and Weight Management Dietetic Practice Group () of the Academy of Nutrition and Dietetics (the Academy). Membership is free at An overview of GLP-1 agonists and recent cardiovascular outcomes trials. BMI Calculator If a patient expects to lose 20 pounds in the first three months of being on the medication, but only loses 15 pounds, they may be disappointed and discontinue the medication. Science magazine named this class of medication, glucagon-like peptide-1 (GLP-1s), as the 2023 Breakthrough of the Year. It is not meant in any way as a substitute for the professional advice provided by your physician or any other healthcare professional. By finding the right combination for your body, you can create a pathway to long-term wellness and vitality. The £40 million pilots will explore how approved drugs can be made safely available to more people by expanding specialist weight management services outside of hospital settings. There is evidence from clinical trials that, when prescribed alongside diet, physical activity and behavioural support, people taking a weight-loss drug can lose up to 15 per cent of their body weight after one year. From oral medications to multi-targeted injectables, here’s a look at the most anticipated weight loss drugs expected to emerge between 2025 and 2028. These drugs are for people who have health conditions stemming from obesity or overweight. The STEP 1, 2, and 4 trials found greater improvements in weight- and physical health–related QOL at week 68 in patients treated with semaglutide compared with placebo 1••, 50, 52••. Alongside Ozempic®, the Food and Drug Administration (FDA) approved Wegovy® in June 2021, which is a higher dose formulation of semaglutide compared to Ozempic®. Indeed, the prescription weight-loss drug market grew 72% more than initially forecasted in 2023, ballooning to a 2.3 billion dollar industry . Ozempic® has skyrocketed demand in the pharmaceutical space for the weight-loss drug market. Drugs in this category have also shown promising efficacy levels in terms of average weight loss. This literature review examines the rise of off-label prescribing practices in the management of weight, with a focus on GLP-1 agonists. Gelesis100 was not significantly more effective in individuals with prediabetes or drug-naïve T2D with respect to mean percent change in body weight, which had been a notable observation in the pilot study First Loss of Weight (FLOW) (112). Tirzepatide (trade name Zepbound) is approved for the treatment of obesity (BMI ≥ 30) or overweight (BMI ≥ 27) with at least one weight-related comorbidity. Mean change in body weight was -13.3% with semaglutide and -2.6% with placebo over 52 weeks. Cleveland Clinic is a non-profit academic medical center. It’s important to discuss these with your healthcare provider. In all cases, the studies were reviewed and approved by institutional review boards at the authors' home institutions (University of Pennsylvania for TAW, AMC and JST and University of Pittsburgh for JMJ). Most weight loss medicines are prescription only. Your healthcare provider can help you understand the pros and cons of this treatment and if it’s right for you. This will include reducing the high costs of these medications and assuring their coverage by public and private insurers . Bold, persistent effort also will be required at a societal level to ensure that persons from socioeconomically disadvantaged populations, who disproportionately bear the burden of obesity and its health complications, have access to second-generation AOMs. To determine if coverage is available, your healthcare provider may request a coverage review.Although phase 2 trials have used oral semaglutide at a dose of 40 mg, the Oral Semaglutide Treatment Effect in People with Obesity (OASIS) 1 trial used oral semaglutide at a dose of 50 mg once a day; this dose can cause greater reductions in body weight with a similar safety profile to 40 mg.Now had for weight loss turned into an episode of vertigo accompanied by cardiac symptoms and a hospitalization for evaluation.If you’re like nearly half of all adults in the U.S, you’re actively trying to lose weight or struggling to keep it off.For an adult who is 5 foot 8 inches tall, that's a weight of 197 pounds or more.As a result, healthcare professionals are exploring how to leverage microbiome-based strategies to help patients achieve their weight loss goals more effectively.According to the Centers for Medicare & Medicaid Services, the proposal would increase Medicare spending by $25 billion and Medicaid spending by $15 billion over 10 years (net of rebates) and would apply to around 3.4 million people with Medicare and 4 million people with Medicaid. Bariatric surgery is one of the most effective treatments for people with obesity, especially when other methods haven’t worked. Medications are most effective when combined with healthy eating and exercise and are typically prescribed for those with a BMI of 30 or higher, or 27+ with weight-related health issues, such as type 2 diabetes. These medications are designed to reduce appetite, increase feelings of fullness and affect how your body processes food. Pharmaceutical treatments offer a new way of helping people with obesity gain a healthier weight and this new pilot will help determine if these medicines can be used safely and effectively in non-hospital settings as well as a range of other interventions we have in place. This next generation of obesity drugs have the potential to help people lose significant amounts of weight, when prescribed with exercise, diet and behavioural support. You should only use weight loss drugs if you plan on keeping regular checkups with your healthcare provider. The decision to begin weight loss drugs should only happen after you and your provider discuss your health history. The landscape of obesity pharmacotherapy has been fundamentally transformed by breakthrough medications that achieve unprecedented weight loss efficacy, comparable to the outcomes of bariatric surgery. Effective management of medication-related adverse effects is crucial for optimizing treatment adherence and long-term success in obesity pharmacotherapy. The superior efficacy of tirzepatide and semaglutide compared to other approved medications justifies their use as first-line therapies when clinically appropriate and accessible. These agents may provide valuable alternatives for patients who cannot tolerate or access approved obesity medications; however, their use requires careful consideration of the risk-benefit profiles and comprehensive informed consent. This innovative mechanism targets 2 complementary incretin pathways, resulting in unprecedented weight loss efficacy that surpasses that of all other obesity medications. Meta-analyses were conducted with random effects models, and a pooled mean difference for both weight (kg) and waist circumference (cm) were calculated. Hard data and deep insights on clinical trials strategy & operations The trial is investigating how a nasal administration of the hormone drug could help with obesity and binge eating disorder. Week 24 interim data appears promising with Altimmune reporting that approximately 50% of subjects achieved 10% or more weight loss. The FDA recommends that semaglutide be used as an adjunct to a reduced calorie diet and increased physical activity , long considered the cornerstone of obesity management when combined with behavior-change strategies 5, 6. As a more tolerable treatment, it may overtake Ozempic in the weight loss market. "As much as 40% of people using these drugs give up after the first month." It's still not a perfect drug strategy for weight loss, though. That's why it has also become extremely popular as a weight loss treatment. These new drugs have now altered what I teach in the classroom, and as a researcher I believe they raise many questions about the current approach to weight management and health. In the past five years, several new drugs have been brought to market that could lead to a profound, if not revolutionary, change in how health care providers – and the public – view weight loss. Short (16 weeks) and longer (one year) randomized-controlled studies in patients with obesity have shown that 400 mg of zonisamide daily is effective in promoting modest weight loss (~5 kg placebo-subtracted weight) (155,156). In this study, pramlintide-treated patients experienced a 3-fold increase in successfully achieving a total body weight loss of ≥ 5%, when compared to those who received placebo. Short-term studies and meta-analyses in individuals with obesity and without prediabetes/diabetes consistently demonstrate ~2% weight loss beyond placebo, with a greater response in those with more insulin resistance (124). Many people think of weight loss interventions as short-term solutions. However, it is too early to know how Medicaid coverage for anti-obesity medications impacts utilization and whether there are other insurance-related barriers, such as prior authorizations, that hinder use. Encouragingly, Pennsylvania is one of the few states in which the state Medicaid program covers anti-obesity medications, including some of the newer GLP-1s. “Given that obesity differentially impacts persons from underserved group, in the absence of robust insurance coverage, the medications may not be affordable to those who need them the most," he points out. When the medication is stopped, hunger often increases, and the body may regain weight.” “I think it’s really critical” to test the degree to which these medicines have protective health effects, Aronne said, “and very exciting that we’re at this point.”She says many insurers consider weight loss cosmetic and refuse to cover the drugs, which are priced at more than $1,000 per month.There’s hope in the form of chiropractic care and a heart-healthy diet rich in lycopene, a superhero nutrient found in red fruits and veggies.Treatment with pramlintide (up to 240 ug three time daily) for 16 weeks resulted in a placebo-corrected reduction in body weight of 3.7% (P131).This is the time to start changing some eating patterns that will be beneficial for weight loss.That means it is absorbed more easily in the body and doesn't require dietary restrictions like Rybelsus does.However, congenital and genetic defects of leptin result in obesity from internal mechanisms.Exenatide extended-release has been shown in studies to cause thyroid tumors in animals, but it's not yet known if it can cause thyroid cancer in people. Semaglutide, relative to placebo, also resulted in larger self-reported reductions in hunger and food cravings, increased fullness and satiety, better control of eating, and lower preference for energy-dense foods . In contrast, semaglutide 2.4 mg has a half-life of about 180 h, which allows once-weekly subcutaneous dosing 1••, 3•. Liraglutide 3.0 mg and semaglutide 2.4 mg are both glucagon-like peptide 1 (GLP-1) receptor agonists . AOMs are considered potentially appropriate for individuals with a BMI ≥ 30 kg/m2 or a BMI ≥ 27 kg/m2 with an obesity-related comorbidity (e.g., hypertension). Approximately 55–65% of participants lose ≥ 5% of weight, 30–35% lose ≥ 10%, and 10–15% achieve ≥ 15% (Fig. 1). Morgan Stanley analysts recently said "obesity is the new hypertension" and predicted industry revenue from U.S. obesity drug sales could rise from its current $1.6 billion to $31.5 billion by 2030. Weighed 198 lbs, a 40-lb weight loss with four inches off his waistline. At a visit with his primary care provider in May 2023, he agreed to maintain the 5 mg per week dose due to his sufficient and steady weight loss. Now had for weight loss turned into an episode of vertigo accompanied by cardiac symptoms and a hospitalization for evaluation. When P.B.’s A1c rose to 6.3%, (prediabetes range) in November 2022 and he weighed in at 240 lbs, his primary care provider suggested he take the medication Mounjaro at the starting 2.5 mg dose for four weeks. Limitations of lifestyle modification include the plateauing of weight loss at 6–9 months , even when participants still have obesity and may receive continued counseling 6, 31. Percentage of participants who achieved categorical losses ≥ 5%, ≥ 10%, ≥ 15%, and ≥ 20% of baseline body weight with intensive lifestyle modification alone as compared with semaglutide and tirzepatide (combined with approximately monthly, brief lifestyle counseling) (NR, not reported) Combining lifestyle modification with high-protein, very-low-calorie diets (≤ 800 kcal/day) increases short-term weight loss to 12–20% but with more costs, side effects, and weight regain than less restrictive diets . To examine the effectiveness of behavioural weight management interventions for adults with obesity delivered in primary care. As more medications hit the market, it will become easier for doctors to not only treat obesity but other metabolic disease as well as improving quality of life. The randomised, placebo-controlled, double-blind, multicentre clinical study is due to enrol 300 participants who will be randomised across two arms, one arm receiving the drug and the other the placebo. Although the pipeline drug is yet to be approved for other therapies, other trials are being conducted to review its safety and efficacy for the prevention of chronic migraines. Alternative MoAs in anti-obesity drugs are being investigated, however experts believe that GLP-1 agonists will remain the main player in the market. We understand that we cover matters that require an additional explanation of how they may assist in a particular care plan or treatment protocol. We utilize functional health and wellness protocols to treat and support care for injuries or disorders affecting the musculoskeletal system. We will discuss probiotics such as Akkermansia muciniphila and their role in gut barrier function, placing them in a proper clinical context. Finally, this post will equip clinicians with the tools to evaluate the burgeoning, critical, and often misleading weight-loss supplement market. Similarly, sibutramine (Meridia®) had sympathomimetic properties, inhibiting serotonin 5-HT reuptake, which helped to promote satiety, was also withdrawn in 2010 given its propensity to increase blood pressure, myocardial infarction and stroke risk, primarily in patients with existing CVD 18, 19. FDA and EMA medication approvals are usually accompanied by the requirement of post-marketing adverse event monitoring and cardiovascular risk research studies . Medications will be very useful to bridge the gap between lifestyle modifications and surgery and have been shown to increase the success of long-term weight maintenance. Since the 1980s, the prevalence of obesity has almost doubled worldwide, with over 500 million men and women being classified as obese . The medication comes in an extended-release tablet that is taken once or twice per day, and the dose gradually increases over time as directed by the physician.Further, most of these drugs are injections, rather than oral pills, and usually require refrigeration for storage.Medical weight management trends are transforming; these are powered by remarkable advances in technology and pharmacology and also a growing focus on holistic, patient-centered care.Weight loss surgery has long been the gold standard for substantial and sustained weight loss in severely obese individuals.“This is why we were excited that the benefits of NK2R agonism translated to diabetic and obese non-human primates, which represents a big step towards clinical translation.”It’s like your body saying, “Inflate the bouncy castle – party’s over for those bacteria!Semaglutide reliably reduces baseline body weight by approximately 15% at 68 weeks, in contrast to 5–10% for lifestyle modification.Recently, the SURMOUNT-2 phase 3, double-blind, randomized, placebo-controlled trial has reported favorable results in weight reduction (Garvey WT et al., 2023).Contrave is a combination of the antidepressant bupropion and naltrexone, which is an anti-addiction medication. For example, small-molecule GLP-1 pills appear to lower blood pressure even more than semaglutide and tirzepatide, says Vilsbøll. Matthew Herper covers medical innovation — both its promise and its perils. Pfizer, which is developing an oral GLP-1, estimates the total market could approach $100 billion in less than a decade, bigger than any other drug market and nine times Major League Baseball’s annual revenue. The GLP-1 medicines are already used to treat diabetes, and they generate $23 billion in annual sales. For drugmakers, this represents one of the biggest financial opportunities ever. —Follow for updates as these therapies progress through clinical trials and FDA revieW The next few years promise significant advancements in obesity treatment, with a focus on efficacy, convenience, and patient-centered approaches. That’s why developing healthy eating and exercise habits should be part of your treatment plan, too. The weight can come back if you stop the medication. The future of obesity pharmacotherapy lies in personalized treatment selection based on individual patient characteristics, genetic factors, and predictive biomarkers. These disparities reflect complex interactions among healthcare access, clinician bias, insurance coverage, and cultural factors that the healthcare system must address to achieve equitable care for obesity. These effects are often dose-dependent and may be reversible with a reduction in dose or discontinuation of the medication.