Obesity is an all-too-common metabolic disease that is the substrate/foundation of so many other illnesses. Diseases such as diabetes, heart disease, high blood pressure, osteoarthritis of the knees, and liver disease are a few of the many disorders that begin with, or are accompanied by, obesity. Becoming obese is the easy part in most cases. Delicious food options are limitless, and Americans are tempted to sample some beautiful dish they see in a TV ad, in a magazine display, or in their mind as they drive by McD’s, Taco Bell, or Subway on the way home. The “Big Mac Attack” (just like “Whopper or White Castle attacks”) is a real entity because I’ve had one on more than a few occasions. The urge of these “attacks” is unavoidable and unsatisfied until you’ve eaten that Big Mac, all 566 calories of it. Before too long, all these temptations have increased your weight to a level you never dreamed possible. But you had fun getting there.
Then, you look at yourself in the mirror and can’t believe what you see. How did I ever get like this? Now comes the hard part—losing all those extra pounds you gained while you were enjoying yourself. Losing weight has numerous options, too. Many of them require pain and sacrifice—pain because the diet you try leaves you hungry all the time, and sacrifice because to lose weight you can’t (or shouldn’t) eat hot fudge sundaes or chocolate chip cookies, nor should you, as much as you want to, have a second helping of lasagna.
The weight loss industry has been a billion dollar business for decades and until recently was dominated by numerous diet plans, food substitutes, exercise programs, fasting, diet pills, and bariatric surgery. In the 1990’s, the advent of Laparoscopic surgery caused bariatric surgery numbers to explode. Patients tolerated laparoscopic procedures much better than open operations so, by 2022, nearly 280,000 people had a bariatric procedure at a cost of $8.5 Billion. In fact, an estimate of total spending on various weight loss products, plans, or procedures reached and annual $58 Billion.
In the very next year, 2023, the number of patients having bariatric surgery declined by 25.6%. The impact of the introduction of GLP-1’s was being felt already, and GLP-1 use has gone nowhere but up! From 2018 to 2023, there was a 500% increase in the use GLP-1’s, and along with that, revenues rose to $71.7 Billion, a pharmaceutical boondoggle. Wow! By 2024, the increase rose to 600%.
The efficacy of GLP-1’s, and the statistics on obesity have compelled pharmaceutical companies to look for new and better GLP-1s. First came semaglutide that affected “appetite and blood sugar” followed by tirzepatide which targeted both GLP-1 and GIP (“Glucose-dependent insulinotropic polypeptide”) agonists. Tirzepatide had fewer side effects and better weight loss. Both drugs gained huge popularity.
Up until now, GLP-1’s we’re available only as injectables. Oral preparations are the first improvement to appear and represent an improvement in patient desirability. Most folks would prefer a pill/capsule over a shot, but the efficacy ascribed to GLP-1’s overrode the anxiety of an injection. “Oral semaglutide is already approved for use in diabetes….recent data is showing weight loss of up to 15.1%.” Eli Lilly has a new GLP-1 called orforglipron which “has already shown clinically meaningful weight loss in early trials.”
Up until now, GLP-1’s have had limited action meaning they are focused on a single target. New variations are coming that have dual action, ie. two targets, and in addition to “weight loss, preserve bone mass and lean body mass and have shown improvements in cardiovascular risk factors.” Another new variation lowers blood sugar better while preventing the development of a fatty liver.
Lilly now, also, has a three receptor drug, retatrutide, which suppresses appetite, enhances insulin sensitivity, and slows gastric emptying. It has shown “average body weight reduction of up to 24.2% over 48 weeks; results comparable to bariatric surgery.” Retatrutide “helped patients lose 58 pounds on average in less time than semaglutide or tirzepatide.
Other delivery methods and pharmaco-technology are being developed that are more effective, easy to take, and are better tolerated. A drug by Amgen may be a once-a-month or every-other-month injection. These may be available in 2026 or 2027.
So, has science discovered the anti-dote for obesity? Maybe. We don’t know for certain. But to me preventing from occurring in the first place is preferable to eliminating it after it occurs. We’re not there yet, but the speed at which new formulations are occurring is encouraging. A true obesity-preventing drug may some day appear. When it does, life as we know it will change forever.
Reference: Peck J. Anti-Obesity Medications Set to Explode Entering 2026. Medscape 2025 October 22.
