The landscape of obesity treatment is constantly evolving, requiring healthcare providers to stay informed about the latest advancements. The 2020s have witnessed a surge in the popularity of glucagon-like peptide-1 receptor agonists (GLP-1 receptor agonists), followed by the emergence of dual receptor agonists like Mounjaro (indicated for type 2 diabetes) and Zepbound (approved for obesity).
Determining Candidacy for Weight Loss Medications
The first step in determining whether someone is a candidate for weight loss medications is to assess their Body Mass Index (BMI). A treatment plan for obesity can comprise multiple forms of treatment, including medications, diet, exercise, and/or surgery. For each individual case, the doctor and patient should discuss the patient’s current health issues, other medications, and family medical history. The guidelines for tirzepatide (Zepbound) and semaglutide (Wegovy) state that a patient should have a BMI of 30 or a BMI of 27 with weight-related health problems.
Types of Weight Loss Medications
With a growing selection of weight loss medications available, patients may ask what the strongest or most effective weight loss prescription medication is, and which one is best for them. The answer is complicated, and newer is not always better.
GLP-1 Receptor Agonists
One class of drugs called glucagon-like peptide-1 (GLP-1) agonists is used to treat both obesity and type 2 diabetes. GLP-1 is a hormone that's found in your digestive system. It's released when you eat and tells your body to make insulin to control your blood sugar. It also slows down how quickly your food moves from your stomach to your intestines, and it gives your brain the signal that you feel full. If you don't have enough of this hormone, or if it doesn't work the way it should in your body, a GLP-1 agonist can give your system a boost. The FDA approved the first GLP-1 agonist, exenatide, to treat type 2 diabetes in 2005. Semaglutide also first came to market as a type 2 diabetes treatment under the brand name Ozempic.
Semaglutide (Wegovy, Ozempic)
Wegovy is a brand name for semaglutide, a GLP-1 receptor agonist. It was FDA-approved in 2021. Semaglutide is a GLP-1 agonist. It imitates an intestinal hormone that stimulates insulin production, lowering your appetite and making you feel full. It is administered as an injection and approved for use in adults and children aged 12 years or more with obesity (BMI ≥30 for adults, BMI ≥ 95th percentile for age and sex for children) or some adults with excess weight (BMI ≥27) who also have weight-related medical problems. The dose must be increased gradually over 16 to 20 weeks to arrive at the 2.4 mg dosage. This progression can help to alleviate side effects, which include gastrointestinal symptoms, headache, dizziness, and fatigue. It is intended to be used indefinitely, in combination with a healthy diet and exercise. Ozempic may be a more familiar name to some patients.
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How to take Wegovy: Wegovy is a shot you give yourself once a week with a prefilled pen in the skin of your abdomen, thigh, or upper arm. You start with a low dose, 0.25 milligrams, and increase it gradually over several months to the amount your doctor has prescribed, either 1.7 or 2.4 milligrams.
Side effects: Most side effects are mild and temporary. They include: nausea, diarrhea, abdominal cramping, constipation, vomiting, gas, headache, fatigue, heartburn. Less common but more serious possible side effects include an allergic reaction; problems with your gallbladder, kidneys, or pancreas; blurred vision; increased heart rate; and suicidal thoughts. Semaglutide has been shown in studies to cause a rare kind of thyroid tumor in animals, but it is not known if it can cause thyroid cancer in people.
Liraglutide (Saxenda, Victoza)
Liraglutide is a daily injectable medication that acts on hormones that send signals from the gut to the brain to make the patient feel full quicker and decrease hunger signals. Saxenda is an injection you give yourself once a day in the skin of your abdomen, thigh, or upper arm using a prefilled pen. You start with 0.6 milligrams for the first week and gradually increase the dose over a month until you reach 3 milligrams a day. Doses start at 0.6 mg to 3 mg a day. Some patients may lose 5-10% of body weight, especially with the higher dose of liraglutide. Liraglutide is also approved for Type 2 Diabetes, under the brand name Victoza.
Side effects: Common side effects include: abdominal pain, nausea, vomiting, diarrhea, constipation. Serious potential side effects can include an allergic reaction, raised heart rate, pancreatitis, gallbladder disease, kidney problems, and suicidal thoughts. Liraglutide has been shown in studies to cause thyroid tumors in animals, but it is not yet known if it can cause thyroid cancer in people.
Dulaglutide (Trulicity)
Dulaglutide is another kind of GLP-1 agonist. It imitates an intestinal hormone that stimulates insulin production, lowering your appetite and making you feel full. It's only approved to treat type 2 diabetes, but people taking it do lose weight.
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How to take Trulicity: Trulicity is an injection you give yourself once a week under the skin of your abdomen, thigh, or upper arm using a prefilled pen. The dose starts at 0.75 milligrams for the first week, then increases to 1.5 milligrams. Some people may be prescribed up to 4.5 milligrams.
Side effects: Common side effects of Trulicity include: nausea, diarrhea, vomiting, abdominal pain, indigestion, fatigue. Less common but more serious side effects include an allergic reaction, pancreatitis, kidney damage, vision changes, and gallbladder problems. Dulaglutide 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.
Exenatide (Byetta, Bydureon BCise)
Exenatide is the oldest of the GLP-1 agonists approved to treat type 2 diabetes. It imitates an intestinal hormone that stimulates insulin production, lowering your appetite and making you feel full. It's not approved for weight management, but people who take it do lose weight.
How to take Byetta: Byetta is an injection you give yourself twice a day under the skin of your abdomen, thigh, or upper arm using a prefilled pen. Take it an hour or less before a meal, and make sure the doses are at least 6 hours apart. Bydureon BCise is an injection you give yourself once a week using a prefilled pen.
Side effects: Common side effects of Byetta include: nausea, vomiting, diarrhea, constipation, indigestion, dizziness, headache. Less common but more serious side effects include an allergic reaction, pancreatitis, gallbladder problems, and kidney damage. Some people develop an immune system reaction to exenetide. Your immune system could produce antibodies that make the drug stop working. Another kind of immune reaction can lead to serious bleeding. 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.
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Dual GIP and GLP-1 Receptor Agonists
The newest class of drugs that treat both type 2 diabetes and obesity work with both of the main digestive hormones that tell your body to make insulin: GLP-1 and glucose-dependent insulinotropic polypeptide (GIP). Tirzepatide is the first such drug that's made it to market.
Tirzepatide (Zepbound, Mounjaro)
Zepbound is approved to treat obesity in adults with a BMI of 30 or greater. Tirzepatide imitates both GLP-1 and GIP, increasing your body's production of insulin and lowering your blood glucose levels. It also slows down how quickly food moves from your stomach to your intestines and helps you feel full. It is both a GLP-1 and a GIP receptor agonist. Like semaglutide, it works by reducing appetite and is meant to be used in combination with diet and exercise to lose weight.
In the SURMOUNT-1 trial, adults with obesity or overweight (without diabetes) taking tirzepatide achieved up to 22.5% average body weight reduction at 72 weeks. In addition to impressive weight loss, studies show improvements in cardiovascular risk factors and metabolic markers.
Other Medications
Phentermine
Phentermine is the oldest and most widely used weight loss medication. It was originally used as a short-term medication to jump-start weight loss, but now newer medical guidelines have added it to long-term therapy.
Side effects: Side effects include headache, overstimulation, high blood pressure, insomnia, rapid or irregular heart rate, and tremor.
Phentermine-Topiramate
Topiramate can be combined with phentermine to decrease appetite and cravings. Adults with migraines and obesity are good candidates for this weight-loss medication. Some patients may lose an average of 5-10% of body weight. Daily doses with four strengths start at 3.75 mg/23 mg to 15 mg/92 mg.
Side effects: Side effects include abnormal sensations, dizziness, altered taste, insomnia, constipation, and dry mouth.
Naltrexone-Bupropion (Contrave)
Naltrexone-bupropion combines an opioid receptor antagonist with an antidepressant to affect the pleasure-reward areas of the brain and thereby decrease cravings and appetite. Start with a daily dose of one 8/90 mg tablet and gradually increase to four tablets a day.
Side effects: The most common side effects include nausea, constipation, headache, vomiting, dizziness, insomnia, dry mouth, and diarrhea. Bupropion has caused some people to have suicidal thoughts or actions or unusual changes in behavior, whether or not they are taking medicines used to treat depression.
Orlistat (Xenical, Alli)
Orlistat is a lipase inhibitor that comes in a capsule. Undigested fat is then passed through the body. Some patients may lose about 5% of their body weight. An over-the-counter formulation is available at 60 mg capsules with each fat-containing meal.
Side effects: The most common side effect of orlistat is changes in bowel movement (BM) habits.
Setmelanotide
Setmelanotide is a melanocortin-4 receptor agonist indicated for chronic weight management in adult and pediatric patients six years and older, with obesity due to certain rare genetic disorders.
Medical Devices
Plenity
A medical device rather than a medication, Plenity was FDA-cleared in 2019 for people with a BMI of 25 to 40. It consists of a capsule that releases a biodegradable, super-absorbent hydrogel into the stomach. The gel helps to increase satiety, enabling the person to eat less.
The Future of Weight Loss Medications
With fervent consumer demand for weight loss medications, combined with rising obesity rates, more medications are bound for the market in the coming years. Pharmaceutical platform Ozmosi predicts one to two GLP-1 launches annually starting in 2026 specifically for obesity. Lilly is developing at least two new options. The first, orforglipron, is an oral GLP-1 inhibitor that completed a Phase 3 clinical trial in early 2025. It could provide a welcome alternative for people who do not want injections. The other, retatrutide, targets GLP-1, GIP, and glucagon. At this writing, it is in Phase 3 clinical trials. Amgen is developing MariTide, a monoclonal antibody designed to increase GLP-1 receptor activity while reducing GIP receptor activity. The once-monthly injection entered Phase 3 clinical trials in March 2025. Researchers continue to study hormones that play a role in appetite for other ways to target obesity with medication. Those of interest include not only GLP-1, but also peptide tyrosine-tyrosine (PYY) and cholecystokinin (CCK). With more options available, doctors will be increasingly able to personalize treatments.
Important Considerations
Cost and Insurance Coverage
As with many medications, some weight loss drugs have been on the market longer, have generic alternatives, and tend to be more affordable. GLP-1s are notoriously costly. The Kaiser Family Foundation estimates the annual net price of Wegovy at $13,600. Insurance coverage varies and will affect many patients’ choices about going on weight loss medications.
Metabolic Adaptation and Weight Regain
AOMs may counter the effects of metabolic adaptation and prevent weight regain. After weight reduction, the body metabolically adapts, often causing an increase in hunger hormones and a decrease in satiety hormones and resting metabolic rate, all of which can contribute to weight regain. Most people regain weight if AOMs are discontinued.
Counterfeit Medications
Some online healthcare providers claim to sell Ozempic, Wegovy, or Zepbound at reduced prices. However, the FDA warns against buying medications from any source other than a state-licensed pharmacy. In April 2025, they banned the sale of “counterfeit” semaglutide and tirzepatide. These medications are not made or packaged by the original manufacturers. Instead, they are compounded medications. Compounded versions of medications are made by compounding pharmacies, often to tailor a medication to specific patient needs, like an allergy to an inactive ingredient. Compounded medications are not FDA-approved.
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