Navigating Your Options—Medical Treatments for Overweight and Obesity

The GLP-1 Shift Accelerates

The landscape for medical treatments of overweight and obesity has transformed rapidly. In December 2025, the FDA approved an oral version of semaglutide as the first pill in the GLP-1 class for chronic weight management and reducing major adverse cardiovascular events in adults with obesity or overweight plus related conditions. This followed years of injectable dominance by drugs like Wegovy and Zepbound (tirzepatide), which achieved substantial weight reductions but required weekly shots. The resolution of national shortages for key GLP-1s in 2025—after demand outstripped supply since 2022—removed a major barrier, yet affordability remains acute. List prices often exceed $1,000 monthly without insurance, and coverage varies widely. Medicare still prohibits coverage for obesity alone, though new voluntary models and manufacturer deals aim to expand access starting mid-2026. Some states have cut or limited Medicaid coverage for these drugs due to budget strains, while others explore inclusion. Beyond weight loss, GLP-1 therapies offer broader metabolic benefits, including better glycemic control, reduced cardiovascular risks, and improvements in conditions like obstructive sleep apnea. The World Health Organization issued guidance in late 2025 endorsing long-term use in adults, while classifying obesity as a chronic relapsing disease, though with caveats on costs, equity, and long-term safety data. Tensions persist. Weight often rebounds quickly after discontinuation—studies show regain rates around 0.4 kg per month—meaning patients may need indefinite treatment. Side effects, including gastrointestinal issues, and emerging concerns over muscle loss or other long-term impacts add complexity. Meanwhile, the boom disrupts food industries, with companies reformulating products for lower appetite, and fuels debates over whether these drugs medicalize a societal issue or finally address a major driver of preventable death. Over 1 billion people globally live with obesity, linked to higher mortality from heart disease, cancer, and diabetes. In the US, where prevalence exceeds 40% in many areas, these treatments represent a pivotal shift toward viewing obesity as a treatable medical condition rather than a lifestyle failing alone.