wegovy Tag

Novo Nordisk Launches Late-Stage Trial to Find the Lowest Effective Dose of Oral Wegovy

Key Takeaways: 

• Novo Nordisk has begun OASIS-5, a 60-week late-stage trial testing lower maintenance doses of the oral Wegovy pill.
  
• The trial will enrol 450 adults with a BMI of 30 or above, or 27 with a weight-related health condition.
  
• Interest in lower dosing reflects real-world practice, where cost and side effects already drive some people to take reduced doses.
  
  
  

A trial built around dose flexibility

Danish drugmaker Novo Nordisk has started testing smaller doses of its Wegovy pill in a new late-stage study designed to identify the lowest dose that still supports weight loss, according to a listing on a US clinical trials database.

The study, known as OASIS-5, began on 12 August and is scheduled to run until 2028. It will examine lower strengths of the daily maintenance dose – the dose used to sustain weight loss once it has been achieved, rather than the escalating doses used at the start of treatment. At present, the approved long-term dose of the Wegovy pill is 25 milligrams.

“Having a broader range of maintenance doses could provide greater flexibility in treatment and optimising the patient experience,” Novo said in an emailed statement to Reuters.

Novo has not specified which new dose strengths are being tested. The Wegovy pill is also approved in doses of 1.5 mg, 4 mg and 9 mg.

What OASIS-5 will measure

The 60-week trial will recruit 450 adult participants who have previously struggled to lose weight, with a Body Mass Index of 30 or above, or 27 in combination with a weight-related health issue.

The primary objective is to establish whether lower doses of oral semaglutide – the active ingredient in Wegovy – produce greater weight loss than placebo over the 60-week period. Secondary objectives include changes in waist circumference, other health benefits and the side effect profile at these reduced strengths.

The study will exclude people living with diabetes, those who have experienced recent major weight changes, and anyone currently being treated with GLP-1 medications.

Seeking health benefits beyond weight loss

The trial arrives against a backdrop of dosing behaviour that is already happening outside clinical protocols. Some people taking GLP-1 medicines, including Wegovy and Lilly’s Zepbound injections, are microdosing or otherwise taking lower-than-approved doses. The practice has become popular largely because of the high cost of the medicines and the side effects associated with them.

“People are using low dosages of these products… they just decide on their own,” Novo CEO Mike Doustdar told Reuters in an interview last week, noting that patients often seek health benefits beyond weight loss.

That observation points to a broader question facing prescribers: what people hope to gain from GLP-1 therapy is not always confined to the number on the scales. Understanding the pharmacology behind dose escalation and maintenance, and being able to discuss the trade-offs between efficacy, tolerability and cost, is increasingly central to safe prescribing. It is a theme covered directly in the College of Contemporary Health’s CPD short course GLP-1RAs in Practice: Prescribing, which examines dose titration, monitoring and shared decision-making in day-to-day clinical settings.

Competitive pressure in a growing market

Novo is under pressure after losing ground to US rival Eli Lilly in an obesity drug market projected to exceed $100 billion by 2030. Investors are watching the Wegovy pill closely; it generated second-quarter sales of 3.22 billion Danish kroner ($499.89 million).

Doustdar expects market segmentation to prevent a winner-take-all contest with Lilly – a view consistent with a future in which different doses, formulations and treatment goals serve different groups of people rather than a single product dominating.

Lilly did not immediately respond to a Reuters request for comment on whether it plans to test smaller doses of its oral drug Foundayo, which has lowest approved doses of 0.8 mg and 2.5 mg.

What this could mean for practice

If OASIS-5 demonstrates that lower maintenance doses deliver meaningful weight loss, it would give clinicians a wider set of options for people who cannot tolerate higher strengths, who are managing the cost of long-term therapy, or who have reached a weight they wish to maintain rather than continue reducing. It would also bring an existing real-world practice within the evidence base, replacing self-directed dose reduction with an approved, monitored alternative.

Results are not expected until 2028, so any change to prescribing practice remains some way off. In the meantime, conversations about dosing, expectations and adherence will continue to sit with the healthcare professionals supporting people through treatment.

CCH insight

Dose selection, titration and tolerability are among the most common practical challenges in GLP-1 prescribing. The College of Contemporary Health’s CPD short course GLP-1RAs in Practice: Prescribing covers dose escalation and maintenance, managing side effects, patient selection and monitoring – equipping healthcare professionals to make confident, evidence-based decisions as the treatment landscape evolves. 

Explore GLP-1RAs in Practice: Prescribing →

Source: Reuters

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Stanford Scientists Use AI to Discover a “Natural Ozempic” Free of the Usual Side Effects

Key Takeaways: 

• Stanford Medicine researchers used a purpose-built AI algorithm to identify BRP, a 12-amino-acid peptide that reduced food intake in mice and minipigs.
  
• BRP appears to act specifically in the hypothalamus, and in animal testing did not produce the nausea, constipation or major muscle loss linked to semaglutide.
  
• The findings remain preclinical, with receptor identification and peptide durability still to be resolved before human trials can begin.
  
  
  

A naturally occurring molecule with semaglutide-like effects

Researchers at Stanford Medicine have identified a naturally occurring molecule that may suppress appetite and reduce body weight in a manner resembling semaglutide, the active ingredient in Ozempic. In animal studies, the molecule also appeared to sidestep several of the problems associated with the drug, including nausea, constipation and substantial muscle loss.

The molecule, known as BRP, works through a different but related metabolic pathway and activates a separate group of neurons in the brain. That distinction could make it a more precise tool for controlling appetite and body weight.

Why a hypothalamus-focused signal matters

The appeal of BRP lies in where it appears to act. Semaglutide’s receptor targets are distributed widely across the body, which helps explain the breadth of its effects – and the breadth of its unwanted ones.

“The receptors targeted by semaglutide are found in the brain but also in the gut, pancreas and other tissues,” said assistant professor of pathology Katrin Svensson, PhD. “That’s why Ozempic has widespread effects including slowing the movement of food through the digestive tract and lowering blood sugar levels. In contrast, BRP appears to act specifically in the hypothalamus, which controls appetite and metabolism.”

The hypothalamus is a small region deep within the brain that helps regulate hunger, body temperature, hormone activity and energy use. Because BRP appears to act mainly in this area, it may influence appetite without producing as many effects elsewhere in the body.

Svensson has co-founded a company that plans to begin clinical trials of the molecule in humans in the near future.

Svensson is the senior author of the research, which was published on 5 March in Nature. Senior research scientist Laetitia Coassolo, PhD, is the lead author of the study.

Hunting for hidden peptides with artificial intelligence

The discovery depended heavily on artificial intelligence, which allowed the researchers to search through proteins belonging to a group known as prohormones.

Prohormones are inactive precursor molecules. They do not perform their final biological function until enzymes cut them into smaller fragments called peptides. Some of these peptides then act as hormones, carrying signals that influence metabolism, appetite and other complex processes in the brain and throughout the body.

A single prohormone can be cut in several different ways, producing many possible peptides. Finding the biologically important ones is difficult, because genuine peptide hormones are relatively rare and can be buried among large numbers of ordinary fragments created during normal protein processing and breakdown.

Traditional laboratory methods can isolate and identify peptides, but the process can generate enormous quantities of data. Researchers may need to sort through hundreds of thousands of molecules to find the few that have meaningful effects.

Narrowing the search to prohormone convertase 1/3

The team concentrated on an enzyme called prohormone convertase 1/3. This enzyme cuts prohormones at specific amino acid sequences and has previously been linked to obesity in humans.

One of the peptides produced through this process is glucagon-like peptide 1, or GLP-1. GLP-1 helps regulate hunger and blood sugar, and semaglutide works by copying its effects in the body.

The researchers reasoned that the same enzyme might produce other peptides that influence energy balance and appetite. To find them, they turned to artificial intelligence.

Peptide Predictor: from 20,000 genes to 373 prohormones

Rather than manually extracting proteins and peptides from tissues and then using methods such as mass spectrometry to identify huge numbers of molecules, the researchers created a computer algorithm called Peptide Predictor.

The program searched all 20,000 human protein-coding genes for the types of sites where prohormone convertases typically cut proteins. The researchers then narrowed the search to genes that produce proteins secreted outside the cell – a common feature of hormones – and that contained at least four possible cleavage sites.

That process reduced the field to 373 prohormones, giving the team a far more manageable group to investigate.

“The algorithm was absolutely key to our findings,” Svensson said.

Peptide Predictor estimated that prohormone convertase 1/3 could produce 2,683 distinct peptides from those 373 proteins. Coassolo and Svensson then focused on the sequences that seemed most likely to affect the brain.

They selected 100 peptides, including GLP-1, and tested whether they could stimulate neuron-like cells grown in the laboratory.

A 12-amino-acid peptide with an outsized effect

As expected, GLP-1 strongly activated the neuronal cells, increasing their activity to three times the level seen in untreated control cells.

One much smaller peptide produced an even more dramatic response. Made from only 12 amino acids, it increased neuronal activity tenfold compared with controls.

The researchers named the peptide BRP after its parent prohormone, BPM/retinoic acid inducible neural specific 2, or BRINP2 (BRINP2-related-peptide).

Amino acids are the basic building blocks of proteins and peptides. A molecule containing only 12 of them is extremely small compared with most full-sized proteins, yet BRP produced the strongest response in the initial cell tests.

Food intake fell by up to 50 per cent

The researchers next tested BRP in lean mice and in minipigs, which more closely mirror human metabolism and eating patterns than mice do.

An intramuscular injection given before feeding reduced food intake during the following hour by as much as 50 per cent in both species.

The team also gave daily BRP injections to mice with obesity for 14 days. On average, the treated animals lost 3 grams, with nearly all of the reduction coming from body fat. Animals in the control group gained about 3 grams over the same period.

The treated animals also showed improved glucose and insulin tolerance. These measures reflect how effectively the body regulates blood sugar and responds to insulin, the hormone that helps move glucose from the bloodstream into cells.

Because incretin-based therapies are now a routine part of weight management for many people living with obesity, clinicians looking to keep pace with the underlying pharmacology and with structured patient support pathways increasingly turn to focused CPD such as the College of Contemporary Health’s GLP-1RA Complete Programme.

No clear signs of the usual side effects

Behavioural testing found no meaningful differences between treated and untreated animals in movement, water consumption, anxiety-like behaviour or faecal output.

The absence of changes in faecal output was especially notable, because semaglutide can slow digestion and cause constipation. The researchers also did not observe the nausea-related responses or major muscle loss associated with some existing weight loss treatments.

Additional measurements of brain activity and body function showed that BRP acts through metabolic and neuronal pathways that differ from those activated by GLP-1 or semaglutide.

Those findings suggest that BRP may reduce appetite through a more focused biological route, although the results remain limited to animals.

What still needs answering before human testing

The researchers are now working to identify the cell-surface receptors that attach to BRP. Receptors are molecular structures that receive signals from hormones, drugs and other chemical messengers. Determining which receptor BRP uses will help scientists understand exactly how the peptide changes appetite and metabolism.

The team also wants to map the full sequence of events that occurs after BRP binds to its target.

Another challenge is duration. Small peptides are often broken down quickly in the body, which can shorten their effects. The researchers are investigating ways to make BRP last longer so that, if it eventually works in people, it could be administered on a more practical schedule.

“The lack of effective drugs to treat obesity in humans has been a problem for decades,” Svensson said. “Nothing we’ve tested before has compared to semaglutide’s ability to decrease appetite and body weight. We are very eager to learn if it is safe and effective in humans.”

CCH insight

Discoveries like BRP sit at the frontier of a field that is already reshaping day-to-day practice. For healthcare professionals supporting people living with obesity, a working command of GLP-1 receptor agonist pharmacology, patient selection, side-effect management and long-term follow-up is now core knowledge rather than a specialism.

The College of Contemporary Health’s GLP-1RA Complete Programme brings this together across three courses and a capstone, leading to an Advanced Certificate, with seven CPD hours and seven downloadable clinical tools designed for use in practice.

Explore the GLP-1RA Complete Programme →

Source: Stanford Medicine

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Surgery Plus Medication Outperforms Surgery Alone in Young People

Key Takeaways: 

• Young people who restarted obesity medication a median of one month after sleeve gastrectomy lost more weight at 12 months than those who had surgery alone.
  
• Improvements in eating behaviours, including hunger scores, were significantly greater in the early reinitiation group.
  
• Rates of postoperative complications, readmissions, emergency department visits and reoperations did not differ between the two groups.
  
  
  

Combining pharmacotherapy with surgery in adolescent obesity care

Restarting obesity medication, including glucagon-like peptide-1 (GLP-1) receptor agonists, shortly after sleeve gastrectomy is associated with greater weight loss at one year than surgery alone in adolescents, according to a research letter published online on 22 July in JAMA Surgery.

The finding speaks to a question that has become increasingly pressing as both metabolic and bariatric surgery and highly effective obesity pharmacotherapy have become available to younger patients: whether the two should be sequenced, or used together.

What the researchers set out to examine

Dr Alaina P. Vidmar, of Children’s Hospital Los Angeles, and colleagues evaluated the 12-month safety, weight trajectory and eating behaviour outcomes associated with early reinitiation of obesity medication following metabolic and bariatric surgery.

The analysis included 99 young people aged 7–20 who underwent sleeve gastrectomy between November 2023 and February 2026.

Half the cohort restarted medication within a month of surgery

Of the 99 young people in the cohort, 53 reinitiated obesity medication, with a median time to reinitiation of 1.0 month.

Among those who restarted treatment, most resumed the same class of medication they had been prescribed before surgery. Postoperative regimens were nonetheless generally consolidated, with fewer young people requiring multiagent therapy after their operation than before it.

Weight trajectories diverged after the six-month mark

Through the first six months, the two groups experienced similar early postoperative weight loss.

The picture changed by the end of the first year. The early reinitiation group achieved a greater mean reduction in body mass index (BMI) percentage at 12 months than the group who had surgery alone, at −29.3% versus −25.5%. The same pattern held for excess BMI loss percentage, at −53.6% versus −45.7%.

Eating behaviours improved more with combined treatment

Improvements in eating behaviours were significantly greater in the early reinitiation group at 12 months than in the surgery-only group. Median hunger scores on the Adult Eating Behaviour Questionnaire, for example, fell by 3.5 points in the early reinitiation group, compared with a rise of 0.2 points among those treated with surgery alone.

This behavioural dimension is a reminder that appetite regulation after surgery is not a fixed quantity, and that the interaction between pharmacological and surgical mechanisms is an area where prescribing clinicians increasingly need structured, up-to-date grounding. The College of Contemporary Health addresses precisely this territory in its GLP-1RA Complete Programme, which covers the pharmacology, patient selection, monitoring and behavioural support that underpin safe long-term use of these agents.

Safety outcomes were comparable between the groups

There was no difference between the groups in postoperative complications, including biliary events requiring cholecystectomy, readmissions, emergency department visits and reoperations.

A lifespan view of severe obesity

The authors frame the results as support for treating severe obesity in young people as a chronic condition requiring more than one modality.

“Bariatric surgery is the most durable and effective treatment for severe obesity, but for youth with severe disease, we need a multimodal approach, which means combining medication and surgery over the lifespan,” Vidmar said in a statement.

CCH insight

For clinicians supporting young people through and beyond metabolic and bariatric surgery, findings like these shift the practical question from whether to prescribe to when, what and for how long. Confidence with GLP-1 receptor agonists, and with the behavioural and monitoring work that surrounds them, is becoming a core competency rather than a specialist interest.

The College of Contemporary Health’s GLP-1RA Complete Programme is designed for healthcare professionals who want that grounding: mechanisms of action and the wider incretin landscape, patient selection and contraindications, dose escalation and adverse effect management, and the behaviour change support that helps people sustain outcomes over time. It is CPD-accredited and studied entirely online, so it fits around clinical commitments.

Explore the GLP-1RA Complete Programme →

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Weight Bias at Work: What New GLP-1 Research Reveals About Women’s Employment Prospects

Key Takeaways: 

• Women who were unemployed when they started GLP-1 medications saw their employment rate rise by nearly 27 percentage points over 18 months, according to a 2026 NBER working paper.
  
• The gains appeared only among women entering the workforce – those already employed saw no rise in pay or promotion, pointing to perception rather than capability.
  
• The findings echo long-standing evidence on the financial cost of weight bias, from documented pay gaps to hiring professionals’ judgements based on photographs alone.
  
  
  

A new way to measure an old problem

For years, economists have documented what they call the “obesity penalty” – the social and financial disadvantages people can face because of their weight. It has been a difficult phenomenon to measure cleanly, because the factors that shape someone’s body weight also tend to shape their income, health and opportunities.

The rapid uptake of GLP-1 medications has given researchers something closer to a natural experiment. When large numbers of people begin treatment within a short window, and others who want the same treatment have not yet been able to start, it becomes possible to compare two otherwise similar groups and observe what changes.

That is the approach taken in a 2026 working paper published by the National Bureau of Economic Research, in which Harvard economist Rebecca Diamond examined what happened to women’s employment after they began taking GLP-1 medications.

What the researchers did

Diamond looked at survey data from around 15,000 people. She compared women who had started taking GLP-1 medications with similar women who wanted to take them but had not yet started. The two groups were matched on factors including income, race, body mass index and overall health, so that the comparison was not simply between people in very different circumstances to begin with.

The design matters. Because the comparison group consisted of women who also wanted the medications, the study is less vulnerable to the criticism that people who seek treatment are systematically different in motivation from those who do not.

The result that stands out

Among women who were unemployed at the point they began treatment, the employment rate rose by nearly 27 percentage points over the following 18 months, compared with the matched group who had not yet started.

To put that figure in context, it is a larger gap than the difference in employment between American women with a high school diploma and those holding a university degree. In other words, an 18-month change in body weight was associated with a bigger shift in employment than several years of formal education.

The research does not suggest that losing weight made these women more intelligent, more capable or better qualified for work. Nothing about their skills, experience or credentials changed. What the study raises is a different and more uncomfortable question: whether a change in appearance alters how women are perceived by employers.

Changes beyond the workplace

The effects were not confined to employment. The study also found that single women taking GLP-1 medications were nearly 29 percentage points more likely to get married or move in with a partner than similar women who had not started treatment.

Taken together, the employment and partnership findings describe something broader than a labour market effect. They describe a shift in social response.

The financial cost of weight bias

GLP-1 medications have moved quickly into the mainstream. In 2026, 11% of US adults said they were currently taking one to lose weight, up from just 3% in 2024, according to Gallup.

But the question of how weight shapes women’s working lives long predates the current wave of prescribing. Research was already pointing in this direction well before GLP-1 medications entered the cultural conversation.

What hiring professionals saw

A report from Fairygodboss, an employer review site for women, offered a particularly troubling look at how appearance can shape hiring decisions. In one study, hiring professionals were shown images of women with different body types and asked to evaluate them.

The woman pictured at the highest body weight was judged far more harshly than the others. Twenty percent of respondents described her as “lazy”, a label applied less frequently to every other woman pictured. Just 18% said she appeared to have leadership potential, while 21% described her as “unprofessional”.

These are judgements made on the basis of a photograph alone, with no information about experience, qualifications or performance.

Earnings gaps documented long before GLP-1 medications arrived

The pay data tells a similar story. In 2011, the Federal Reserve Bank of St Louis cited research finding that white women living with overweight earned about 4.5% less than white women whose BMI fell within what researchers classified as the normal range. White women living with obesity earned nearly 12% less.

Two caveats are important here. Those figures were specific to white women and do not apply to everyone. They also say nothing about anyone’s value, ability or contribution. What they suggest is that weight-related bias was already showing up in some women’s pay long before GLP-1 medications became widely available.

When appearance pays

The argument that appearance carries an economic premium is not new, and it is sometimes made bluntly. Codie Sanchez, CEO and founder of Contrarian Thinking, has said that women who wear makeup to work earn about 30% more on average than women who do not.

“Pretty privilege is very real,” she said on an episode of The Burnouts Podcast. “And you can either say ‘That’s not fair, so I’m not doing it.’ or you can win.”

Sanchez acknowledged that the advantage is unfair, but argued that women should use it rather than ignore it. “If it’s going to make me more money to paint my face, clown me up,” she said.

Diamond’s findings suggest weight bias may operate along similar lines. The women who benefited most were those seeking to enter the workforce, where first impressions carry disproportionate weight and where an employer’s judgement is formed quickly and on limited information. For women already in a job, whose managers had direct evidence of their performance, the effect disappeared.

Why this matters in clinical practice

For healthcare professionals, findings like these complicate the consultation room. People starting GLP-1 medications may be motivated by clinical goals, social goals, economic goals, or some mixture of all three, and those motivations shape expectations, adherence and how someone responds if treatment is paused or stopped.

Understanding the pharmacology well enough to have that conversation credibly is increasingly part of everyday practice rather than a specialist concern. Building that grounding is the focus of professional training such as the College of Contemporary Health’s GLP-1RAs in Focus – Why Drugs Like Ozempic Work, a CPD-accredited online short course covering GLP-1 physiology and pharmacology for prescribers and non-prescribers alike.

An uncomfortable conclusion

Losing weight does not make a person more intelligent, more capable, harder working or better qualified for a job. But it may change how other people perceive them.

That is precisely what makes Diamond’s findings difficult to sit with. If some women gain access to more opportunities after losing weight while their underlying abilities remain exactly the same, then the economic benefit is not really a benefit at all. It is a measure of how heavily appearance still shapes the way women are perceived and treated – and of how much value has been withheld from them beforehand.

The medication changed the response. It did not change the woman.

CCH insight 

Findings like these are a reminder that GLP-1 medications carry social and economic weight as well as clinical effect – and that patients arrive at the consultation with motivations shaped by far more than a treatment target. CCH’s GLP-1RAs in Focus – Why Drugs Like Ozempic Work CPD short course (2 CPD hours, fully online, CPD-accredited) builds the foundation in GLP-1 physiology and pharmacology that healthcare professionals need to explain the science clearly, set realistic expectations and contribute confidently to treatment discussions, whether or not they prescribe. 

Explore GLP-1RAs in Focus →

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Sensing, Liking and Wanting: Why Food Feels Different on GLP-1RAs

Key Takeaways: 

• A Frontiers in Nutrition review finds that altered eating experience on GLP-1 receptor agonists (GLP-1RAs) reflects changes in food reward rather than impaired taste function.
  
• The authors separate three processes: sensing food, liking it, and wanting it.
  
• The evidence is heterogeneous and largely observational, so the framework is a conceptual model, not proof of causality.
  
  
  

Why reports of “taste changes” may not be about taste at all

Some people taking GLP-1RAs report that their favourite foods become less enjoyable or tempting, without this necessarily reflecting impaired basic taste function. That distinction sits at the centre of a recent review published in the journal Frontiers in Nutrition, in which the authors conducted a structured narrative review of current evidence on how glucagon-like peptide-1 receptor agonists influence sensory perception, food enjoyment and food motivation, using a sensory-liking-wanting framework.

Obesity is a chronic, progressive metabolic disease with growing global prevalence, which increases the demand for effective long-term treatment options. GLP-1RAs are widely used in obesity treatment because they enhance satiety, delay gastric emptying, reduce energy intake and support meaningful weight loss. Alongside those effects, some people also report that food tastes different, feels less enjoyable, or no longer seems tempting. These experiences are often described as “taste changes”, but the review argues that they may reflect several biological processes rather than a single taste disorder. Further research is needed to understand these mechanisms and to improve nutritional care during treatment.

Looking beyond appetite suppression

GLP-1RAs have changed the way obesity is managed by reducing energy intake and supporting meaningful weight loss. Growing clinical experience, however, shows that their effects extend beyond a simple reduction in hunger.

Some people describe food tasting different, reduced pleasure in eating, or lower cravings for high-calorie foods. The review suggests that these experiences should not be treated as simple taste disturbances, but as a combination of three components related to eating behaviour: sensory perception, liking and wanting.

The three components of eating behaviour

Eating begins with sensory perception, which includes detecting taste, smell and food texture. This stage determines how food is initially recognised.

The second component is liking, defined as the subjective pleasure or hedonic value associated with eating. It is influenced by flavour, prior experience, context, cognitive factors and physiological state.

The third component, wanting, describes the motivation or craving to seek out and consume food. Separating these components helps explain why reports of “taste changes” may in fact reflect different biological processes.

How GLP-1RAs may influence food reward and the eating experience

The review sets out how GLP-1RAs may influence eating behaviour through interconnected biological pathways rather than by directly changing taste. Preclinical studies indicate that endogenous glucagon-like peptide-1 (GLP-1) is produced by some mammalian taste bud cells and may modulate taste signalling. Those findings do not establish that GLP-1RA treatment directly alters taste in humans, and the limited human studies available have produced inconsistent results.

Taste signals are integrated in the nucleus of the solitary tract (NTS) before reaching brain regions involved in appetite and reward. Human studies have associated GLP-1RA treatment with reduced craving and weaker neural responses to calorie-dense food cues in some participants. Those findings are more consistent with altered food valuation and motivation than with impaired basic taste.

Gastrointestinal effects, including nausea and early satiety, may also reduce the pleasure of eating, which makes it difficult to distinguish altered food reward from genuine changes in taste perception.

What the clinical evidence does and does not show

Randomised controlled trials usually focus on body weight and metabolic outcomes. Eating-related experiences are rarely included as prespecified measures and are more often captured sporadically as adverse events.

Patient-reported outcome questionnaires may provide a more sensitive window into changes in food enjoyment and preference, but assessment methods vary considerably between studies. Real-world evidence presents additional challenges, as reports of “taste alterations” may encompass several distinct sensations, including olfactory changes, dry mouth, gastrointestinal discomfort and other symptoms that are difficult to distinguish clinically.

Spontaneous reporting databases can identify safety signals but cannot establish incidence or risk. Cohort studies, by contrast, provide better-defined populations and follow-up, yet remain vulnerable to subjective reporting and confounding.

Because this was a narrative review rather than a systematic review or meta-analysis, the authors did not conduct a formal risk-of-bias assessment.

A framework for understanding what people report

According to the review, alterations in the eating experience during GLP-1RA treatment should not be regarded solely as a biological phenomenon, but understood as the interaction between different processes.

Peripheral taste pathways, brainstem integration, central reward networks, interoceptive state and learned behaviour may all contribute. Their relative importance may differ between individuals and across treatment stages. A person’s report of a “taste change” may therefore not correspond to a clinically defined gustatory disorder.

The authors also note that alternative explanations should be considered when interpreting eating-related changes, including nausea, delayed gastric emptying, altered satiety, behavioural adaptation and medication adherence.

The framework additionally accommodates limited treatment response, persistent appetite, weight regain after treatment withdrawal or interruption, and rare atypical or paradoxical responses.

Clinical relevance and a possible stage-dependent pattern

The review highlights that reported changes in eating experience should not automatically be classified as taste abnormalities. Healthcare professionals may find it useful to establish whether a person is describing altered taste perception, reduced satisfaction from eating, or diminished interest in food, as these experiences can reflect distinct processes. Distinguishing between them well depends on the quality of the conversation in the consultation, and supporting people through the eating-related changes that accompany GLP-1RA treatment is the focus of professional training such as the College of Contemporary Health’s GLP-1RAs in Practice: Supporting Patients During Treatment, a CPD-accredited online short course.

The authors present these points as translational implications rather than formal clinical recommendations. They also propose a stage-dependent pattern in which these experiences may change over time.

Early in treatment, gastrointestinal discomfort and enhanced satiety may reduce the appeal of food, whereas later stages may involve a more persistent reduction in motivation towards highly rewarding foods in some individuals.

Why this matters for nutrition and obesity management

The proposed sensory-liking-wanting framework has practical implications for obesity treatment and nutritional counselling. Understanding whether someone is experiencing altered sensory perception, reduced enjoyment of food, or lower motivation towards food may support more individualised dietary guidance and improve communication between people receiving treatment and the professionals caring for them.

The review also highlights that the existing body of evidence is heterogeneous, owing to differences in endpoint definitions, measurement methods, populations, drugs, doses and follow-up periods. Much of the human evidence is observational, secondary or exploratory, and many studies were not designed to separate sensory function from liking and wanting. Current findings are therefore better interpreted as a conceptual framework for organising available evidence than as proof of a single causal pathway.

Future studies using standardised, multimodal assessments and longer follow-up may help clarify how these eating-related changes influence food preferences, dietary behaviour, long-term weight management and treatment adherence.

Conclusion

The review concludes that altered eating experiences during GLP-1RA therapy are more consistent with changes in food reward, hedonic evaluation and motivational drive than with a uniform impairment of taste function, although modulation of peripheral taste pathways may contribute in some cases.

Current evidence supports interpreting reported “taste changes” within a sensory-liking-wanting framework that distinguishes sensory perception from food enjoyment and craving. Because responses vary between individuals and the available evidence remains heterogeneous, the proposed framework should be considered a conceptual model rather than definitive proof of causality.

Longitudinal, multimodal human studies measuring sensory function, hedonic response, motivational drive and state-related symptoms in parallel are needed to clarify these effects and their implications for nutrition, dietary behaviour, treatment adherence and long-term obesity management.

CCH insight: 

When someone says food no longer tastes right on a GLP-1RA, the clinically useful question is which part of eating has changed: the sensing, the liking or the wanting. Each points towards different advice, and each can shift as treatment progresses. CCH’s GLP-1RAs in Practice: Supporting Patients During Treatment CPD short course (2 CPD hours, fully online, CPD-accredited) equips healthcare professionals to have exactly those conversations – recognising what people are really describing, adapting dietary and nutritional support through the course of treatment, and monitoring for the changes that matter. 

Explore GLP-1RAs in Practice: Supporting Patients During Treatment →

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GLP-1 Therapies Linked to Lower Fragility Fracture Risk in Adults Living With Type 2 Diabetes

Key Takeaways:

• Adults aged 50 and over living with type 2 diabetes who started a GLP-1 receptor agonist had a 21% lower three-year risk of fragility fracture than those starting a DPP-4 inhibitor (HR 0.79).
  
• Reductions were strongest for vertebral (HR 0.68) and hip or femur fractures (HR 0.70), and appeared independent of changes in BMI and HbA1c – pointing to a possible direct skeletal effect.
  
• The findings do not extend to younger people using GLP-1 medications for weight management alone, or to those with osteoporosis; among adults without diabetes, fracture risk was higher (HR 1.13).
  
  
  

A large-scale look at bone health during GLP-1 treatment

Initiating a GLP-1 receptor agonist for type 2 diabetes was associated with a lower risk of fragility fractures in adults aged 50 and over, including fractures of the hip and spine, according to a large target trial emulation study published in JAMA Network Open.

Over three years of follow-up, adults who newly started a GLP-1 medication had a 21% lower risk of fragility fracture than those who newly started a DPP-4 inhibitor (HR 0.79, 95% CI 0.76–0.83), reported Christopher Hamad, MD, of the University of California Los Angeles, and colleagues.

The authors were careful to frame the size of the effect in context rather than overstate it.

“Although the absolute risk reduction at 3 years was modest (0.79%), this magnitude is clinically relevant given a baseline 3-year major osteoporotic fracture risk of approximately 3% to 4% in comparable populations and the substantial morbidity and mortality associated with hip and vertebral fractures,” the authors wrote.

Why a modest absolute reduction still matters

The clinical weight of these numbers rests on how serious the events being prevented are. Hip fractures, for example, are associated with one-year mortality rates of up to 25% in women and up to 36% in men.

Given the potential for such severe outcomes, Hamad’s group emphasised that even modest absolute reductions in fragility fractures – which stem from low-energy trauma, such as a fall from standing height – can prevent a meaningful number of events at population level.

The findings build on several smaller observational studies in people living with diabetes that have similarly linked the use of GLP-1 medications such as semaglutide (Ozempic, Wegovy) to a reduced fracture risk. Hamad’s team noted that their analysis drew on the largest dataset assembled on this question to date.

Which fractures showed the strongest signal

The protective association was most pronounced at precisely the sites that carry the highest morbidity and mortality:

• Vertebral fractures: HR 0.68, 95% CI 0.63–0.73
  
• Hip or femur fractures: HR 0.70, 95% CI 0.63–0.79
  
• Rib fractures: HR 0.83, 95% CI 0.77–0.91
  

No significant associations were identified for fractures of the distal radius or ulna, or of the proximal humerus.

Weight loss, glycaemic control and the question of a direct skeletal effect

One of the more striking elements of the analysis concerns the mechanism. Mediation analyses indicated that the associations were independent of changes in BMI and HbA1c, a pattern consistent with a potential direct skeletal effect of GLP-1 medications.

That matters because weight loss itself is associated with reduced bone mineral density and a higher fracture risk – a relationship reflected in the study’s own data, which found that cumulative BMI loss was tied to a 2% increase in fracture risk. In other words, the expected consequence of the weight reduction these medications produce would be a rise in fracture risk, not a fall.

“Yet, GLP-1 RA [receptor agonist] use was associated with lower fracture risk despite these changes, suggesting that potential direct skeletal effects may outweigh the adverse consequences of weight loss,” the authors wrote.

Reassessing the assumption of neutral skeletal effects

Current American Diabetes Association Standards of Care classify GLP-1 medications as having neutral effects on the skeleton. The researchers argued that their results suggest this assumption warrants reevaluation.

They also acknowledged the limits of what an observational design can establish, noting that the findings could still reflect unmeasured factors such as improved balance or greater physical activity among people taking these medications. Making sense of evidence like this – and of the mechanistic arguments used to interpret it – is the focus of professional training such as the College of Contemporary Health’s GLP-1RAs in Focus, a CPD-accredited online short course that grounds healthcare professionals in how these medications act on the body.

How the study was conducted

For this comparative effectiveness study, the researchers drew data from the TriNetX Research Network, analysing 66,803 matched pairs, or 133,606 people in total, aged between 50 and 90 years.

Mean age was approximately 63 years, roughly 53% of participants were male, 58% were White, and average baseline BMI was around 33.

All participants were living with type 2 diabetes and had newly initiated either a GLP-1 receptor agonist or a DPP-4 inhibitor between 2015 and 2022. Dulaglutide (Trulicity), semaglutide and liraglutide (Victoza) together accounted for 91% of index prescriptions in the GLP-1 group. Exclusion criteria included fractures resulting from high-energy trauma, as well as osteoporosis and osteopenia.

Where the protective association held – and where it did not

In subgroup analyses, the lower fracture risk was consistent across age groups, across sexes and across levels of frailty.

A separate matched cohort, however, evaluated participants according to diabetes status and produced a notably different picture. Among adults living with type 2 diabetes, GLP-1 use retained a protective association (three-year HR 0.91, 95% CI 0.88–0.95). Among adults without diabetes, it was associated with an increased fracture risk (HR 1.13, 95% CI 1.04–1.23, P<0.001 for interaction).

Consequently, the authors emphasised that the findings cannot be generalised to younger people using GLP-1 medications solely for weight management, nor to those with known osteoporosis or a previous fragility fracture, who were excluded from the study altogether.

What this means for practice

Overall, “the findings do not argue against GLP-1 RA use on the basis of fracture risk, though bone health monitoring remains prudent,” according to the researchers.

They called for prospective randomised trials to evaluate the associations observed, including among people with osteopenia or early osteoporosis, alongside preclinical work to understand the potential mechanisms involved.

CCH insight 

For healthcare professionals, this study is a useful reminder that the skeletal consequences of GLP-1 treatment are not yet settled science – and that the answer appears to differ depending on who is being treated and why. Interpreting findings of this kind with confidence depends on a firm grasp of how these medications act in the first place, from gut hormones and appetite regulation through to their wider effects beyond glycaemic control. That is exactly what CCH’s GLP-1RAs in Focus – Why Drugs Like Ozempic Work CPD short course (2 CPD hours, fully online, CPD-accredited) is built to provide, giving clinicians a clear grounding in the mechanisms behind these therapies and the ability to appraise emerging evidence critically, whether or not they prescribe.

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Ozempic and Mounjaro Linked to Modest Rise in Hair Loss Risk, BMJ Study Finds

Key Takeaways: 

• Adults living with type 2 diabetes taking GLP-1 receptor agonists developed alopecia more often than those taking SGLT-2 inhibitors (37% higher risk) or DPP-4 inhibitors (68% higher risk), a BMJ study reports.
  
• Absolute risk stayed low, at 6.91 cases per 1,000 person years for GLP-1 receptor agonists against 5.04 for SGLT-2 inhibitors and 3.89 for DPP-4 inhibitors.
  
• The association was confined to non-scarring alopecia, where the follicle stays intact and regrowth remains possible.
  
  
  

A modest signal, but one worth discussing in the consultation

Medications from the GLP-1 receptor agonist class, now widely used in the management of type 2 diabetes and obesity, may be associated with a modest increase in hair loss. The finding comes from a study published by The BMJ on 22 July 2026.

The class includes semaglutide, marketed under brand names such as Ozempic and Wegovy, and tirzepatide, marketed as Mounjaro and Zepbound. Researchers found that adults living with type 2 diabetes who were treated with GLP-1 receptor agonists went on to develop alopecia more frequently than people prescribed two other commonly used classes of diabetes medication.

Although the relative increase was significant, the researchers emphasised that the absolute risk of hair loss remained low. Even so, awareness of the possible adverse effect could help people and their clinicians reach better informed treatment decisions together.

Reports of hair loss with semaglutide and tirzepatide

Hair loss has been reported before as a possible adverse effect of GLP-1 receptor agonists, particularly with medications containing semaglutide or tirzepatide. What has been missing is research that directly compares the risk among people taking these medicines with the risk among people taking alternative diabetes treatments.

To address that gap, the research team analysed electronic health records from the University of Pennsylvania Health System (Penn Medicine). They compared rates of alopecia among adults living with type 2 diabetes who began treatment with GLP-1 receptor agonists, SGLT-2 inhibitors or DPP-4 inhibitors.

The analysis covered people treated between January 2019 and September 2024. One comparison included 12,004 people taking GLP-1 receptor agonists and 15,221 taking SGLT-2 inhibitors. A second, separate comparison included 11,964 people taking GLP-1 receptor agonists and 11,233 taking DPP-4 inhibitors.

Accounting for differences between the treatment groups

The groups differed in several important respects before the researchers adjusted their results.

Compared with people taking SGLT-2 inhibitors, those taking GLP-1 receptor agonists were younger (mean age 58 v 65), had a higher body mass index (36.2 v 32.3), and had lower rates of cardiovascular disease and chronic kidney disease.

A similar pattern was seen in the comparison with DPP-4 inhibitors. People taking GLP-1 receptor agonists were again younger (mean age 58 v 67) and had a higher body mass index (36.2 v 31.3).

To limit the influence of these imbalances, the researchers adjusted for factors that might otherwise have shaped the findings, including age, sex, ethnicity, pre-existing conditions, use of other medications, and body mass index.

Higher rates of alopecia after adjustment

Once those adjustments were made, use of a GLP-1 receptor agonist was associated with a 37% higher risk of alopecia than use of an SGLT-2 inhibitor (6.91 v 5.04 per 1,000 person years).

The difference was larger in the second comparison. Risk was 68% higher among people taking GLP-1 receptor agonists than among those taking DPP-4 inhibitors (6.53 v 3.89 per 1,000 person years).

Further analysis indicated that the association was limited to non-scarring alopecia, the form in which hair follicles remain intact and the potential for regrowth is preserved. For this type of hair loss, risk was 53% higher among people taking GLP-1 receptor agonists than among those taking SGLT-2 inhibitors, and 72% higher than among those taking DPP-4 inhibitors.

Why rapid weight loss might disturb the hair cycle

The study did not establish why GLP-1 medications might be connected to hair loss, but the authors set out several plausible explanations.

Rapid weight loss is a well established cause of increased hair shedding. It may also contribute to iron or zinc deficiency, either of which can interfere with the normal hair growth cycle. Hormonal changes related to weight loss or to treatment itself could play a part as well, although further research will be needed to identify the mechanisms at work.

Important questions that remain open

The researchers acknowledged a number of limitations. The available clinical records did not contain enough detail to determine the severity, extent or duration of the alopecia. Nor could the team assess whether hair grew back after people stopped taking the medication.

Because the study was observational, it cannot demonstrate that GLP-1 medications directly caused the hair loss. Other factors that were not measured may have influenced the results.

Set against that, the authors described their work as rigorous, drawing on high quality data from a large and representative group of patients. The findings also held up across additional analyses, which supports their reliability.

What the findings mean for practice

For clinicians, the practical value of a study like this lies less in the headline percentages than in what it adds to the conversation before and during treatment. Anticipating adverse effects, recognising them early and folding them into shared decision-making are core parts of the GLP-1 consultation – the ground covered by CPD courses such as the College of Contemporary Health’s GLP-1RAs in Practice: How to Safely Prescribe Ozempic, Wegovy & Mounjaro, which works through initiation, titration and the avoidance of adverse reactions.

The researchers concluded: “Our findings extend previous anecdotal safety signals and provide more systematic evidence to inform clinical awareness of this potential adverse effect.”

CCH insight

This may seem like an odd perspective, but this could be a good thing if it means that people considering taking GLP-1 medications for vanity reasons (to slim down to their perfect weight when they do not have obesity or type 2 diabetes) are put off, leaving better availability for those who genuinely need it. I am sure that for most people living with obesity or diabetes, a small increased risk of alopecia is worth taking when balanced against the huge health benefits that these drugs usually bring.

Hair loss is unlikely to change prescribing decisions on its own, but it is exactly the kind of adverse effect that patients notice, worry about and sometimes stop treatment over. Knowing how to raise it, put the absolute risk in context and respond if it appears is part of delivering GLP-1 therapy well. CCH’s GLP-1RAs in Practice: How to Safely Prescribe Ozempic, Wegovy & Mounjaro (Or Any Other Weight Loss Drug) is a two-hour, CPD-accredited online course covering every stage of the consultation, from patient selection and titration through to managing adverse reactions, grounded in current NICE guidance and the ADA 2026 Standards of Care.

Find out more about GLP-1RAs in Practice →

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Study Identifies Which Patients With Obesity Respond Best to GLP-1-Based Treatment

Key Takeaways: 

• A Mayo Clinic study has identified a distinct biological subtype of obesity – a form of the “hungry gut” phenotype – that responds especially well to tirzepatide.
  
• People in this subgroup lost an average of 21.5% of their body weight after six months on tirzepatide, roughly double the 11.7% seen in other subtypes.
  
• The lower appetite-hormone levels traced back to reduced hormone production in the intestine rather than differences in the gut microbiome.
  
  
  

A step towards precision medicine for obesity

Why do some people lose a substantial amount of weight on GLP-1-based medications while others see far more modest results? A new Mayo Clinic study offers a potential answer, identifying a distinct biological subtype of obesity that responds especially well to tirzepatide – a medication that mimics two naturally occurring hormones involved in appetite and blood sugar regulation. The finding moves the field a step closer to precision medicine for obesity, where treatment is matched to an individual’s underlying biology rather than applied uniformly.

The research, published in the journal Gastroenterology, points to a future in which clinicians could predict, rather than simply hope, that a given therapy will work for a given person.

What the researchers found

The team studied 483 adults living with obesity and identified three distinct biological types of the disease. About one in four participants produced lower levels of GLP-1 and other hormones that help people feel full after eating.

This subgroup saw markedly better results on treatment. Patients in this group lost an average of 21.5% of their body weight after six months of tirzepatide, compared with 11.7% for patients in the other groups – losing nearly twice as much weight over the same period.

“Obesity is a complex disease driven by different biological mechanisms,” says senior author Andres Acosta, M.D., Ph.D., a gastroenterologist and the Delaney Family Director of the Nutrition Obesity Research Program at Mayo Clinic in Minnesota. “Our findings suggest we can begin identifying which patients are most likely to respond to specific therapies rather than treating obesity as a single disease.”

Understanding the “hungry gut” subtype

The subgroup that responded so strongly to tirzepatide shares a recognisable biological signature: people in this group produce lower levels of natural appetite-regulating hormones, experience faster stomach emptying and report greater hunger after meals.

Researchers describe this as a form of the “hungry gut” obesity phenotype, which is characterised by an abnormal duration of fullness. Rather than eating unusually large amounts at any one sitting, people with hungry-gut obesity may eat normal portion sizes but find themselves snacking more frequently, because the sense of fullness does not last as long as it should.

Because tirzepatide acts on the same appetite pathways that are underactive in this group, it appears especially well suited to addressing the biology that drives their eating patterns.

Why the underlying biology matters

The study also sheds light on why hormone levels differ in this subgroup. The researchers found that the reduced hormone levels were associated with decreased hormone production in the intestine itself, rather than with differences in the gut microbiome. That distinction offers new insight into the biology underlying this subtype and helps explain where the difference in treatment response originates.

Identifying the right therapy sooner could carry significant long-term benefits. Because obesity increases the risk of diabetes, heart disease, certain cancers and many other serious chronic conditions, matching people to the treatment most likely to help them – rather than relying on a one-size-fits-all approach – could improve long-term health outcomes.

What this means for clinical practice

The findings support growing efforts to personalise obesity treatment based on an individual’s biology. For clinicians, interpreting studies like this one increasingly depends on a firm grasp of how GLP-1-based medications act on appetite hormones and gastric emptying in the first place – the kind of grounding offered by CPD courses such as the College of Contemporary Health’s GLP-1RAs in Focus, which examines why some people respond more strongly to these treatments than others. Still, the authors are careful to note the limits of the current work. They caution that prospective studies are needed before this approach can be incorporated into routine clinical practice.

Even so, the results represent an important step towards more precise, individualised treatment for obesity – and towards a future in which people are guided to the therapy most likely to work for them from the outset.

Studies like this one land almost weekly, and making sense of them starts with understanding how GLP-1 receptor agonists actually work – from gut hormones and appetite regulation to why some people respond far more strongly than others. CCH’s GLP-1RAs in Focus – Why Drugs Like Ozempic Work is a two-hour, CPD-accredited online course created by Prof. Mike Bewick and Nigel Hinchliffe that builds exactly this foundation, whether or not you prescribe. Explore the course and interpret the next headline with confidence.

Source: Mayo Clinic

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Obesity Medications Work Best for Young People When Combined With Lifestyle Support

Key Takeaways: 

• Among young people with obesity, pairing medication with structured behavioural and lifestyle support produced the largest short-term reductions in BMI.
  
• Metformin combined with behaviour and lifestyle treatment lowered BMI by 4.95, whereas metformin used on its own showed no significant change.
  
• Semaglutide plus counselling was linked to the biggest BMI reduction of any approach, although this estimate rested on a single trial.
  
  
  

Support matters as much as the medicine

Children and adolescents with obesity who received a combination of medication and structured lifestyle treatments achieved the greatest short-term reductions in BMI, according to a new evidence synthesis. The findings point away from prescribing in isolation and towards a model in which medication is layered on top of behavioural and family support rather than used as a stand-alone fix.

How the study was conducted

Researchers carried out a systematic review and network meta-analysis, searching the literature databases through June 2025, to work out which obesity treatments perform best for young people. A network meta-analysis allows multiple interventions to be compared against one another even where they have not all been tested head-to-head in the same trial.

The final analysis brought together 42 randomised clinical trials involving 3835 participants aged 10–19 years with obesity. The median age was 14.5 years, and 59.2% of participants were female individuals. Most of the included studies followed up participants over 6–12 months, placing the emphasis firmly on short-term outcomes.

The interventions assessed fell into several categories: structured behavioural and lifestyle treatments, in both standard and intensive forms; counselling; medications, including GLP-1 receptor agonists, metformin, orlistat, and phentermine–topiramate; and combinations of medication with lifestyle treatment.

The primary outcomes were changes in BMI and BMI z-score, while the secondary outcomes were changes in waist circumference, fat mass, and lean mass. The interventions were then ranked in order of effectiveness.

On study quality, the risk for bias was judged low in 21.4% of trials and high in 26.2%, with the remaining 52.4% raising some concerns. The overall certainty of the evidence ranged from very low to high, so the strength of the findings varies considerably from one comparison to another.

What the analysis found

Across the 35 trials that reported BMI and the 19 that reported BMI z-score, medications produced larger reductions when paired with lifestyle treatments than when used alone. Metformin illustrates the pattern clearly: combined with behaviour and lifestyle treatment it was associated with a reduction of 4.95 in BMI, whereas metformin used on its own showed no significant change in BMI.

Semaglutide plus counselling was associated with the largest reduction in BMI (mean difference [MD], −8.31) and in BMI z-score (MD, −1.80). This estimate, however, came from a single trial, so it should be read with caution.

Behavioural and lifestyle treatment on its own was associated with reductions in BMI (MD, −3.85; five studies) and in BMI z-score (MD, −0.89; one study) – results that matched or exceeded the effect of certain medications used alone. Combination treatments were linked to the largest reductions in fat mass, drawing on 21 studies.

What it means in practice

The authors framed the combined approach as consistently outperforming medication given without support. “[The] finding suggests that even combining medication with basic counselling was still superior to giving medication without any lifestyle support,” the researchers wrote. “Medications should never be prescribed in isolation; a person-centered, family-centered approach matching treatment intensity to medical need is essential,” they added.

Where the research came from

The study was led by Ke-wen Wan, MSc, of Hong Kong Baptist University in Hong Kong SAR, China. It was published online on 22 June in JAMA Pediatrics.

Limitations to consider

Several caveats temper the results. The findings for newer medications were based on only a few small trials, which limits confidence in those specific estimates. The wide age range may have obscured differences by age or stage of puberty, since a 10-year-old and a 19-year-old can respond very differently to the same intervention. Most of the trials also did not report data on race, ethnicity, or income, leaving open questions about how the findings apply across different populations.

Funding and disclosures

The study received funding from grants from Hong Kong Baptist University. One author reported serving on professional boards related to childhood obesity and receiving travel grants or reimbursements, and another author reported receiving consulting fees from pharmaceutical companies. Detailed disclosures are available in the original article.

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GLP-1 Medicines for Weight Loss Reach Record Use Among US Adults

Key Takeaways: 

• Eleven per cent of US adults report currently taking GLP-1 medicines for weight loss in 2026, a substantial rise from three per cent in 2024.
  
• Awareness of GLP-1 medicines intended for weight loss has increased to 91 per cent, while the US adult obesity rate has declined from its 2022 peak of 39.9 per cent to 36.4 per cent so far in 2026.
  
• Brand-name GLP-1 medicines remain the most commonly used option, but cost and insurance coverage appear to be driving some people towards compounded or custom-mixed versions.
  
  
  

GLP-1 use for weight loss continues to rise

The proportion of US adults who say they are currently taking GLP-1 medicines for weight loss has reached a new high in 2026, according to data from the Gallup National Health and Well-Being Index.

Eleven per cent of US adults now report current use of these medicines for weight loss purposes. This represents a significant increase from 2024, when three per cent reported current use. Lifetime use has also risen, with 15 per cent of US adults saying they have taken a GLP-1 medicine for weight loss at some point. This is an increase of nine percentage points.

The findings are based on a web survey of 5,065 US adults conducted between 28 May and 5 June 2026. The survey used the probability-based Gallup Panel, which includes respondents from all 50 US states and the District of Columbia.

How Gallup measured GLP-1 use

To assess whether people had ever used GLP-1 medicines for weight loss, Gallup asked respondents:

“Have you ever taken weight loss medications such as semaglutide (brand names Ozempic and Wegovy), liraglutide (brand name Saxenda) or tirzepatide (brand names Mounjaro and Zepbound)?”

People who answered “yes” were then asked a follow-up question to determine whether they were currently taking one of these medicines:

“Are you currently taking weight loss medications such as semaglutide (brand names Ozempic and Wegovy), liraglutide (brand name Saxenda) or tirzepatide (brand names Mounjaro and Zepbound)?”

These questions allowed Gallup to distinguish between lifetime use and current use among US adults.

FDA approvals have expanded the market

The rise in GLP-1 use follows the approval of several medicines for weight loss in the US. The Food and Drug Administration approved Novo Nordisk’s Wegovy, which contains semaglutide, for weight loss in 2021.

Since then, additional options have become available. Eli Lilly’s Zepbound, which contains tirzepatide, received FDA approval in November 2023.

As more treatment options have entered the market, public awareness has also increased. Gallup reports that 91 per cent of Americans are now aware of GLP-1 medicines intended for weight loss, up from 80 per cent in 2024.

Adult obesity has declined from its 2022 peak

Gallup’s latest findings show that the US adult obesity rate has continued to fall after reaching a record high of 39.9 per cent in 2022. So far in 2026, the adult obesity rate stands at 36.4 per cent.

Gallup describes this as a statistically meaningful decline. The trend has continued to move in the opposite direction to national GLP-1 use, which has increased over the same period.

Gallup calculates obesity using the federal standard of a body mass index of 30 or higher. BMI is calculated using respondents’ self-reported height and weight.

The organisation notes that self-reported data may produce somewhat lower estimates than studies based on randomised clinical measurements of height and weight. Gallup suggests that a “vanity effect” in how people report their own height and weight may help explain this difference. However, because Gallup has used a consistent method over time, the data still provides useful information about changes in the adult obesity rate.

Diabetes diagnoses have levelled off

While obesity levels have declined, the proportion of US adults who report having been diagnosed with diabetes has remained steady since 2023. This follows 15 years of gradual increases that occurred alongside rising obesity rates.

Gallup notes that a falling obesity rate would be expected to stabilise, but not necessarily reduce, the proportion of adults who have ever been diagnosed with diabetes. Diabetes is described in the original analysis as a lifelong disease that can be managed but not cured.

To measure diabetes prevalence, Gallup asked US adults:

“Has a doctor or nurse ever told you that you have diabetes?”

The diabetes rate includes people with Type 1 diabetes and people with Type 2 diabetes. The 2026 figures for obesity and diabetes are based on 10,091 respondents from surveys conducted from 18 February to 3 March and from 28 May to 5 June 2026.

Brand-name GLP-1 medicines remain the most common option

Among adults currently taking GLP-1 medicines for weight loss, brand-name options remain the most common.

Gallup found that 68 per cent of current use involves brand-name GLP-1 medicines such as Ozempic or Wegovy. By comparison, 19 per cent of current use involves compounded or custom-mixed versions of the medicine.

A further 12 per cent of people currently taking a GLP-1 medicine for weight loss are unsure whether they are using a brand-name medicine.

People using compounded versions report slightly higher effectiveness

Gallup also compared perceived effectiveness between people taking brand-name GLP-1 medicines and those taking compounded or custom-mixed versions.

People using compounded or custom-mixed GLP-1 medicines were slightly more likely to describe the medicine as “extremely effective”. Thirty-nine per cent of people in this group gave that response, compared with 32 per cent of people using brand-name GLP-1 medicines.

However, both groups generally regarded the medicines as effective. Seventy-seven per cent of people using compounded or custom-mixed versions said the medicine was either “effective” or “extremely effective”. Among people using brand-name GLP-1 medicines, the figure was 74 per cent.

Some people are switching from brand-name to compounded GLP-1 medicines

Although brand-name medicines continue to account for most current GLP-1 use, Gallup’s findings suggest that compounded or custom-mixed versions are gaining ground.

Among people currently using compounded or custom-mixed GLP-1 medicines, 35 per cent report having switched from a brand-name medicine. By contrast, 10 per cent of people currently using brand-name GLP-1 medicines say they switched from a compounded or custom-mixed version.

This suggests that movement towards compounded or custom-mixed GLP-1 medicines is greater than movement in the opposite direction.

Cost and insurance coverage appear to be major factors in this shift. Among people who switched from a brand-name GLP-1 medicine to a compounded version, 66 per cent cited cost or insurance coverage as their main reason for switching. Among those who switched from a compounded version to a brand-name medicine, 34 per cent cited cost or insurance coverage as the primary reason.

Wider implications for obesity and diabetes trends

The growing use of GLP-1 medicines for weight loss may point to broader health implications for adults in the US. Gallup’s analysis indicates that increased use of these medicines has coincided with a decline in the adult obesity rate and a levelling off in diabetes diagnoses after years of increases.

Previous research cited in the original analysis has shown a general alignment between GLP-1 use and declining obesity rates across age groups. One exception is adults aged 65 and older, among whom the reported effectiveness of GLP-1 medicines is lower.

Brand-name GLP-1 medicines still lead the market by a wide margin. However, the lower cost of compounded or custom-mixed versions appears to be contributing to a shift away from brand-name options for some people. This may be expanding access to GLP-1 medicines across broader sections of the population, although access remains limited.

Gallup suggests that this broader availability may be one factor helping to drive overall GLP-1 use higher in the US.

Source: Gallup

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Statins Bring Many People With Obesity Level With Healthy-Weight Peers on Cholesterol and Blood Pressure, Study Finds

Key Takeaways:

• Among adults over 40 in high-income countries, gaps in cholesterol and blood pressure between people with obesity and those of a healthy weight have narrowed or vanished.
  
• The convergence is driven largely by wider use of statins and blood-pressure medications among people living with obesity.
  
• In adults under 40, people with obesity still show higher cholesterol and blood pressure, and obesity continues to raise the risk of other conditions.
  
  
  

A narrowing gap in cardiovascular risk 

Many adults living with obesity now have cholesterol and blood pressure readings that are “indistinguishable” from those of people at a healthy weight, largely because of the use of statins, a major new study has found. In some cases, researchers reported, people with obesity were “better off” than their healthy-weight counterparts.

Historically, adults with obesity were more likely to have raised blood pressure and higher levels of unhealthy cholesterol. The study found, however, that differences in unhealthy cholesterol and blood pressure have “narrowed or disappeared” among people aged 40 and over.

Experts attribute the shift chiefly to the greater use of cholesterol-lowering medications, such as statins, and blood-pressure treatments – both of which are more commonly prescribed to people living with obesity. They said the findings were important to “give a picture of the cardiovascular health” of the population most likely to be offered weight-loss medications, whose popularity has risen rapidly, and warned that it was important not to “lose sight” of these results as more people take such drugs.

What the researchers examined

The study, published in the Lancet, drew on data from almost 1 million adults aged 20 to 79 across England, Japan, South Korea, Taiwan, Thailand, Finland and the United States. Researchers analysed blood pressure, cholesterol levels and body mass index (BMI) scores recorded in 110 health surveys carried out between 1990 and 2024. They also reviewed the use of cholesterol-lowering drugs and blood-pressure treatments, known as antihypertensives.

The team found that unhealthy cholesterol levels and blood pressure “declined over time”, particularly among people aged 40 and over. Those declines were larger among people with obesity, “leading to a convergence of these risk factors between obesity and normal BMI in people older than 40 years”.

The researchers wrote: “As a result of these trends, in England, the US, Thailand, South Korea, and Japan, older people with obesity often became indistinguishable from, or better off than, those with normal BMI in terms of non-HDL cholesterol and SBP (systolic blood pressure).”

They added: “We found that differences in non-HDL cholesterol and SBP between those with obesity and those with a normal BMI narrowed or disappeared, especially in older adults, in some cases making those with and without obesity indistinguishable in terms of these cardiometabolic traits.”

Why the gap has closed

Prof Majid Ezzati, from the School of Public Health at Imperial College London, said: “Our study suggests that, in high-income countries, taking medication to lower blood pressure and cholesterol has helped middle-age and older adults lower their cardiovascular risk to levels that are similar to people with normal BMI [body mass index].

“At a time that weight-loss medications are becoming more widely used, our results give a picture of the cardiovascular health of people likely to be prescribed them, which allows the healthcare system to understand how blood pressure and cholesterol treatments benefit the population alongside weight-loss medications.”

Younger adults remain at higher risk

The convergence was not seen across all age groups. In adults under 40, people with obesity still had higher levels of unhealthy cholesterol and higher blood pressure than their healthy-weight peers.

One of the research team, Prof Edward Gregg from Imperial College London, stressed that “it doesn’t mean that obesity does not still increase your risk of other outcomes”.

Another of the authors, Yse d’Ailhaud de Brisis, also from Imperial College London, said: “While good news for older adults with obesity, our results suggest that cardiovascular health risks remain higher for adults under 40 than for their counterparts with a normal BMI.

“Early lifestyle interventions, screening and, when appropriate, medication in this younger group should be considered to prevent long-term cardiovascular complications linked to obesity.”

A public health success, with caveats

Commenting on the study, Prof Bryan Williams, the chief scientific and medical officer at the British Heart Foundation, said: “This study highlights a powerful public health success story – it shows just how effective modern treatments for blood pressure and cholesterol have become, with many people over 40 with obesity now reaching levels similar to those with a healthy weight.

“But we must not lose sight of the bigger picture. These medications are needed because of the adverse effects of obesity on cardiovascular disease risk. Moreover, obesity still affects the body in many other ways and increases the risk of other health problems, including diabetes, kidney disease and some cancers.”

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Many Who Stop GLP-1 Medications Restart Within a Year, Study Finds

Key Takeaways: 

• Around 4 in 10 people with type 2 diabetes stopped their GLP-1 medication within the first year, rising to nearly 6 in 10 by the end of two years.
  
• Of those who stopped, more than half restarted within a year and nearly two-thirds within two years, suggesting use is often start-and-stop rather than permanent.
  
• Newer medications, a prescription from an endocrinologist, and fewer stomach-related side effects were all linked to a lower likelihood of stopping.
  
  
  

Use is more start-and-stop than assumed

People prescribed GLP-1 medications are more likely to start and stop treatment than many assume, according to a study being presented on Sunday at ENDO 2026, the Endocrine Society’s annual meeting in Chicago, Illinois.

“Our study asked two questions that haven’t been well answered until now: How many people with type 2 diabetes taking GLP-1 medications actually stop using them? And how many restart them?” said Sainikhil Sontha, M.S., a research associate at Boston University School of Public Health in Boston, Massachusetts.

How the study was carried out

The researchers ran a retrospective cohort study using Komodo Health US claims data covering January 2019 to June 2025. The group included adults aged 18 to 64 years with a BMI of 25 kg/m² or above and type 2 diabetes who had started liraglutide, semaglutide, or tirzepatide, and who had previously enrolled within the last year with more than six months of follow-up.

Discontinuation was defined as a gap of more than 60 days in filling a GLP-1 prescription. Obtaining a new fill after discontinuation was counted as reinitiation.

How many people stopped

“Using insurance records from more than 60,000 Americans with type 2 diabetes, we found that about 4 in 10 patients stopped their GLP-1 medication within the first year, and nearly 6 in 10 had stopped by the end of two years,” Sontha said.

But the team also found something more encouraging.

How many people restarted

“More than half of those who stopped restarted therapy within a year (41.5%), and nearly two-thirds did so within two years (58%),” Sontha said. “This suggests that for many patients, these medications aren’t being abandoned permanently; use is more start-and-stop than most people assumed.”

Who was more likely to stop

Using Cox proportional hazards models, the researchers also accounted for sociodemographic, clinical, and provider-level predictors.

Sontha and colleagues found that people on Medicaid or Medicare, people who are Black, and those experiencing nausea or other stomach-related side effects (37%) were more likely to discontinue a GLP-1 medication within a year.

What was linked to staying on treatment

People were 10% less likely to stop if their first GLP-1 medication was prescribed by an endocrinologist.

The type of medication also made a difference. People taking newer medications such as tirzepatide were 41% less likely to discontinue than those taking older drugs such as liraglutide, while people taking semaglutide were 28% less likely to discontinue anti-obesity medication use than those on older medications.

Why it matters

“This research matters because consistent use of these medications is what produces their protective effects,” Sontha said. “Stopping early may mean missed opportunities to prevent heart attacks, kidney disease progression and other complications.”

The researchers hope the findings give providers, insurers, and policymakers a clearer picture of which patients need more support to stay on GLP-1 medications.

CCH insights:

This study suggests most patients see GLP-1 medications as a temporary treatment to lose weight, rather than a long-term treatment for obesity and cardiometabolic health. It also suggests patients are not getting good advice regarding GLP-1 therapy. In the long-term, patients should be advised to reduce down to the minimum dose that enables them to maintain weight loss and also maintain gains in metabolic markers and improvements in cardiovascular risk factors, rather than stopping and restarting treatment.

Getting that judgement right – knowing when to hold a dose, when to step down rather than stop, how to keep a patient nourished when side effects bite, and how to prepare them for the long term – is exactly what our two-hour CPD course GLP-1RAs in Practice: Supporting Patients During Treatment is built around, for any clinician supporting patients across the full arc of therapy.

Source: Endocrine Society

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