How Entrepreneurs are Looking Beyond GLP-1s for Obesity Innovations

Michael Donnelly-Boylen didn’t expect to be alive this year.

The Associate Dean of Enrollment and Strategic Initiatives at Roger Williams University School of Law shared his journey from living with obesity to turning his life around with medication — but only after a diagnosis with Type 2 diabetes that let him access GLP-1-based medications — and lost more than 100 pounds.

“I was preparing documents for my husband for a life I didn’t think I’d have,” said Donnelly-Boylen, on a panel on obesity at the BIO International Convention recently. “It’s completely changed my life.”

His remarks set the tone for a wide-ranging discussion about the scientific advances, access challenges and persistent stigma shaping one of the fastest-growing categories in medicine. He was joined on stage by endocrinologist Beverly Tchang, MD, of Weill Cornell, Skye Bioscience CEO and President Punit Dhillon, and Steffen-Sebastian Bolz, MD, PhD, Co-founder of Aphaia Pharma.

The panelists described the current state of weight loss medication research. While GLP-1 drugs are blockbusters, researchers are exploring new technologies and modalities including CB1-inhibition, dual-hormone approaches, microbiome-targeting therapies and hormone release restoration.

“If this were cancer, we wouldn’t be judging people for trying to get medicine from overseas,” said Tchang. “Instead, we’re seeing patients on TikTok reconstituting research chemicals in their kitchen because it’s the only option they have.”

Limited Access GLP-1, Growing Demand for Obesity Treatments

Roughly two-thirds of Americans live with obesity, but access to treatment remains limited. Even as GLP-1 drugs become more widely prescribed, cost and insurance coverage remain significant barriers. Several speakers noted that the shift toward recognizing obesity as a chronic medical condition is still incomplete, especially among payers.

“The problem is that the person receiving the product isn’t the one paying for it,” said Tchang. “There are incentives for insurers and pharmacy benefit managers to keep prices high, deny coverage or push back against reimbursement.”

Compounding pharmacies, which stepped in during shortages, have become a lifeline for some patients, but also a source of risk and legal uncertainty. Donnelly-Boylen said he has friends obtaining semaglutide and tirzepatide from international sellers or unregulated online vendors.

“People are making unsafe decisions just to stay alive,” he said.

Cure Patient Survey Shows Costs Impacts Patients Access to Treatment

A recent patient survey conducted by Cure found 31 percent of people taking GLP-1s abandon treatment due to cost. In a separate survey of specialty physicians' off-label prescribing practices, Cure found the main challenge in getting medications to patients was insurance coverage issues – an issue for 89 percent of physicians.

Meanwhile, investors are hunting for new and differentiated treatments for weight loss. According to a February briefing by analysts at Jefferies, more than 100 investigational obesity drugs are in development, many of which aim to emulate or improve upon GLP-1 pathways. (See: “Obesity Drug Market Charts New Course for Patients, Investors”).

Obesity Science Looks Beyond Incretins

For drug developers, the next wave of innovation may come from adding to or replacing the GLP-1 hormone class. Skye Bioscience’s Dhillon described his company’s work studying a CB1-targeting antibody, which may complement GLP-1s or offer a new mechanism altogether.

“There’s a massive opportunity here,” Dhillon said. “We’re thinking about how to rewire the metabolic system for better quality and sustainability of weight loss.”

Aphaia Pharma’s Bolz described an approach aimed at restoring the body’s natural hormonal symphony by reactivating dormant gut hormone cells. The strategy may also complement new combination therapies that blend GLP-1s with agents targeting metabolism, tolerability or additional hormonal signals.

“It’s like rebuilding the orchestra,” he said. “You can’t expect a single hormone to do what dozens were designed to do together.”

Reframing the Obesity Narrative

The panel also discussed the societal and historical roots of obesity stigma. Tchang pointed to a legacy of American “healthism” that conflates moral character with thinness, fueled by decades of diet fads and personal responsibility narratives. Health, she argued, should be easy, not a punishment.

“Why should we expect people to suffer just to be healthy?” she said.

While the science of obesity continues to advance, many patients are still navigating a medical system unprepared to meet demand or offer empathy.

“My primary care doctor gave me a box of medication and sent me to a website,” Donnelly-Boylen said. “That was it.”

He learned about nutrition, mindset and diabetes management through TikTok, not from a medical professional. Still, he sees hope in the broader acceptance that biology drives weight gain, not a lack of willpower.

“GLP-1s gave me a fighting chance,” he said. “Now I want to make sure others get one too.”