That "miracle weight loss shot" flooding your social media? The doctors working on the frontlines of obesity treatment want you to know something: reality is much more complicated.
At a recent Biotech Showcase 2025 panel in San Francisco, moderated by Cure’s CEO Seema Kumar, healthcare experts painted a more nuanced picture of GLP-1 drugs like Wegovy and Ozempic.
The panel discussion coincided with Cure's release of two white papers examining GLP-1 medications from different angles: patient experiences with weight loss treatment and specialty physicians' off-label prescribing practices. The reports, and the panel discussion, brought to light surprising insights about adherence, side effects and emerging therapeutic applications.
"We view obesity as a treatable medical condition now, not as a simple lifestyle issue – that's a big achievement," said Minji Kim, PhD, MBA, President of Cross Border Partners, LLC. "But this is not a cure at all – this is just the starting point."
Obesity has become a significant health concern globally. One in eight people in the world are living with the condition, which has more than doubled in adults since 1990 and quadrupled in adolescents, according to World Health Organization. In the U.S., the Centers for Disease Control and Prevention reports more than 100 million adults, or about 42 percent of the population, are living with obesity, accounting for $173 billion in medical expenditures.
GLP-1 Drugs are a $100 Billion Market
It's no wonder then that the demand is high for glucagon-like peptide-1 (GLP-1) medicines, such as Eli-Lilly’s Zepbound and Novo Nordisk’s Wegovy and Ozempic, approved by the FDA for weight loss in recent years.
Goldman Sachs analysts estimate the market for such drugs could grow to $100 billion by 2030. However, the high cost of these drugs—Ozempic, for example, costs approximately $969 per month — has led to challenges in patient access and insurance reimbursement. To address affordability, the U.S. government announced in January it has included GLP-1 drugs in Medicare’s price negotiation program, aiming to reduce costs for beneficiaries starting in 2027.
High costs and insurance barriers have pushed patients and physicians to seek alternative paths to these medications. Doctors also struggle to get their patients prescriptions for these medications: according to Cure's specialty physician survey white paper, published in January, 89 percent faced coverage challenges when prescribing GLP-1s beyond obesity and diabetes.
Yet physicians are finding promising uses across specialties - cardiologists prescribe them for cardiovascular disease (88 percent), gastroenterologists for nonalcoholic fatty liver disease (72 percent), and addiction medicine specialists for chemical dependency (59 percent). The survey found that 62 percent of physicians rated these expanded uses as "very" or "extremely" effective.
"These GLP-1 agonists can be a two-in-one solution for diabetes and weight loss," Robert Fontana, MD, a Michigan Medicine hepatologist said in an online interview included in the Cure report, "maybe a three-in-one solution if they prove to be safe and effective for metabolic associated steatohepatitis as well."
Troubling Pattern in Patient Adherence to GLP-1 Drug Therapy
Despite their effectiveness, adhering to the injectable drugs have proven challenging. Only 15 percent of people who take the medications stay on them for two years, according to a survey by Prime Therapeutics.
According to Cure's January 2025 patient survey white paper, side effects from taking GLP-1s were common but typically manageable. Among previous GLP-1 users, 49 percent experienced nausea, 33 percent had diarrhea, and 32 percent reported stomach pain. Severe side effects were only experienced by 7 percent of patients, including delayed gastric emptying and 1 percent reporting gastroparesis or pancreatitis. Current users reported fewer issues overall, with just 36 percent experiencing any side effects that their physicians attributed to the medication.
Perhaps most concerning to researchers is what happens when patients stop taking these medications. The weight often returns rapidly, and in a troubling pattern – fat comes back faster than muscle, said Cameron Pye, PhD, Co-Founder and CEO of Unnatural Products.
"You rebound the fat mass much faster than muscle, so you actually start impinging pretty heavily on lean muscle if you go through multiple rounds of these cycles," Pye said at the Biotech Showcase panel. "Originally that was thought to be mostly skeletal, we're starting to see some evidence that's smooth, and even cardiac tissue that's being lost as well."
This shift is pushing researchers to look beyond the simple calories-in-calories-out equation. Some patients might need treatments focused on preserving muscle mass. Others might benefit more from therapies targeting specific metabolic pathways or hormonal responses.
The goal: moving away from treating obesity as a singular condition toward precision approaches based on an individual's biology. In this way, future obesity treatments might look more like modern cancer care than traditional weight loss approaches, said Ashley Zehnder, PhD, Co-Founder and CEO of Fauna Bio.
"A lot of cancer types used to be treated as a homogeneous condition," said Zehnder. “That changed with molecular phenotyping. What we're seeing big pharma start to do now is better molecular phenotyping of patients to identify responders and non-responders."
Learning from Ground Squirrels, Elephant Seals
This hunt for new solutions has scientists looking in unexpected places – researchers at Fauna Bio are studying hibernating animals that maintain muscle mass despite months without eating. Ground squirrels, for instance, can rebuild muscle even after five months underground – and without taking in any new calories.
"These animals are motionless under the ground for six months," said Zehnder. "If you're laying in a hospital bed for six months, you would not have a lot of muscle mass left. But not only do they maintain a lot of the muscle they start with, about a month before they emerge in the spring they start to rebuild muscle. Even though they have not eaten in five months."
Equally intriguing are elephant seals, which manage an even more impressive balancing act. "The female elephant seals are actually lactating while they are fasting," Zehnder said. "It's a completely different model of metabolic flexibility."
These natural examples of metabolic control have caught the attention of major pharmaceutical companies. Eli Lilly partnered with Fauna Bio to explore novel targets beyond GLP-1s, looking for ways to help humans maintain healthy metabolism during weight loss.
Patient Support During GLP-1 Drug Therapy
The surge in GLP-1 prescriptions has exposed another challenge in obesity treatment: the healthcare system isn't set up to provide the sustained support patients need. Many struggle to even start the conversation with their doctors – one survey found 32 percent of patients don't feel comfortable discussing weight care with their physicians, said Sari Kaganoff, MBA, Chief Commercial Officer of Rock Health.
"You can't think of this only as medication" Kaganoff said. "Seventy percent of consumers in the survey say they're working on diet as part of their weight loss journey. Another 60-something percent are using exercise and 36 percent said managing their stress is a big part of their weight care journey."
Some patients report that initial weight loss from GLP-1s helped them to tackle these lifestyle changes, according to Unnatural Products’ Pye.
"We discovered that patients are saying 'I used to not go to the gym because I was so overweight and felt very self-conscious, but after GLP-1s I kind of got to a place where I didn't feel embarrassed going to the gym,'" Pye said.
Capital Not Well Spent on GLP-1 Drug Variations
As investors and drug companies rush to fund new and improved versions of GLP-1s, some scientists worry the industry might be missing bigger opportunities. The current surge in patient demand for these medications and their projected revenue growth has spawned hundreds of biotech companies working on slight variations of existing drugs, said Mineralys Therapeutics’ Kim.
"Can we justify hundreds of GLP-1 biotech companies out there?" said Kim. "From the innovation and effectiveness in capital allocation perspective, most of the capital will not be well spent on the innovation side."
Kim drew parallels to what happened with cancer immunotherapy drugs. After the first PD-1 inhibitors proved successful, companies raced to develop similar treatments. But ultimately, a few leading companies dominated the field while many me-too drugs failed to reach the market.
Instead of incremental improvements, researchers advocate for exploring entirely new approaches. This might mean combining GLP-1s with drugs that preserve muscle mass, developing treatments that target specific obesity subtypes or creating oral medications that could replace weekly injections.
Thinking about Body Health Beyond Weight Loss
The future of obesity treatment may ultimately stretch far beyond weight loss. As researchers dig deeper into metabolic pathways and study natural models of adaptation, they're uncovering insights that could reshape our understanding of how the body heals and maintains itself.
"Just focusing on GLP-1s is great, but we have to be mindful that maybe there may be some other way to provide better treatment options" Kim said. "We really need to think about how we can tackle these issues in a more holistic way."