By Dr. Asnat Raziel, bariatric surgeon specializing in obesity treatment, metabolic health and healthy longevity; Director of the Multidisciplinary Center for Obesity Treatment, Assia Medical, Assuta Ramat HaChayal, Tel Aviv
Obesity medication: who it’s for and what it offers
Obesity medication has changed dramatically in recent years. In the major trials, the new drugs led to average weight loss of about 15% to 21% of body weight, not just a few kilograms. Some have also shown heart protection and a delay in the onset of diabetes. In this guide I explain who treatment is for, which medications are available, what they offer and what you should know before you start.
Obesity is a chronic disease
Obesity is not a lack of willpower. It is a chronic disease in which the brain’s hunger and satiety systems work against weight loss. When you lose weight by dieting, the body ramps up hunger and slows down the rate at which it burns energy. That is why many people return to their starting weight, even after tremendous effort.
The new medications, however, target exactly these mechanisms. They increase satiety and reduce “food noise,” the intrusive, nagging thoughts about food. A general overview of how anti-obesity medications work shows how far the field has come.
Who is a candidate for obesity medication?
In the large trials and in the official indications, these drugs target adults with a BMI of 30 or higher. They also suit people with a BMI of 27 or higher who have at least one weight-related condition, such as high blood pressure, prediabetes, high blood lipids or sleep apnea.
That said, the decision is not just about a number. At our clinic, we review underlying conditions, regular medications, family history and personal goals. For the latest professional guidelines, see my detailed article on guidelines for obesity medication.
Which medications are available today?
Most of the new drugs belong to the GLP-1 family. They mimic a natural hormone that the gut releases after a meal. You’ll find the full list of options on my page about medications for obesity and metabolic disease.
Weekly injections: Wegovy and Mounjaro
Wegovy contains semaglutide. In the STEP 1 trial, a dose of 2.4 mg a week led to an average weight loss of 14.9% after 68 weeks, compared with 2.4% on placebo. Higher doses of 7.2 mg have also been studied recently.
Mounjaro contains tirzepatide, which acts on two hormones, GLP-1 and GIP. In the SURMOUNT-1 trial, average weight loss after 72 weeks reached 15.0%, 19.5% and 20.9% at doses of 5, 10 and 15 mg, respectively. In the placebo group, weight loss was 3.1%.
Saxenda, pills and older medications
Saxenda contains liraglutide, and patients inject it once a day. In the SCALE trial, patients lost an average of 8.4 kg, compared with 2.8 kg on placebo.
There are now pills as well. For example, in December 2025, the US Food and Drug Administration (FDA) approved the Wegovy pill, semaglutide 25 mg once a day. Then, in April 2026, the FDA also approved Foundayo (orforglipron), a pill you can take without any food or drink restrictions. In the ATTAIN-1 trial, the highest dose led to an average weight loss of 11.2%, compared with 2.1% on placebo. You’ll find more details in my article on orforglipron for weight loss.
Alongside these, there are older medications such as Mysimba and orlistat. Their effect on weight is modest, but they are still a good fit for some patients. It is also important to distinguish between prescription drugs and supplements. After all, dietary supplements are no substitute for a medication that researchers have tested in controlled clinical trials.
What obesity medication offers beyond weight loss
To begin with, weight loss improves blood pressure, blood sugar and blood lipids. Beyond that, the SELECT trial enrolled 17,604 people with heart disease and overweight but no diabetes. Semaglutide reduced the risk of a major cardiovascular event, such as a heart attack or stroke, by 20%. Such events occurred in 6.5% of those on the drug, compared with 8.0% on placebo.
There is also growing interest in how these drugs affect the aging process. The field is still in its infancy, and I reviewed it in my article on geroprotectors, drugs that may slow aging.
Side effects and safety
The common side effects are nausea, diarrhea, vomiting and constipation. They are usually mild and appear at the start of treatment or after a dose increase. That is why treatment starts at a low dose, which your doctor then raises gradually. Rare side effects include gallstones and pancreatitis. In addition, doctors do not prescribe GLP-1 medications to anyone with a personal or family history of medullary thyroid cancer, and patients should stop them before a planned pregnancy.
Obesity medication over the long term
These medications work only as long as you take them. In the extension of the STEP 1 trial, participants who stopped semaglutide regained about two-thirds of the weight they had lost within a year. Most of the improvement in heart and blood sugar markers also returned to baseline. In other words, as with high blood pressure, this is usually long-term treatment.
That is why it makes sense to think about the budget as well. After all, long-term treatment is an ongoing expense, and it is sometimes worth planning for it like any other major household cost. In Israel, all four health funds (HMOs), Clalit, Maccabi, Leumit and Meuhedet, offer Wegovy and Mounjaro through their supplementary insurance plans at a discount of about 50%. The health funds also publish their prices on their websites. I wrote about prices and insurance coverage in my article on the cost of obesity medication.
How to start the right way
First, see a doctor who knows the field for a thorough evaluation. Second, set realistic goals and choose a medication based on your underlying conditions and preferences. Finally, combine the medication with a protein-rich diet, strength training and good sleep. All of these are part of a healthy lifestyle, and they make the difference between temporary weight loss and lasting success.
The bottom line
Overall, the new obesity medications are an effective, research-based medical tool. In general, they suit adults with a BMI of 30 or higher, or 27 or higher with a related condition. They lead to significant weight loss, improve metabolic markers and, in some cases, protect the heart. They do, however, require medical follow-up, a personalized approach and changes in habits along the way.
The information in this article is general and does not replace personal medical advice.
Frequently asked questions
How long does obesity medication treatment last?
Usually for the long term. Stopping generally leads to regaining a large part of the weight, so you should make the decision to stop together with your doctor.
Is obesity medication suitable for people without diabetes?
Yes. In fact, the key trials, STEP 1 and SURMOUNT-1, enrolled people with obesity who did not have diabetes.
Injection or pill: which is better?
In the trials, the weekly injections led to greater weight loss. A pill, on the other hand, suits people who prefer to avoid injections. The choice is personal and made together with your doctor.
Who should oversee treatment?
Ideally, a multidisciplinary team of a doctor, a dietitian and sometimes a psychologist. You can read more about my experience in this field on the page about Dr. Asnat Raziel.
Sources
Once-Weekly Semaglutide in Adults with Overweight or Obesity
Tirzepatide Once Weekly for the Treatment of Obesity
A Randomized, Controlled Trial of 3.0 mg of Liraglutide in Weight Management
Orforglipron, an Oral Small-Molecule GLP-1 Receptor Agonist for Obesity Treatment
Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes
Novo Nordisk A/S – Form 6-K, December 22, 2025
FDA approves Foundayo, an oral GLP-1, for adults with obesity
