The evolving landscape of obesity pharmacotherapy

Obesity is a chronic, relapsing disease driven by complex interactions between genetic, environmental, neuroendocrine and behavioural factors. The advent of incretin-based therapies and the expansion to multi-receptor agonist peptides targeting glucagon-like peptide 1 (GLP1), glucose-dependent insulinotropic polypeptide (GIP), glucagon, and amylin receptors has transformed obesity treatment, demonstrating average weight loss of more than 20% in humans and improvements in a broad range of obesity-related comorbidities. In this Review, we trace the recent evolution of obesity pharmacotherapy from GLP1 receptor agonists to next-generation multi-receptor agonists, alongside strategies that incorporate oral formulations, weight-loss quality approaches and tissue-specific drug targeting. We outline major translational and biological challenges, identify key gaps for future research and discuss emerging approaches aimed at achieving durable and scalable obesity treatment.