It’s been a few years since the first forms of semaglutide (GLP-1) drugs revolutionized the treatment of obesity. Since then, a multitude of new entrants have entered the fray with fresh developments seemingly at a daily pace. Those key steps forward were on show at the third annual BMO Metabolic Health Summit in New York City in March.

At the Summit, Evan Seigerman, Managing Director and Head of Healthcare Research, BMO Capital Markets, led a series of panels that explored the latest scientific developments, emerging treatments and ongoing challenges facing companies, healthcare providers and patients.

Here are some of the highlights:

While established injectable GLP-1s continue to dominate the treatment space, the approval of Wegovy’s oral form – and the fact that it has demonstrated comparable, though slightly lower, weight‑loss outcomes than the injectable form – marked a sea change. Dr. Katherine Saunders, co-founder of FlyteHealth and an internationally recognized obesity expert, explained during “Obesity 103” that although oral semaglutide has been available for years (for diabetes), the latest version may have more tolerable side effects than the earlier version. In addition, the reduced cost may allow more patients to remain on the medication long-term or afford treatment in the first place.

The treatment field is moving away from focusing solely on percentage of body weight lost, in part because of diminishing returns as percentages increase. Dr. Louis Aronne, a professor of metabolic health at Weill Cornell Medicine, compared this scenario to two blood pressure medications, where one treatment might offer a marginally better outcome. “There may be some benefit for some people, but there’s also risk of side effects.”

The takeaway was whether patients or benefit providers will be willing to pay the higher costs for slightly better results or pursue the most cost-effective route that still provides significant health benefits.

Both doctors, in their respective sessions, discussed the importance of, and the evolution toward, personalized pharmaceutical treatments to ensure patients receive the medication that works best. Dr. Saunders emphasized the importance of comprehensive patient care and considering older medications in addition to the new ones. Dr. Aronne noted that combination treatments that include a GLP-1 as well as another therapeutic could be the answer for patients who plateau or simply don’t respond to a first-line GLP-1.

This new frontier in obesity medicine personalization is where the next phase of treatments is focused. Participants on the Emerging Companies panel noted that GLP‑1s may be approaching practical limits in terms of efficacy and patient tolerance, opening the door to other drug classes – either as replacements or additions to GLP-1 treatment.

Other important factors that panelists agreed will determine future success for companies include less frequent and easier dosing, improved GI tolerability and wider health impacts. For example, a medication that helps patients lose weight but also improves chronic kidney disease or another cardiometabolic disorder could help one company stand out from the rest.

Still, despite scientific advances and enormous interest, access and affordability continue to be barriers for the majority of patients who would benefit from obesity treatment. The current cost of injectables has not meaningfully decreased to date, and insurance coverage is hit-or-miss, with many companies excluding weight-loss medication from their plans entirely.

More and more patients are paying out of pocket; however, the costs may limit the feasibility of long-term treatment for many. “To pay a few hundred dollars a month for a medication that needs to be taken long term is really out of reach for 99% of people,” Dr. Saunders noted.

Participants in the panel on access and reimbursements discussed the Trump administration’s announcement last year of a temporary Medicare and Medicaid pilot program that would begin covering certain GLP‑1 weight‑loss treatments starting in summer 2026. While this coverage has the potential to be transformational for many patients who have previously been unable to afford these medications, Dr. Saunders pointed out in her earlier discussion that we’re still missing many important details.

For employers and self-insured plans, one of the main issues is paying high drug costs and waiting months for rebates, which reduces cash flow for other benefit coverage. The hope across the board is that as the number of therapeutics increases, drug costs will decrease and enable insurance plans to offer more consistent coverage. Early signs of this can be seen as oral GLP‑1s begin entering the market.

While lowering costs may improve patient access, that doesn’t necessarily guarantee it. During the holistic care delivery panel, panelists from both FlyteHealth and WeightWatchers underscored the importance of comprehensive, ongoing and affordable care delivery to ensure patients don’t discontinue obesity medications.

Ongoing care can help solve what GLP-1s alone cannot: addressing side effects, changing a patient’s lifestyle to support weight loss, setting realistic expectations and more. Comprehensive care also helps patients understand that meaningful obesity treatment outcomes extend beyond lower body mass index, including improvements in metabolic markers like glucose and blood pressure.

The future of obesity care and metabolic health holds promise, especially as the world of GLP-1s continues expanding to include additional oral semaglutides and entirely new medications.

“We’ve come such a long way,” noted Dr. Saunders. “It's incredible that we have such effective tools to treat this really difficult-to-treat disease.”