First established as a treatment for diabetes, semaglutide’s popularity as a weight-loss drug has opened the door to new therapies.Credit: Ricardo Rubio/Europa Press via Getty
What do tennis star Serena Williams, television personality Oprah Winfrey and actors Kathy Bates and Whoopi Goldberg have in common? They are some of the many celebrities who have spoken publicly about using GLP-1 receptor agonists to lose weight.
Glucagon-like peptide-1 (GLP-1) receptor agonists — which bind to GLP-1 receptors that are found on the surface of a wide range of cells in the human body — have made their way into popular culture as a byword for weight loss. The drugs even received a mention by comedian Jimmy Kimmel when he hosted the 2023 Academy Awards.
But the treatment is no joke. Endocrinologist John Wilding, at Aintree University Hospital in Liverpool, UK, has spent much of his career seeing people with type 2 diabetes struggle with their weight, fight to maintain diets and exercise regimes, and wrestle with nagging ‘food noise’ — intrusive thoughts about food even when people aren’t hungry. For him, the impact of this new class of drugs is “astounding”.
One of his patients was first diagnosed with type 2 diabetes when she was 17 years old. By her early twenties, the disease had progressed to the point where she was taking three diabetes medications and was facing the prospect of insulin therapy, which can cause weight gain.
Instead, Wilding decided to prescribe her a GLP-1 receptor agonist. The treatment brought the patient’s previously high blood-glucose levels down to the normal range and she lost around one-quarter of her body weight; about 30 kilograms. “It’s totally transformed her life,” says Wilding, who is also a clinical researcher at the University of Liverpool and has been involved in research on GLP-1 receptor agonists. “There’s lots of stories like that, also in older patients, where people have had responses that are really quite remarkable in terms of how much weight they’ve lost and how it’s changed their quality of life.”
The drugs’ popularity has extended well beyond the realm of type 2 diabetes. Between 2019 and 2023, use of GLP-1 receptor agonists by individuals in the United States with obesity surged by around 700%1, as popular brand names found their footing in the market — most notably Ozempic and Wegovy, which are forms of the GLP-1 receptor agonist semaglutide.
“This era of drug development for obesity has the potential to be a landmark in the history of medicine,” says endocrinologist Timothy Garvey at the University of Alabama at Birmingham. “I think it’s on par with the discovery of insulin, the discovery of penicillin, the polio vaccine.”
The first chapter
To trace the origins of semaglutide, one must start with the Gila monster (Heloderma suspectum): a venomous orange and black lizard that is native to the arid deserts of Mexico and the US southwest.
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