Integrative Biomedical Research
Integrative Biomedical Research (Journal of Angiotherapy) | Online ISSN 3068-6326
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Volume 10 Number 1 2026
REVIEWS (Open Access)
Obesity Pharmacotherapy in the GLP-1 Era: Efficacy, Equity, and the Long-Term Unknowns of Incretin-Based Care
Nafel Sammah Alharbi 1*, Hanadi Naji Hajrasi 1, Nuha Naif Alshammari 2
Integrative Biomedical Research 10 (1) 1-8 https://doi.org/10.25163/biomedical.10110910
Submitted: 21 May 2026 Revised: 10 July 2026 Accepted: 20 July 2026 Published: 22 July 2026
Abstract
Obesity has become one of the defining chronic diseases of this century, and the arrival of glucagon-like peptide-1 (GLP-1) receptor agonists and multi-receptor co-agonists has, arguably, changed what clinicians can honestly promise their patients. Still, it is worth asking whether the enthusiasm surrounding these agents has outpaced our understanding of who benefits, who is left behind, and what happens once the injections stop. This review set out to synthesize the current evidence on the efficacy, tolerability, equity, and durability of incretin-based obesity pharmacotherapy across adult and pediatric populations. We conducted a structured narrative synthesis of nineteen peer-reviewed sources published largely between 2024 and 2026, retrieved through a search strategy combining controlled vocabulary and free-text terms related to obesity, GLP-1 receptor agonists, dual and triple incretin co-agonists, treatment persistence, and body composition. Screening, data extraction, and thematic organization followed a reproducible, pre-specified protocol suitable for replication. Selective GLP-1 receptor agonists produce mean weight reductions near 15%, dual GIP/GLP-1 agonism extends this to 20.9-22.5%, and triple agonism reaches up to 24.2% at 48 weeks. These gains, however, come bundled with real costs: gastrointestinal intolerance drives 46-65% of patients to discontinue therapy within a year, lean mass accounts for roughly a quarter to two-fifths of total weight lost, and persistence rates vary almost sevenfold between reimbursed and out-of-pocket healthcare systems. Incretin-based pharmacotherapy has undeniably narrowed the gap between medical and surgical obesity treatment, but its long-term value will hinge on solving three stubborn problems-tolerability, affordability, and the preservation of lean tissue-rather than on chasing further increments in weight-loss percentages alone.
Keywords: GLP-1 receptor agonists; tirzepatide; obesity pharmacotherapy; incretin-based therapy; treatment persistence; lean mass preservation; health equity
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