The appetite for weight-loss drugs, known as glp-1 agonists, has been insatiable since they hit the market a decade ago. In 2024 global spending on them reached $54bn, a figure that is sure to rise in the coming years. These drugs, better known under their brand names of Wegovy, Ozempic, Mounjaro and Zepbound, do not merely promise trimmer waistlines but also seem to reduce the risks of a variety of maladies of the heart, liver and kidneys. As pharmaceutical firms elbow each other for a slice of the pie, the buffet of options will grow in 2026.

One big change to watch for will be the arrival of the first glp-1 drugs that can be taken orally. Novo Nordisk, the Danish company behind Wegovy and Ozempic, is preparing to launch a pill version of semaglutide, those drugs’ active ingredient, with an average weight loss, after a year, of 16.6%. A rival pill, orforglipron, from Eli Lilly, the American maker of Mounjaro and Zepbound, delivered a 12.4% reduction. Though pills are less effective than jabs, which can reduce weight by 16-23% after one year, they are far more convenient. But Ahmed Ahmed of Imperial College London notes that the pills may fall short of these results outside controlled clinical settings. With a daily pill rather than a weekly jab, patients may be more likely to forget doses, or choose to skip an occasional pill to avoid unwelcome side-effects.

Chart: The Economist

Meanwhile, improved versions of injectable drugs are also on the way. In 2026, attention will turn to Lilly’s new candidate, retatrutide, a “triple agonist” injectable which activates three receptors involved in weight control and has been dubbed the “Godzilla” of weight-loss medicines. In phase-two trials, participants lost 24% of their body weight over 48 weeks; these results will need to be replicated in the larger phase-three trials, which are due to report at the end of 2025. Nipping at its heels is CagriSema from Novo Nordisk. This drug, a combination of Wegovy and an analogue of a molecule called amylin, which has a satiating effect, demonstrated a 23% loss in phase-three trials.

In the meantime, others are working on longer-acting GLP-1 jabs that can be administered monthly, rather than weekly. Amgen, another American firm, has developed a monthly injectable called MariTide that seems to offer a 20% weight loss after a year, though this will need to be confirmed in phase-three trials. And efforts are under way to make new treatments that temper the loss of muscle associated with using GLP-1 drugs. Eli Lilly is working on an antibody drug known as bimagrumab, which binds to receptors in the body that increase skeletal muscle mass. Tests so far indicate that, when it is combined with semaglutide, it can deliver a 22% reduction in weight after 72 weeks, 93% of which comes from fat (versus 72% with semaglutide alone). Trials of this drug will continue in 2026.

One change to watch is the arrival of weight-loss drugs in the form of pills

The surge in new products will enrich pharmaceutical firms. But competition could also drive down the costs of treatment, as first-generation drugs, or those that offer slightly poorer top-line results, command lower prices. Some government-funded health systems are likely to make population-scale deals in the coming years, which could broaden access. And as the patent for semaglutide expires in many markets (but not America and Europe) in 2026, generic manufacturers will be able to make cheap copies and expand availability in countries such as Brazil, China and India).

If generic semaglutide were made available to everyone with obesity and diabetes globally, it could save 2.1m-3.1m lives a year, according to one model. Moreover, glp-1 medications are known to reduce cardiovascular events, improve sleep apnoea, protect the kidneys and liver, and even show promise for reducing addictive behaviours. Early data have even hinted at reduced risks of cancer and Alzheimer’s. More results on these unexpected side-benefits of GLP-1 use will be published in the coming months. However you slice it, 2026 is shaping up to be a pivotal year for these remarkable drugs.