What the evidence says.

Each study, what it measured, what it found, and where to read it. Every entry is marked with who paid for it.

Effectiveness

How much weight comes off

Independent

Liraglutide, semaglutide and tirzepatide compared

International Journal of Obesity, 2026 · trials of 52 weeks or longer

A network meta-analysis of liraglutide, semaglutide and tirzepatide at approved weight-management doses, run outside the manufacturers.

All three produce clinically meaningful weight loss against placebo over a year or more. Semaglutide 7.2mg ranked consistently above 2.4mg, but the average incremental benefit was only 2 to 3 percentage points, with few statistically significant differences between doses. The authors weigh that against tolerability and patient preference.
Authors declare no conflict of interest. PubMed
Manufacturer funded

STEP 1, once-weekly semaglutide 2.4mg

NEJM, 2021 · 1,961 participants · 68 weeks

Adults with a BMI of 30 or above, or 27 with a weight-related condition and no diabetes, randomised to weekly semaglutide or placebo alongside lifestyle counselling.

Body weight fell 14.9% on semaglutide against 2.4% on placebo. 86.4% of the semaglutide group lost at least 5% of their weight, against 31.5% on placebo.
Manufacturer funded

SURMOUNT-1, tirzepatide in obesity

NEJM, 2022 · 2,539 participants · 72 weeks

Adults with obesity, or overweight with a related condition, randomised to 5mg, 10mg or 15mg weekly tirzepatide or placebo.

Average reduction was 16.0% at 5mg, 21.4% at 10mg and 22.5% at 15mg, against 2.4% on placebo. Around a third on the higher doses lost at least 25% of their body weight. Fat mass fell roughly three times more than lean mass.
NEJM  ·  PubMed  ·  Lilly release
Comparison

Wegovy or Mounjaro

Independent

Tirzepatide versus semaglutide, network meta-analysis

Journal of Diabetes, 2026 · network meta-analysis

A network meta-analysis comparing tirzepatide and semaglutide across the trial literature rather than relying on the single head-to-head study.

Tirzepatide ranked ahead of semaglutide, consistent with SURMOUNT-5. The authors caution that SURMOUNT-5, while an important advance, is one trial in one population, which limits how far it generalises.
Independent

Tirzepatide versus semaglutide, direct comparative studies

Cureus, 2025 · 28,980 participants · 7 studies

A systematic review restricted to studies comparing tirzepatide and semaglutide head to head, covering five observational studies and two randomised trials, followed for six to twelve months.

Tirzepatide produced greater weight reduction across the pooled comparisons, matching both the randomised evidence and what clinicians report seeing.
Manufacturer funded

SURMOUNT-5, tirzepatide versus semaglutide

NEJM, 2025 · 751 participants · 72 weeks

The first direct comparison: adults with obesity and no type 2 diabetes, on the maximum tolerated dose of either tirzepatide (10 or 15mg) or semaglutide (1.7 or 2.4mg).

Tirzepatide produced greater sustained weight reduction over 72 weeks. Researchers attribute the gap to tirzepatide acting on GIP receptors as well as GLP-1 receptors, which are distributed differently in the brain regions governing food intake.
After treatment

What happens when you stop

The registration trials measured people while they were taking the medicine. This is what follows, and the trial evidence and the real-world evidence do not fully agree.

Independent

Weight regain after cessation of weight-management medication

The BMJ, 2026 · 9,341 adults · 37 studies

An Oxford team systematically reviewed every study tracking adults who stopped a weight-management medicine, from older drugs like orlistat through to semaglutide and tirzepatide. Average time on treatment was 39 weeks, with 32 weeks of follow-up after stopping.

Weight rose by an average of 0.4kg a month, roughly four times faster than after a behavioural weight-loss programme, and independent of how much had been lost. At that rate people return to their starting weight in about 1.7 years, and cardiometabolic benefits are lost with it. Co-author Susan Jebb framed obesity as a chronic relapsing condition where some form of continued treatment is needed to hold the gains.
Funded by the NIHR Oxford Biomedical Research Centre; the lead author reports partial funding from the Novo Nordisk Foundation. Oxford  ·  Medscape  ·  TCTMD  ·  Expert reaction
Independent

Trajectory of weight regain after GLP-1 cessation

eClinicalMedicine (Lancet), 2026 · 3,236 participants · 52 weeks after stopping

A meta-regression modelling the shape of regain rather than a monthly average, assuming rapid early regain that progressively slows.

Modelled maximum regain was 75.3% of the weight lost, with a half-life of about 23 weeks. Independent commentators note the one-year estimate is supported by trial follow-up, but the 75% plateau is extrapolated beyond the observed data, so the long-term figure carries real uncertainty. The authors point out that prescribing guidance largely ignores the issue: NICE caps semaglutide at two years for weight loss but sets no limit for tirzepatide.
Independent

Discontinuation and body habitus, by agent

Obesity Reviews, 2025 · systematic review and meta-analysis

Pooled weight change after stopping, separated by which medicine people had been on.

Mean regain was 2.20kg after liraglutide and 9.69kg after semaglutide or tirzepatide, proportional to the amount originally lost. The medicines that work best have the most to give back.
Independent

Obesity treatments and weight change after discontinuation

Diabetes, Obesity and Metabolism, 2026 · 7,977 patients · 1 year after stopping

A Cleveland Clinic study of people who started semaglutide or tirzepatide and stopped within three to twelve months, following what they did next. Trials measure controlled withdrawal; this captures people restarting, switching, or changing approach.

Average weight change a year after stopping was small. Among those treated for obesity, 55% gained while 45% held or kept losing; in the diabetes group 44% gained. Many restarted the same medicine or moved to another treatment. The same group had earlier found the dominant reason for stopping was cost, ahead of side effects.
Independent

Weight outcomes 24 months after GLP-1 cessation

Epic Research, 2025 · 188,722 patients · 24 months after stopping

An analysis of electronic health records covering people who took a GLP-1 for at least 90 days, lost at least five pounds, then stopped. Published by Epic Research, a health-data organisation analysing its own dataset, and not peer reviewed.

At 24 months, 56% of semaglutide, 55% of tirzepatide and 52% of liraglutide patients had kept the weight off or lost more. Complete regain occurred in 23%, 21% and 27% respectively. Trajectories mostly settled after the first year.
Other effects

Beyond weight

Manufacturer funded

SELECT, cardiovascular outcomes without diabetes

NEJM, 2023 · 17,604 participants · mean 40 months

Adults 45 and over with existing cardiovascular disease and a BMI of 27 or above, but no diabetes. The question was whether semaglutide prevents cardiovascular events, not whether it reduces weight.

Major cardiovascular events occurred in 6.5% on semaglutide against 8.0% on placebo, a 20% relative reduction. Weight loss continued for 65 weeks and held for up to four years, averaging 10.2% at 208 weeks. Adverse events led 16.6% to stop treatment, against 8.2% on placebo.
Manufacturer funded

SURMOUNT-1 extension, progression to type 2 diabetes

NEJM, 2024 · 1,032 with prediabetes · 176 weeks

The prediabetic participants from SURMOUNT-1 continued on treatment for a further two years, testing whether weight loss held and whether diabetes was delayed.

Weight reduction was sustained over three years and the risk of progressing to type 2 diabetes was markedly lower than on placebo.
Independent

Late-life semaglutide in female mice

Nature, 2026 · mice · from 20 months to end of life

Healthy female mice aged 20 months, roughly equivalent to a 60-year-old human, were given semaglutide until the end of life and compared with untreated mice and with a group fed 24% less to match the appetite suppression.

Median lifespan was 834 days against 742 in the control group, about 12% longer. Treated mice explored more, remembered a maze route better and held blood sugar more steadily. Against the calorie-restricted group, longevity outcomes were similar, but treated mice did better on spatial memory and glucose control, and their metabolic rate stayed near normal while the dieting mice slowed.
Funded by the US National Institute on Aging. The University of California has filed a patent application covering GLP-1 receptor agonists for healthy ageing. A mouse study: nothing about human lifespan follows from it. Nature  ·  Nature News  ·  NIH  ·  UC Berkeley  ·  C&EN  ·  Scientific American
Emerging research

Cravings and reward

People taking these medicines often report that other cravings quieten too. The mechanism is plausible and well studied in animals, but human evidence is early: two randomised trials on alcohol, and observational data everywhere else. Nothing is approved for any of this.

Independent

Once-weekly semaglutide in alcohol use disorder

JAMA Psychiatry, 2025 · 48 participants · 9 weeks

A phase 2 randomised, double-blind trial at an academic medical centre, using low doses of 0.25mg and 0.5mg weekly. Participants had alcohol use disorder but were not seeking treatment for it. The primary measure was how much they drank in a laboratory setting before and after treatment.

Semaglutide reduced alcohol craving, the amount consumed and the frequency of heavy drinking days against placebo. In the laboratory, the semaglutide group drank less by both grams of alcohol and breath alcohol concentration. Reductions in cigarettes per day were also observed. This is a small, short, early-phase trial, and the participants were not trying to cut down.
Independent

SEMALCO, semaglutide in alcohol use disorder with obesity

The Lancet, 2026 · randomised, double-blind, placebo-controlled

A Danish trial of once-weekly semaglutide in treatment-seeking patients who had both alcohol use disorder and obesity, addressing the main limitation of the earlier trial.

Semaglutide showed what the authors describe as robust therapeutic effects in this group, supporting the earlier preclinical and clinical signals. The population had comorbid obesity, so how far it extends to people with alcohol use disorder alone is not settled.
Independent

GLP-1 agonists in substance use disorders

Systematic review, 2026 · PRISMA, PROSPERO registered

A systematic review of preclinical and early clinical work on GLP-1 agonists across alcohol, nicotine, cocaine and opioid use disorders.

GLP-1 receptors sit in the ventral tegmental area and nucleus accumbens, the brain's reward circuitry. In animals, GLP-1 agonists blunt the dopamine surge triggered by alcohol, nicotine, cocaine and amphetamine, and reduce both self-administration and relapse-like behaviour. That gives a coherent mechanism for why one medicine might affect several unrelated cravings at once. Human variants of the GLP-1 receptor gene are associated with alcohol use disorder.
Independent

State of the evidence in addiction medicine

Medscape, 2026 · clinical review

A survey of where the field stands, canvassing addiction specialists rather than reporting a single result.

Most of the evidence is still animal studies, observational research and patient reports. Large retrospective analyses associate GLP-1 use with lower rates of overdose and new substance use disorders, but association is not causation, and observational data on people already taking these medicines carries obvious confounding. Not one regulator has approved a GLP-1 for any addiction indication. Reports of effects on gambling and compulsive shopping come largely from anecdote and social media analysis, not trials.
New Zealand

Approval and funding

Independent

Medsafe approval and Pharmac funding status

Medsafe and Pharmac · ongoing

Medsafe holds the approved data sheets and consumer information for every product sold here and reviews emerging safety signals. Pharmac decides what is publicly funded.

Wegovy, Mounjaro and Saxenda are approved for weight management but not funded, so patients pay privately. Funded GLP-1s for type 2 diabetes (Trulicity, Victoza) are available under Special Authority. Pharmac has Wegovy on its Options for Investment list following a high-priority recommendation from its Obesity Treatment Advisory Group.