In short: In ten years, weight loss changed more than in the half century before. The biggest shift was a new generation of medicines: semaglutide (Wegovy, 2021) and tirzepatide (Zepbound, 2023) brought average losses of about 15% to 21% in their main trials, then proved benefits for the heart, sleep apnea and liver disease, and in 2025 and 2026 arrived as daily pills. Around them came a clearer food label, a medicine for rare genetic obesity, a stomach-stitching procedure done without incisions, and glucose monitors sold over the counter. Here are ten milestones, listed by date, not ranked, with what each changed and what it did not. Checked on October 7, 2026.
For where these options fit today, see every FDA-approved weight-loss medication compared or answer a few questions in Find My Options. For the longer story, from 1860s diets to fen-phen, read our history of weight loss.
A decade in numbers
- 2.4 to 14.9%average weight loss on placebo vs semaglutide 2.4 mg in STEP 1 (68 weeks)NEJM 2021
- 20.9%average loss on tirzepatide 15 mg in SURMOUNT-1 (72 weeks)NEJM 2022
- 20%lower risk of heart attack, stroke or cardiovascular death with semaglutide in SELECT (hazard ratio 0.80)NEJM 2023
- 2GLP-1 weight-loss pills approved, December 2025 and April 2026Drugs@FDA
Checked on October 7, 2026
1. 2016: A Nutrition Facts label built around calories
In 2016 the FDA finalized the first major redesign of the Nutrition Facts label in more than two decades. Calories, servings per container and serving size got larger, bold type; “added sugars” appeared in grams and as a percent Daily Value; and serving sizes were updated to reflect what people actually eat (a serving of ice cream went from half a cup to two-thirds, a soda from 8 to 12 ounces). Large manufacturers had to switch by January 1, 2020, and smaller ones by January 1, 2021. Why it mattered: it made the single number most people track easier to find and harder to shrink with tiny serving sizes. What it didn’t do: labels inform; they don’t change appetite. Our calorie deficit guide explains how to use them.
2. 2019: A swallowable hydrogel for fullness
On April 12, 2019, the FDA authorized Plenity through its De Novo pathway, as a prescription aid for weight management in adults with a BMI of 25 to 40 alongside diet and exercise. The capsules release particles of a cellulose-and-citric-acid hydrogel that swell in the stomach to add a feeling of fullness. Why it mattered: it was a new kind of option, a device taken by mouth rather than a drug or a procedure. What it didn’t do: commercial staying power; its maker, Gelesis, filed for Chapter 7 liquidation in October 2023. Our procedures hub covers the devices and procedures that remain.
3. 2020: The first medicine for rare genetic obesity
On November 25, 2020, the FDA approved Imcivree (setmelanotide) for obesity caused by three rare genetic conditions (POMC, PCSK1 or LEPR deficiency) confirmed by genetic testing. It was later approved for Bardet-Biedl syndrome (2022) and, on March 19, 2026, for acquired hypothalamic obesity. Why it mattered: it was the first weight medicine aimed at a specific biological cause, and it underlined that some obesity is driven by identifiable defects in the brain’s appetite pathway. What it didn’t do: it is not a general weight-loss medicine; it works only in the conditions on its label.
4. 2021: Wegovy and the new era of GLP-1 medicines
On June 4, 2021, the FDA approved Wegovy (semaglutide 2.4 mg) for chronic weight management. In the STEP 1 trial, 1,961 adults lost an average of 14.9% of their body weight over 68 weeks, compared with 2.4% on placebo, and 86.4% lost at least 5%. Why it mattered: for comparison, daily liraglutide (Saxenda) averaged 7.4% vs 3.0% in its 56-week label trial, a separate study; Wegovy’s results put GLP-1 medicines at the center of obesity care. Our GLP-1 medications guide explains how they work. What it didn’t do: it isn’t a short course. In the STEP 1 extension, about two-thirds of the lost weight came back within a year of stopping.
5. 2022: Endoscopic sleeve gastroplasty gets its own authorization
On July 12, 2022, the FDA granted De Novo authorization to the Apollo ESG system, an endoscopic suturing device that folds and stitches the stomach into a narrower sleeve from the inside, with no incisions, for adults with a BMI of 30 to 50. In the MERIT randomized trial of 209 adults, published in The Lancet in 2022, total weight loss at 52 weeks was 13.6% with endoscopic sleeve gastroplasty plus lifestyle changes vs 0.8% with lifestyle changes alone, with serious adverse events in 2%. Why it mattered: it opened a middle path between medicines and surgery. What it didn’t do: match surgery; in comparisons, typical losses are smaller than with a sleeve gastrectomy. Our bariatric surgery guide covers the surgical options.
6. 2023: Zepbound and the dual agonist
On November 8, 2023, the FDA approved Zepbound (tirzepatide), which acts on both GIP and GLP-1 receptors. In SURMOUNT-1, published in 2022, 2,539 adults lost an average of 15.0%, 19.5% and 20.9% on the 5, 10 and 15 mg doses over 72 weeks, vs 3.1% on placebo. Why it mattered: it was the first approved weight medicine to act on two hormone pathways at once, and several drugs now in trials combine even more (see “On the horizon” below). What it didn’t do: end the cost problem; access still depends heavily on insurance and price. See our semaglutide vs tirzepatide comparison.
| Item | Treatment | Placebo or control |
|---|---|---|
| Wegovy, STEP 1 (68 wk) | 14.9% | 2.4% |
| Zepbound 15 mg, SURMOUNT-1 (72 wk) | 20.9% | 3.1% |
| ESG, MERIT (52 wk) | 13.6% | 0.8% |
| Wegovy tablets, label trial (64 wk) | 13.6% | 2.4% |
| Foundayo, label trial (72 wk) | 11.1% | 2.1% |
Chronological. Separate trials with different people, lengths and comparison groups; not a ranking. Bars show percent of body weight lost.
Source: NEJM 2021 and 2022; The Lancet 2022 (MERIT); FDA labels on DailyMed (checked on October 7, 2026)
7. 2023-2024: Proof that weight medicines protect the heart
The SELECT trial, published in November 2023, followed 17,604 adults with overweight or obesity and established cardiovascular disease, but without diabetes, for an average of 39.8 months. Heart attack, stroke or cardiovascular death occurred in 6.5% of those on semaglutide vs 8.0% on placebo, a 20% lower risk. On March 8, 2024, the FDA approved Wegovy to reduce the risk of these events in adults with cardiovascular disease and obesity or overweight, the first weight medicine with that indication. Why it mattered: it was the first time a weight-loss medicine was shown in a large outcomes trial to reduce heart attacks, strokes and cardiovascular deaths. What it didn’t do: apply to everyone; the indication is for people with established heart disease.
8. 2024: Glucose monitors go over the counter
On March 5, 2024, the FDA cleared the first over-the-counter continuous glucose monitor, for adults who do not use insulin, including people without diabetes who want to see how food and exercise affect their glucose. Others followed later that year. Why it mattered: it put a once-specialist tool in consumers’ hands and fed a wave of personalized-nutrition apps. What it didn’t do: prove itself for weight loss; pooled studies in people without diabetes show no significant effect on BMI. Our explainer on CGMs for weight loss without diabetes covers the evidence, and a related tracking trend is checked in AI calorie counting from photos.
9. 2024-2025: Treating the conditions that come with weight
On December 20, 2024, the FDA approved Zepbound for moderate-to-severe obstructive sleep apnea in adults with obesity, the first medicine for that condition. On August 15, 2025, Wegovy received accelerated approval for metabolic dysfunction-associated steatohepatitis (MASH) with moderate to advanced liver fibrosis. Why it mattered: weight medicines started to be approved for diseases linked to excess weight, which can also open other coverage routes; for example, Medicare drug plans can cover Zepbound for sleep apnea. Our guides to sleep apnea and weight and fatty liver and weight explain both. What it didn’t do: replace other treatments; CPAP and liver care still matter.
10. 2025-2026: GLP-1 pills, a higher dose and new ways to pay
On December 22, 2025, the FDA approved Wegovy tablets (oral semaglutide 25 mg) for weight management, with average weight change of -13.6% vs -2.4% at 64 weeks in the label trial. On April 1, 2026, it approved Foundayo (orforglipron), a small-molecule daily pill that can be taken with or without food (-11.1% vs -2.1% at 72 weeks on the highest dose). In between, on March 19, 2026, came a 7.2 mg dose, Wegovy HD. At the same time, makers began selling direct at lower self-pay prices, from about $149 a month for the lowest pill strengths as of October 2026, and the Medicare GLP-1 Bridge began on July 1, 2026, with a $50 copay for people who meet its criteria. Why it mattered: no needles, and for many people, a real price. What it didn’t do: make the medicines right for everyone, or remove the need to keep taking them. Our oral GLP-1 guide, insurance guide and cost hub have the details.
The decade at a glance
| Date | Innovation | Type |
|---|---|---|
| 2016 | New Nutrition Facts label finalized (on most foods by 2020-2021) | Food labeling |
| April 12, 2019 | Plenity hydrogel authorized (De Novo); maker liquidated in 2023 | Device |
| November 25, 2020 | Imcivree approved for rare genetic obesity | Medicine |
| June 4, 2021 | Wegovy approved (STEP 1: -14.9% vs -2.4%) | Medicine |
| July 12, 2022 | Endoscopic sleeve gastroplasty device authorized (De Novo) | Procedure |
| November 8, 2023 | Zepbound approved (SURMOUNT-1: up to -20.9% vs -3.1%) | Medicine |
| March 5, 2024 | First over-the-counter CGM cleared | Device |
| March 8, 2024 | Wegovy approved to reduce cardiovascular risk (SELECT) | Medicine |
| December 20, 2024 | Zepbound approved for obstructive sleep apnea | Medicine |
| August 15, 2025 | Wegovy accelerated approval for MASH | Medicine |
| December 22, 2025 | Wegovy tablets approved | Medicine |
| March 19, 2026 | Wegovy HD (7.2 mg) approved | Medicine |
| April 1, 2026 | Foundayo (orforglipron) approved | Medicine |
| July 1, 2026 | Medicare GLP-1 Bridge begins ($50 copay) | Access |
What did not change
Every one of these innovations still sits on the same foundation. All the medicine labels pair treatment with a reduced-calorie diet and more physical activity. Strength training and enough protein remain the main ways to protect muscle while losing weight, as our guide to muscle loss on GLP-1s explains. And keeping weight off still takes ongoing effort, with or without medicine; our maintenance guide covers what helps.
On the horizon (investigational)
We follow these in our retatrutide results explainer, CagriSema explainer, the article on muscle-preserving weight-loss drugs and the emerging medications tracker. For this year’s developments in one place, see what’s new in weight loss in 2026.
Using this history to make your own choices
- Start with what is approvedCheck which options have an FDA label for your situation.
- Look at the trial, not the headlineWho was studied, for how long, and compared with what.
- Count the full costPrice, coverage and how long you would need to stay on it.
- Ask about the basics tooDiet, activity and sleep still shape results with any treatment.
- Talk it throughBring your questions to a clinician, using our tools to prepare.
Our tools, including the BMI, calorie and protein calculators, can help you prepare for that conversation, and the printable questions to ask before starting a GLP-1 is a good next step if a medicine is on your list. For the story of the drugs that came before this decade, see our history of weight-loss drugs.
