Semaglutide

What it does

Semaglutide is a GLP-1 receptor agonist, FDA approved as Ozempic (2017, type 2 diabetes) and Wegovy (2021, obesity). The STEP trials showed roughly 15% weight loss at 68 weeks, and the SELECT trial showed cardiovascular event reduction.

What the research says

• Weight loss in obesity

  Evidence: strong. STEP program: ~15% mean weight loss at 68 weeks in large RCTs.

• Cardiovascular event reduction

  Evidence: moderate. SELECT trial: reduced major adverse CV events in overweight/obese adults with established CVD.

DRAFT: large well-run RCTs for approved indications; longevity or 'optimization' use is off-label and unstudied.

What the experts say

Every position links to its source. We include skeptics alongside supporters.

• Eric Topol

  Source, 2025-05-12 In Super Agers he frames GLP-1 drugs like semaglutide as powerful anti-inflammatory agents that may protect the heart and brain, not just weight-loss tools, while stressing lifestyle as the biggest lever.

• Peter Attia

  “if you're a person who just needs to lose 10 pounds, I'm not convinced that the risk is worth it relative to the reward.”

  Source Cautious: requires DEXA scans for patients on GLP-1s to track lean-mass loss, and does not see the risk/reward as justified for modest weight loss in otherwise healthy people.

Is it worth it?

DRAFT: effective but very expensive without insurance; the cost is the story.